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Does Medicare Cover Ozempic? [2022 Update]

Millions of Americans are prescribed medications to help treat diabetes.  These drugs can be expensive, and many insurance companies don’t cover the full cost of these medications.

One of these drugs, Ozempic, has created a lot of excitement in recent years.

Ozempic has been doubly successful, helping diabetics lower their blood sugar and obese individuals lose weight (15% to 20% of their body weight).

Let’s take a look and see if any of the parts of Medicare cover Ozempic, including:

  • Original Medicare
  • Medicare Advantage
  • Medicare Part D
  • Medicare Supplement Insurance

Summary: Is Ozempic Covered By...

Original Medicare

No, prescription drugs are not covered by Original Medicare (Parts A & B).

Medicare Advantage

Maybe.  Certain Medicare Advantage (Part C) plans cover prescription drugs (but not all).  Check your plan provider’s drug formulary (list of covered drugs).

Medicare Part D

Most likely, as Part D is the part of Medicare dedicated to prescription drug coverage.  Check your plan provider’s drug formulary.

Medicare Supplement (Medigap)

No.  Medicare Supplement Insurance plans only help with your Original Medicare out-of-pocket expenses (copays, coinsurance, deductibles).  They do not cover additional services vs. Original Medicare.

What Is Ozempic?

Ozempic (semaglutide) is an injectable prescription medicine made by Novo Nordisk, used to improve blood sugar control in individuals with type II diabetes.  Ozempic helps your pancreas release more insulin when your blood sugar is high and helps prevent your liver from releasing too much sugar.

Diagram: How Ozempic Works
Diagram of pancreas, liver, and stomach showing how Ozempic works to release more insulin and slow down food from leaving your stomach
Source: Ozempic.com

Be sure to discuss the side effects of Ozempic with your health care provider, as this prescription medication can cause serious allergic reactions and major cardiovascular events, among other side effects.

How Much Does Ozempic Cost?

If Ozempic weren’t expensive, we probably wouldn’t be discussing this, would we?

Indeed, the average cost of Ozempic is $500 per month for diabetics, with the typical dose costing around $70.

The bad news doesn’t stop there.  Using Ozempic for weight loss requires a higher dose.  As a result, the average cost of Ozempic for weight loss jumps to $1,250 per month.

Does Medicare Cover Ozempic?

Original Medicare does not cover Ozempic, as neither Medicare Part A nor Part B covers prescription drugs.

Since Medicare Supplement Insurance does not cover additional services beyond Original Medicare, we can also rule out all Medigap plans (A-N).

However, if you have a Medicare Advantage plan or a Part D prescription drug plan, you may be in luck.

Medicare Part D

Part D is the portion of Medicare dedicated to prescription drug coverage.  It can be purchased by seniors who have Original Medicare coverage or employer-sponsored health insurance.

For most Medicare part D plans, there are four standard tiers of medications. These include:

  • Tier 1:  Generic drugs with the lowest copayment and specific brand name medications without a generic medication available
  • Tier 2:  Most brand-name drugs are in this tier and require a slightly higher copayment than those in the first tier
  • Tier 3:  This tier includes specialty drugs that require more frequent administration or those with high out of pocket costs
  • Tier 4:  These drugs include high-cost prescription medications, such as injectables and infusion treatments used to manage chronic conditions (e.g., rheumatoid arthritis, multiple sclerosis, etc.)

We sampled a handful of Part D plans and found that those from AARP-UnitedHealthcare, Cigna, Express Scripts, and Humana covered Ozempic.

Be sure to check your plan’s formulary (i.e., the list of drugs covered by your plan) to see if your plan explicitly covers Ozempic.

Medicare Advantage Plans

Medicare Advantage plans are an alternative way to get your Medicare Parts A & B benefits.  These plans are offered by private insurance companies, which are approved by and reimbursed by Medicare.

The appeal of Medicare Advantage is bundled coverage.  Original Medicare leaves out essential coverage for seniors, namely coverage for prescription drugs, vision care, dental care, and hearing aids.

Does Medicare Advantage Cover Ozempic?

According to the Centers for Medicare And Medicaid Services, 89% of Medicare Advantage plans include prescription drug coverage.

If you have a Medicare Advantage plan, it is overwhelmingly likely that it covers prescription drugs.  Be sure to check with your provider to see if this particular drug is included in your plan’s formulary.

Frequently Asked Questions

Ozempic (generic name: semaglutide) is a prescription medication used to treat Type 2 diabetes and to assist with weight loss. Ozempic increases sugar metabolism by increasing insulin secretion.

In early June 2021, semaglitude was approved by the FDA for “chronic weight management” and has shown strong potential in helping obese individuals lose weight. In a double-blind, 68-week study, individuals on Ozempic lost 15-20% of their body weight while those with the placebo lost only 2.4%.

It depends. Original Medicare does not cover prescription drugs nor does Medicare Supplement Insurance. However, some Medicare Advantage and Medicare Part D plans do cover Ozempic. Check with your plan provider and ask to see your plan’s formulary (list of covered medicines).

Conclusion

We hope this guide helped you understand whether your health insurance covers Ozempic.

If you have any additional questions, don’t hesitate to leave a comment, and we’ll be sure to get back to you within 24 hours.

Warm Regards,
The GetSure Team

  1. Novo Nordisk. 

    (n.d.). 

    What Is Ozempic. 

  2. Novo Nordisk. 

    (n.d.). 

    How Ozempic Works. 

  3. AARP. 

    (June 11, 2021). 

    Doctors Discuss the ‘Game-Changing’ Diet Drug Semaglutide. 

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