Medicare doesn't cover Ozempic (or Wegovy) for weight loss Over 40% of U.S. adults age 60 and older are considered obese, according to 2017-2020 data from the Centers for Disease Control and Prevention. Despite the prevalence of obesity among older adults, Medicare won't cover weight loss drugs, including Wegovy.
Medicare doesn't cover Ozempic (or Wegovy) for weight loss
Medicare Part D plans are prohibited from covering drugs “used for anorexia, weight loss or weight gain (even if used for a non-cosmetic purpose (i.e., morbid obesity)),” according to the Medicare Prescription Drug Benefit Manual.
Ozempic (semaglutide) is used to improve blood sugar control in adults with type 2 diabetes. There are currently no generic alternatives for Ozempic. Ozempic is covered by most Medicare and insurance plans, but some pharmacy coupons or cash prices could help offset the cost.
If you have private or commercial insurance, such as insurance you receive through an employer, you may be eligible to pay as little as $25 for a 1-, 2-, or 3-month prescription (maximum savings of $150 per 1-month prescription, $300 per 2-month prescription, or $450 per 3-month prescription).
Saxenda is an approved weight loss medication, and is readily available in Australia. Cost is approximately $387 a month. The knock on effect from the Ozempic shortage, is that Trulicity which is manufactured by Ely-Lilly is now in short supply.
On the PBS, Ozempic costs Australians about $42 a month (four weekly injections). On a private prescription, the cost is about $132 a month.
Ozempic® is a prescription medication. Novo Nordisk provides patient assistance for those who qualify. Please call 1-866-310-7549 to learn more about Novo Nordisk assistance programs.
Following the DA communication, health professionals have now been asked to prescribe and dispense Ozempic for only those adults living with type 2 diabetes.
Ozempic is a highly sought after drug for managing diabetes and weight management, but it is important to know that it is prescription only. In Australia, this means you will need to speak with your doctor and have a prescription written up before you can start taking Ozempic.
There has been a global shortage of Ozempic since early 2022 because of an unexpected increase in consumer demand because of off-label use of the drug for weight loss.
'Ozempic stocks are available in Australia; however, there will be limited and intermittent availability until June 2023,' the statement reads.
How Long Can You Stay on Ozempic (semaglutide)? A person can stay on Ozempic® so long as they are tolerating the medication and it is deemed appropriate by their treating provider. There is no specific time frame when someone should stop taking Ozempic as it is a medication that is intended for chronic (long-term) use.
If you qualify for insurance coverage, Ozempic can cost as little as $25 for a monthly supply. However, without insurance, Ozempic costs around $892.06 per month, on average (NovoCare-a, 2022). However, savings programs can sometimes help lower the cost of the medication if you qualify.
Ozempic was developed to help people with type 2 diabetes manage their blood sugar levels but it can also lead to significant weight loss of 15 to 20 per cent of body weight in some people.
Get a prescription from your HCP: The first step is to get a prescription from your HCP. They will provide you with a prescription that you can take to your local pharmacy. Purchase from a local pharmacy: Once you have your prescription, you can purchase Ozempic® from your local pharmacy.
Is Ozempic available for those without diabetes? Ozempic is only approved by the FDA for the treatment of type 2 diabetes. People who don't have diabetes may be able to take Ozempic “off-label” with a prescription from their doctor. “Off-label” means for use other than what is approved by the FDA.
Ozempic is a type 2 diabetes medication which is prescribed to manage blood glucose levels. It is not a medication for people who do not have diabetes or are at risk of type 2 diabetes.
So, on average, with the recommended starting Ozempic dose of 0.25 mg, a 500 to 1000 calorie reduced diet, and exercise 3 times a week, you can expect to lose 3-5 pounds in the first month of treatment, which works out to about 3% of body weight for most overweight or obese individuals.
If you take Wegovy or Ozempic to lose weight, will you need to keep taking the drugs indefinitely? Yes. As with many chronic conditions, most people who use the drugs for diabetes or weight loss will need to keep taking them to keep benefiting from them.
Overseas-registered Ozempic is available
While the Australian-registered Ozempic is subsidised on the Pharmaceutical Benefits Scheme (PBS), the overseas-registered products currently are not.
Research has proven that higher doses of Ozempic — 2.4 milligrams of semaglutide — are very effective for reducing weight in people with obesity. In one landmark study, people with obesity who used the drug in combination with lifestyle interventions lost about 15% percent of their body weight in 68 weeks.
"And the costs can be anywhere between $1,000 to $1,500 a month." Both Ozempic and Mounjaro are approved by the U.S. Food and Drug Administration to treat Type 2 diabetes, but some doctors prescribe them "off-label" for weight loss.