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In 2022, Medicare Part D spending on Ozempic exceeded $4 billion, reflecting its widespread use among beneficiaries.
What is Ozempic?
Ozempic, a semaglutide-based medication, is FDA-approved to manage blood sugar levels in people with type 2 diabetes (T2D) and obesity. It also helps reduce the risk of cardiovascular complications in these patients. Although Ozempic is not FDA-approved for prediabetes or weight loss, it has gained attention for its effectiveness in these areas.
Does Medicare cover Ozempic?
Yes, Medicare Part D may cover Ozempic if prescribed to manage type 2 diabetes. Coverage depends on whether the medication is included in your plan’s formulary and if the prescribed use aligns with FDA-approved indications.
Learn more about Medicare Part D prescription drug coverage below.
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Does Medicare cover Ozempic Prediabetes?
No, Medicare does not cover Ozempic for Prediabetes. The FDA has not approved medications for prediabetes, and Medicare only covers drugs for conditions officially recognized as diseases.
Does Medicare cover Ozempic for weight loss?
No, Medicare does not cover Ozempic for weight loss. Current laws prohibit Medicare from covering drugs used solely for weight loss, even when prescribed by a doctor.
How much does Ozempic cost with Medicare?
The cost of Ozempic with Medicare varies depending on your plan’s formulary and its tier placement. Higher-tier drugs typically have higher copayments, but most Medicare beneficiaries pay less than the list price of $968.52 per monthly injection.
How do I get Ozempic covered by Medicare?
To get Ozempic covered by Medicare, ensure it is listed in your Medicare Part D plan’s formulary. Your doctor must also prescribe it for an FDA-approved use, such as managing type 2 diabetes.
Is there a Medicare Ozempic coupon available?
No official Medicare Ozempic coupon exists. However, checking with your Part D plan for potential discounts or assistance programs can help reduce costs.
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Medicare Part D: A Coverage Overview
Medicare Part D offers prescription drug coverage to anyone with Medicare, helping cover medication costs, including certain vaccines. Private insurers provide these plans, which vary in cost and cover prescription drugs. Enrollment is available during the Initial Enrollment Period, Annual Enrollment Period, or Special Enrollment Period.
In 2024, 44% of enrollees chose stand-alone Part D plans. These plans cover most generic and brand-name drugs, insulin (with a $35 maximum copayment), and vaccines like shingles shots.
Coverage Highlights
Part D plans must cover a range of drugs, including:
- Anticancer medications (if not covered by Part B)
- Antidepressants and antipsychotics
- HIV/AIDS treatments
- Anti-seizure and immunosuppressant drugs
They also cover vaccines like shingles shots, though flu, pneumococcal, and COVID-19 vaccines fall under Medicare Part B.
Exclusions
Part D generally does not cover:
- Weight loss/gain or cosmetic drugs
- Over-the-counter medications
- Erectile dysfunction treatments
- Fertility drugs
- Vitamins and minerals (except certain exceptions like prenatal vitamins)
