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Written byKim Porter
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Co-authored the book “Future Millionaires’ Guidebook”
13 years writing personal finance content
A former chief copy editor at Bankrate and past managing editor at Macmillan, Kim specializes in writing easy-to-understand, actionable personal finance content.
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Edited byAshley Cox
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7+ years in content creation and management
5+ years in insurance and personal finance content
Ashley is a seasoned personal finance editor who’s produced a variety of digital content, including insurance, credit cards, mortgages, and consumer lending products.
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Updated June 27, 2024
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Table of contents
About 42% of U.S. adults have obesity, according to the Centers for Disease Control and Prevention.[1] If you’ve struggled with this chronic disease in the past, you may be curious about Ozempic, a treatment for diabetes that studies have shown helps people lose weight.
Medicare plans typically cover Ozempic, but they have restrictions. Here’s what you should know about Medicare coverage for Ozempic.
Medicare’s coverage for weight-loss drugs
Federal legislation prohibits Medicare from covering weight-loss drugs, though it does cover services like weight-loss counseling for some people with morbid obesity.[2][3]
In recent years, some medications have helped older adults battle weight gain as an off-label use. For example, Ozempic is the brand name for semaglutide, a prescription drug designed to treat Type 2 diabetes. A healthcare provider may also prescribe Ozempic for weight loss when you couple the medicine with lifestyle changes, like regular exercise and a balanced diet.
Medicare won’t cover Ozempic if you’re using it solely for weight management. But the federal healthcare program covers Ozempic if you’re using it to treat diabetes. Between 2018 and 2022, Medicare Part D spent $9.3 billion on Ozempic for nearly 1.7 million Medicare beneficiaries, making it one of Medicare’s top-selling drugs.[4]
To get Ozempic coverage, you’ll need a Medicare drug plan. For example, you can add Part D coverage to Original Medicare, which includes Part A and Part B. Each stand-alone Medicare Part D plan has a formulary of approved prescription medications it’ll cover.
Formularies usually contain three to five tiers, each with defined copayments and out-of-pocket expenses. Drugs in a lower tier generally cost less than drugs in a higher tier.[5] Many plans put Ozempic somewhere in the middle, so this drug may come with a higher copayment compared to generic drugs or preferred brand-name drugs.
Good to Know
Another option is getting prescription drug coverage through Medicare Advantage plans. Private health insurers bundle Medicare Parts A, B, and C and sell them as Advantage plans to Medicare enrollees. With some Medicare Advantage prescription drug plans, you may need to get approval before they’ll cover certain medications.
Factors that affect Medicare coverage for Ozempic
Medicare coverage of Ozempic depends on the reason you’re taking it and the specific plan you have.
Nearly all Medicare Part D plans cover the drug if you take it to treat Type 2 diabetes. But the federal government currently prohibits Medicare from covering drugs, including Ozempic, for the purpose of chronic weight management.
Plus, each Medicare prescription drug plan varies, and yours may have different requirements for Ozempic coverage.
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Read More: Can You Go Back to Original Medicare From an Advantage Plan?
Ozempic costs with Medicare
There’s no official Ozempic price under Medicare coverage. Because prescription coverage varies with each plan, the cost of Ozempic depends on a few factors, including:
Your Medicare plan
Whether you receive prescription drug coverage through Part D or Medicare Advantage
Your stage of coverage, such as whether you’re paying the deductible or getting initial coverage
Important Information
A new federal law also caps maximum out-of-pocket costs for Medicare Part D beneficiaries. In 2024, beneficiaries will pay an annual maximum of up to $3,800 for their prescription drugs. The cap lowers to $2,000 in 2025.[6]
Alternatives to Ozempic covered by Medicare
Medicare plans may cover several types of anti-diabetic drugs.[7] Some of these medicines, including Ozempic and Wegovy, are glucagon-like peptide-1 (GLP-1) receptor agonists. In addition to treating diabetes, research shows that GLP-1s may help people lose weight and even lower the risk of heart disease.[8]
Wegovy, in particular, is similar to Ozempic because it can help patients lose weight. The drug also reduces the risk of heart attack and similar medical conditions in adults with known heart disease. In March, Medicare announced it can cover anti-obesity medications like Wegovy for patients at risk of stroke or heart attack, according to a new Centers for Medicare & Medicaid Services policy.
Ozempic costs out-of-pocket compared to Wegovy and Mounjaro
If you want to take Ozempic for weight loss, you must pay for the medicine out of pocket. Below are some costs to consider.
