Does Medicare cover Ozempic?

In this article:

• Ozempic cost
• Does Medicare cover Ozempic?
• Factors that determine coverage
• Ozempic cost with Medicare
• Other ways to save

In this article

• Ozempic cost
• Does Medicare cover Ozempic?
• Factors that determine coverage
• Ozempic cost with Medicare
• Other ways to save

Ozempic (semaglutide) is a prescription medication used to treat Type 2 diabetes and reduce certain cardiovascular and kidney-related risks. Although it’s sometimes prescribed off-label for weight loss, it isn’t FDA approved for that purpose. Medicare Part D plans may cover Ozempic for FDA-approved uses, but coverage varies by plan and the reason it’s prescribed.

How much does Ozempic cost?

Without insurance, Ozempic costs vary but average about $1,245 per pen (a month’s supply) depending on the dosage, where you live, and which pharmacy you use. With an Ozempic coupon from SingleCare, you could pay $860, depending on your choice of pharmacy, dosage, and location.

Typically, brand-name drugs have generic options that cost less, but there’s currently no approved generic semaglutide, which is Ozempic’s active ingredient. Plus, the FDA issued a warning about using unauthorized medications from dubious sources that promote themselves as a generic version of the drug. That said, there are some safe alternatives to Ozempic that may come at lower prices or offer better insurance coverage.

Does Medicare cover Ozempic?

Older adults who are enrolled in original Medicare (Parts A and B) have the option to add a stand-alone Part D plan to their coverage, which helps pay for certain prescription drugs. People enrolled in Medicare Advantage (Part C) usually have a plan that includes drug coverage. Although each plan has its list of approved prescription medications, Medicare Part D will cover a variety of anti-diabetic drugs, according to Medicare’s official diabetes coverage guide, and that may include Ozempic prescribed for diabetes.

A law from 2003 prohibits Medicare Part D from covering weight loss drugs, which means it doesn’t cover Ozempic prescribed solely for weight loss, an off-label use. This was due to the fact that weight loss medications were considered cosmetic, and obesity wasn’t considered a chronic disease back then, according to Jonathan Kaplan, MD, founder of Pacific Heights Plastic Surgery. “There is federal legislation with bipartisan support for obesity medication coverage, but it’s simply too expensive. Estimates show that if you cover only 10% of Medicare beneficiaries with obesity, it would cost 9.35% of the entire Medicare Part D budget,” Dr. Kaplan says.

If someone wants to treat morbid obesity and also has Type 2 diabetes, though, a Medicare plan may cover Ozempic.

RELATED: Can I take Ozempic if I’m not diabetic?

Medicare coverage of obesity drugs

As of July 1, 2026, eligible Medicare beneficiaries can access certain GLP-1 weight loss medications for a $50 monthly copay through the Medicare GLP-1 Bridge program. The program covers Zepbound (KwikPen only), Foundayo, and Wegovy for qualifying Medicare Part D enrollees. Eligibility depends on body mass index (BMI) and certain weight-related health conditions. The program is scheduled to continue through Dec. 31, 2027.

Although Ozempic and Wegovy contain the same active ingredient, semaglutide, only Wegovy is covered for weight loss under this program. Medicare Part D plans may cover Ozempic for other medically accepted uses, such as Type 2 diabetes.

Factors influencing Medicare coverage of Ozempic for diabetes

In 2022, Medicare spent more than $4.6 billion to cover Ozempic for 780,253 beneficiaries, according to the Centers for Medicare & Medicaid Services. However, each Medicare Part D plan is different, so they may have different requirements for Ozempic coverage.

For example, certain private health insurers have buckled down on their coverage of Ozempic and other GLP-1 medications, implementing additional policies that may complicate the process. For example, some plans may require prior authorization, which means a doctor must send the prescription to the insurance provider for approval before the patient receives coverage. Other plans may require Medicare beneficiaries to try other medications (or even diets) first before they cover Ozempic.

Each Medicare prescription drug plan has a formulary, which is a list of all the medications it covers, along with dosages, copays, and alternatives. Formularies usually contain three to five tiers, ranging from generic drugs on tier 1 to specialty brand-name drugs on the higher tiers. Each tier has defined copayments and out-of-pocket costs, and most often, the lower the tier, the lower the cost. Many plans put Ozempic somewhere in the middle.

Costs of Ozempic under Medicare

The cost of Ozempic may vary depending on the specific plan since each plan has its own policies regarding cost-sharing—the amount the beneficiary pays out of pocket, including copayments, deductibles, and coinsurance. According to Scott Maibor, a Medicare adviser and managing director at Senior Benefits Boston, the average cost of Ozempic with Medicare coverage is around $2,300 per year, although he affirms that this price may vary.

Ways to get discounts on Ozempic

Medicare Part D or other health insurance plans might be the most prominent ways to reduce the cost of Ozempic, but it’s not the only one. There are several things you can do to save on Ozempic, but here are five common ones.

Use a SingleCare savings card

This prescription discount card can immediately reduce the cost of expensive prescription drugs. Part D beneficiaries can’t combine these savings with their Medicare prescription drug coverage, but because each Part D plan has a different formulary, sometimes these coupons could offer more savings. Get your free SingleCare discount card here.

Apply for assistance programs

“I would encourage almost everyone to see if they qualify for any drug cost assistance,” says Maibor. “The federal government has programs with different income tiers, and many states have additional assistance programs with higher income thresholds.”

Medicare Extra Help is one of the most prominent federal programs. It’s designed to reduce expenses for Medicare beneficiaries who have a limited income and Medicare Part D. But Extra Help isn’t the only program available. The Medicare website has a search tool for finding state-specific programs.

Look for discounts from the manufacturer

Novo Nordisk offers programs that may help eligible patients save on Ozempic, but not everyone qualifies. Its Patient Assistance Program provides Ozempic at no cost to qualifying uninsured patients who meet certain income and other eligibility requirements. The manufacturer also offers an Ozempic Savings Card for eligible patients with commercial insurance. However, people enrolled in government-funded insurance programs, such as Medicare or Medicaid, are not eligible for the Savings Card. Savings amounts and program requirements may change, so patients should check the manufacturer’s website for current eligibility criteria.

Shop around

This works for most products, but especially for medications since the list price can vary quite a bit between pharmacies and ZIP codes. One report by the U.S. Public Interest Research Group found that prescription drug prices can vary by up to a few hundred dollars between retailers. Doing a little bit of research or driving an extra few minutes could amount to significant savings. Comparing prices is easy to do online or on the go with the SingleCare app.