{"id":627233,"date":"2024-03-07T11:25:15","date_gmt":"2024-03-07T16:25:15","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=627233"},"modified":"2026-10-28T10:59:56","modified_gmt":"2026-10-28T14:59:56","slug":"does-medicare-cover-ozempic","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-medicare-cover-ozempic\/","title":{"rendered":"Does Medicare cover Ozempic?"},"content":{"rendered":"

Ozempic<\/a> (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.<\/p>\n

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How much does Ozempic cost?<\/h2>\n

Without insurance<\/a>, Ozempic costs vary but average about $1,245<\/span> per pen (a month\u2019s supply) depending on the dosage<\/a>, where you live, and which pharmacy you use. With an Ozempic coupon from SingleCare<\/a>, you could pay $860<\/span>, depending on your choice of pharmacy, dosage, and location.<\/p>\n

Typically, brand-name drugs have generic options that cost less, but there\u2019s currently no approved generic semaglutide, which is Ozempic\u2019s active ingredient. Plus, the FDA issued a warning<\/a> 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<\/a> that may come at lower prices or offer better insurance coverage.<\/p>\n

Does Medicare cover Ozempic?<\/h2>\n

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\u2019s official diabetes coverage guide,<\/a> and that may include Ozempic prescribed for diabetes.<\/p>\n

A law from 2003<\/a> prohibits Medicare Part D from covering weight loss drugs, which means it doesn’t cover Ozempic prescribed solely for weight loss<\/a>, an off-label<\/a> use. This was due to the fact that weight loss medications were considered cosmetic, and obesity wasn\u2019t considered a chronic disease back then, according to Jonathan Kaplan<\/a>, MD, founder of Pacific Heights Plastic Surgery<\/a>. \u201cThere 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,\u201d Dr. Kaplan says.<\/p>\n

If someone wants to treat morbid obesity and also has Type 2 diabetes, though, a Medicare plan may cover Ozempic.<\/p>\n

RELATED: <\/b>Can I take Ozempic if I\u2019m not diabetic?<\/b><\/a><\/p>\n

Medicare coverage of obesity drugs<\/h3>\n

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<\/a>. The program covers Zepbound<\/a> (KwikPen only), Foundayo<\/a>, and Wegovy<\/a> 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.<\/p>\n

Although Ozempic and Wegovy<\/a> 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.<\/p>\n

Factors influencing Medicare coverage of Ozempic for diabetes<\/h2>\n

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

For example, certain private health insurers have buckled down on their coverage of Ozempic and other GLP-1 medications<\/a>, 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.<\/p>\n

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.<\/p>\n\t\t