Will my insurance cover Ozempic?

Official answer

by Drugs.com

Most prescription plans cover some or all of the cost for Ozempic when used to treat type 2 diabetes, but it’s not frequently covered for weight loss. The cost for Ozempic typically runs between $0 and $995 per month. Your final cost will depend on your insurance plan, formulary, the state you live in, and any deductibles or copays you may have.

You can also call Novocare, a support program from Novo Nordisk, to determine your cost estimate for Ozempic by phone or online.

Call 1‑844‑Novo4Me (1‑844‑668‑6463) Monday-Friday, 8:00 am to 11:00 pm, and Saturday, 11:00 am to 7:00 pm EST

If you prefer, you can complete an online form on the Novocare website to get a quick response. This service is available 24 hours per day, 7 days per week.

You will need to provide your insurance information.

Commercial or private insurance plans are usually provided by your employer or from the Healthcare.gov Health Insurance Marketplace Plans. They are not government-funded plans like Medicare, Medicaid, CHIP or Tricare, for example.

What are Ozempic and Wegovy approved for?

Ozempic (semaglutide) is approved by the FDA:

For adults with type 2 diabetes to lower blood glucose (sugar), along with diet and exercise.

To reduce the risk of major cardiovascular events such as heart attack, stroke, or death in adults with type 2 diabetes and known heart disease.

Wegovy (semaglutide) is approved by the FDA for chronic (long-term) weight management in adults and children 12 years and older, along with diet and exercise.

Adults should have an initial body mass index (BMI) of 30 kg/m2 or greater (obesity) or 27 kg/m2 or greater (overweight) in the presence of at least one weight-related health condition (for example: high blood pressure, type 2 diabetes mellitus, or high cholesterol).

Children 12 years and older should have an initial BMI at the 95th percentile or greater for age and sex (obesity).

Ozempic and Wegovy both contain semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, but their doses are different. Semaglutide mimics the action of the natural hormone GLP-1 in your body that helps your body keep blood sugar in balance.

These medicines are given as once-weekly subcutaneous injections (by a needle under the skin) in your stomach (abdomen), thigh, or upper arm area. Your healthcare provider will teach you how to use this medicine.

Is Ozempic covered for weight loss?

Most insurance companies cover Ozempic when it’s prescribed to treat type 2 diabetes, but not for weight-loss.

Ozempic use for weight loss is considered “off-label” and is not approved by the FDA. Insurance companies may not pay for “off-label” or unapproved uses of drugs.

If your doctor prescribes Ozempic “off-label” for weight loss, but your insurance will not cover it, you may have other options.

Wegovy is a weekly GLP-1 agonist injectable medicine approved for weight loss that contains the same active ingredient as Ozempic, called semaglutide, but in a higher dose. Saxenda (liraglutide) is another weight loss drug in the same class as Wegovy and Ozempic.

Check with your prescription plan to see which drugs, if any, are covered for weight loss when prescribed by your doctor. Your insurance may help to cover programs that help with behavioral change, nutrition and exercise planning.

Speak to your healthcare provider to determine which weight loss treatments may be a good option for you.

Because these drugs are typically used long-term for weight loss, costs can add up if you must pay a significant amount each month. There are no generic alternatives for Ozempic or Wegovy at this time.

How can I save on Ozempic? How can I get help paying for Ozempic?

Novo Nordisk, the manufacturer of Ozempic, may be able to offer you copay assistance if you have commercial insurance. You could pay as little as $25 for up to a 3-month supply of Ozempic. To receive this offer, your prescription must be for a 1-, 2-, or 3-month supply for the treatment of type 2 diabetes.

For eligible people with commercial (private) insurance, the Novo Nordisk Savings card can offer a maximum savings of $150 for a 1-month prescription, $300 for a 2-month prescription, and $450 for a 3-month prescription. This offer is good for up to 24 months.

Copay assistance is not valid for people using government-assisted programs, such as Medicare, Medicaid, or Tricare or any similar federal or state health care program. People paying full cash for Ozempic are also excluded.

If you do not have insurance, Novo Nordisk may be able to offer patient financial assistance for Ozempic based on your income eligibility. Patient assistance programs provide free or lower-cost medications to people who cannot afford to buy their medicine.

Copay assistance is usually for people with commercial prescription insurance, while patient financial assistance is typically for people who meet certain lower income requirements.

Many pharmaceutical companies have information about patient assistance programs listed on their website. Call them or look on their websites to see what options are offered.

You can also contact RxAssist.org, NeedyMeds.org, or PatientHelpNetwork.org (or call 1-800-218-0694) – sites that offer a listing of resources that offer assistance for low-income families.

If you are paying cash for Ozempic, you might also be able to save some money by using an online coupon for Ozempic.

Does private (commercial) insurance cover Ozempic?

Most private (commercial) insurance companies cover Ozempic for type 2 diabetes, but different insurance plans cover different medicines, and this can change over time. Your coverage and cost depends on your plan and plan benefits.

When you call your insurance company, ask them what “tier” Ozempic falls under and what your copay is, which can differ based on your plan benefits.

Ask them if it is covered for types 2 diabetes and weight loss, depending upon your need.

Insurance plans usually have 4 or 5 tiers for medicines. Costs can range from the lowest (on Tier 1, usually generic drugs), to the highest on Tier 4 or 5 (non-preferred brands or specialty drugs).

Quite often, your insurance may prefer one or two drugs in a particular drug class or group because they can get it at a more affordable rate.

You can usually access your insurance company drug formulary on their website. A formulary is a list of drugs, and their tiers, covered by your insurance. If you still have questions, contact your insurance company directly.

If you have a prescription, your pharmacist can also tell you your copay and suggest what alternatives you might have if you can't afford the medication.

In some cases you may be responsible for a large portion of the cost of Ozempic, even with private or commercial insurance.

This is not all the information you need to know about Ozempic (semaglutide) for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.

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