Ozempic: Novo Nordisk, the company that manufactures Ozempic, lists the price at $935.77 for four weekly doses. A full year’s worth of the medicine would cost $12,165.
Pharmaceutical companies charge similarly high prices for some alternative GLP-1 medications.
Wegovy: The list price is $1,349.02 per four weekly doses, or $17,538 for one year.
Mounjaro: This medication that helps regulate blood sugar has a list price of $1,069.08 — an annual cost of around $13,900.
All three drugs are still under patent protection, so there’s no option to buy a cheaper, generic version of the drug at this time.
But another option comes with lower prices. Hims & Hers Health, a telehealth company that sells prescription and over-the-counter drugs online, offers GLP-1 injections with the same active ingredient as Ozempic. Prices start at $199 per month, which works out to $2,388 per year.
The Hims & Hers semaglutide injectable is a compounded drug, which is a customized medicine that doesn’t have Food and Drug Administration approval.[9] Consider talking with your doctor about whether this is a good fit for you.
Ways to lower your Ozempic costs with Medicare
Your Medicare Advantage or Part D plan can help reduce the cost of Ozempic, but here are some more ways to save:
Use a prescription discount card
Some pharmacies offer prescription discounts that lower the costs of prescription drugs. Ask your pharmacy for details, or reach out to a telemedicine provider such as GoodRx and SingleCare.
Look for manufacturer discounts
Manufacturers may offer similar discounts through patient assistance programs. For instance, Novo Nordisk offers free medication to eligible low-income patients who don’t have health insurance coverage. Patients with private insurance may also qualify for an Ozempic Savings Card.
Apply for patient assistance programs
You can also research financial assistance at the federal, state, and local level. For instance, the Medicare program Extra Help reduces expenses like Part D premiums, deductibles, co-insurance, and other costs for low-income beneficiaries.
Consider using a compounded version
A pharmacy can also mix a medication’s active ingredient into a drug and may sell it at a discount. This practice is legal and may help you save money, although the medicine may not have FDA approval.
Does Medicare cover Ozempic FAQs
Finding out whether Medicare covers Ozempic can leave you with questions. Here’s some additional information that may help.
Does Medicare cover the cost of Ozempic?
Yes, 93% of Medicare plans cover the cost of Ozempic, according to GoodRx. But Medicare only covers the drug if you take it to treat diabetes. Medicare beneficiaries won’t receive coverage when they take Ozempic solely for obesity.
Are there specific Medicare plans that cover Ozempic?
Yes. Medicare Part D and Medicare Advantage plans cover prescription medications, which may include Ozempic.
How much of the cost does Medicare coverage help with for Ozempic?
Prescription drug coverage varies with each plan, so you’ll need to check your formulary for details.
Are there any requirements or limitations for Ozempic coverage under Medicare?
Yes. Medicare only pays for Ozempic if your Part D plan covers the drug and your doctor prescribes it for treating diabetes. The federal health insurance program won’t pay for Ozempic used solely for weight loss.
Sources
- Centers for Disease Control and Prevention. "Adult Obesity Facts."
- Centers for Medicare & Medicaid Services. "Medicare Prescription Drug Benefit Manual."
- Medicare.gov. "Obesity behavioral therapy."
- Medicare.gov. "Medicare Part D Spending by Drug."
- Medicare.gov. "What Medicare Part D drug plans cover."
- Centers for Medicare & Medicaid Services. "Lower out-of-pocket drug costs in 2024 and 2025."
- Medicare.gov. "Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs."
- Mayo Clinic. "GLP-1 agonists: Diabetes drugs and weight loss."
- U.S. Food & Drug Administration. "Drug Compounding and Drug Shortages."
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Kim Porter
Kim Porter is a writer and editor who's been creating personal finance content since 2010. Before transitioning to full-time freelance writing in 2018, Kim was the chief copy editor at Bankrate, a managing editor at Macmillan, and co-author of the personal finance book "Future Millionaires' Guidebook." Her work has appeared in AARP's print magazine and on sites such as U.S. News & World Report, Fortune, NextAdvisor, Credit Karma, and more. Kim loves to bake and exercise in her free time, and she plans to run a half marathon on each continent.
Kim has been a contributor at Insurify since October 2022.
7+ years in content creation and management
5+ years in insurance and personal finance content
Ashley is a seasoned personal finance editor who’s produced a variety of digital content, including insurance, credit cards, mortgages, and consumer lending products.
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