Does Medicare Cover Ozempic?

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.

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.

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

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