{"id":627695,"date":"2024-04-05T16:02:19","date_gmt":"2024-04-05T20:02:19","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=627695"},"modified":"2025-12-23T13:35:32","modified_gmt":"2025-12-23T18:35:32","slug":"does-blue-cross-blue-shield-cover-ozempic","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-blue-cross-blue-shield-cover-ozempic\/","title":{"rendered":"Does Blue Cross Blue Shield cover Ozempic?"},"content":{"rendered":"

Ozempic<\/a> (semaglutide) is one of the most in-demand medications for Type 2 diabetes on the market. Not only has this once-weekly injectable drug shown effectiveness in lowering blood sugar, but it\u2019s also earned a reputation for weight loss.\u00a0<\/span><\/p>\n

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Insurance companies and Medicare prescription drug plans may cover Ozempic when it\u2019s prescribed for Type 2 diabetes, not weight loss, but it depends on the specific plan. Here\u2019s all the information you need to determine whether your Blue Cross Blue Shield (BCBS) plan could provide some assistance.\u00a0<\/span><\/p>\n

Does Blue Cross Blue Shield cover Ozempic?<\/span><\/h2>\n

In short, maybe. BCBS isn\u2019t just one company\u2014it\u2019s a network of <\/span>33 independent licensees<\/span><\/a> of the Blue Cross Blue Shield Association (including Anthem and Empire), and each has unique policies. Some may cover Ozempic, while others won\u2019t. And even with the ones that do, the amount of coverage can vary.\u00a0<\/span><\/p>\n

The insurance landscape for Ozempic and similar medications is constantly in flux, and it might feel difficult to keep up with the changes. But, according to <\/span>Supriya Rao, MD<\/span><\/a>, a quadruple board-certified physician and founder of <\/span>GutsyGirlMD<\/span><\/a>, \u201cpatients generally have been able to get BCBS coverage for Ozempic, but it depends on the individual person\u2019s coverage.\u201d Factors including health conditions prescribed for, drug tier, and whether prior authorization is required may influence Blue Cross Blue Shield\u2019s coverage decision.<\/span><\/p>\n

Health condition<\/span><\/h3>\n

Insurance companies are much more likely to cover Ozempic when it\u2019s prescribed for diabetes than for weight loss. That\u2019s because the Food and Drug Administration (FDA) has <\/span>approved it for Type 2 diabetes<\/span><\/a>, while weight management is technically an <\/span>off-label<\/span><\/a> treatment. Noro Nordisk has a separate semaglutide drug that\u2019s approved and marketed for weight loss: <\/span>Wegovy<\/span><\/a>. For those reasons, some insurance plans might only cover Wegovy for weight loss and Ozempic for diabetes.\u00a0<\/span><\/p>\n

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

Prior authorization<\/span><\/h3>\n

According to Alex Foxman, MD, physician and medical director for <\/span>Achieve Health and Weight Loss<\/span><\/a>, BCBS Ozempic coverage almost always requires <\/span>prior authorization<\/span><\/a>. \u201cCommonly, BCBS requires proof of a diagnosis of Type 2 diabetes and documentation that the patient has not adequately responded to other diabetes medications before approving Ozempic,\u201d he says. \u201cThe insurer may also require information on the patient’s glycemic control, including HbA1c levels, and sometimes documentation of concurrent lifestyle interventions such as diet and exercise.\u201d<\/span><\/p>\n

RELATED:<\/b> BCBS Wegovy prior authorization criteria<\/span><\/a><\/p>\n

Drug tier<\/span><\/h3>\n

Every prescription drug plan has preferred and nonpreferred drugs. Preferred drugs are usually less expensive or have no suitable alternatives. Insurance companies often cover more of the cost for these select drugs. They might provide some coverage for nonpreferred drugs, too, but those often have higher copays and coinsurance for the patient.\u00a0<\/span><\/p>\n

Insurance providers <\/span>organize those drugs into tiers<\/span><\/a>. Generics typically occupy the lowest tier, then preferred brands, then nonpreferred brands, then specialty drugs at the highest tier. In most cases, the lower the tier, the lower the out-of-pocket costs\u2014and Ozempic typically falls in one of the middle tiers.\u00a0<\/span><\/p>\n

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

Let\u2019s say a particular Blue Cross Blue Shield plan doesn\u2019t cover Ozempic. In that case, you may pay about $1,396 without insurance or discounts per month.\u00a0<\/span><\/p>\n

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Save up to 80% on Ozempic with SingleCare<\/p>\n\t\t\t

Different pharmacies offer different prices for the same medication. SingleCare helps find the best price for you.<\/p>\n\t\t\t

\n\t\t\t\t
\n\t\t\t\t\tOzempic 2 mg\/3 mL (1 Pen)\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\t23666 - Hampton, VA\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t
\n\t\t\t\t\t\t
\n\t\t\t
\n\t\t\t\"Kroger\t\t\t<\/div>\n\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t$791.97\n\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\ti<\/span>\n\t\t\t\t\tPrice with signup<\/a>\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t
\n\t\t\t\tGet free coupon<\/a>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
\n\t\t\t
\n\t\t\t\"Harris\t\t\t<\/div>\n\t\t\t
\n\t\t\t\t
\n\t\t\t\t\t$791.97\n\t\t\t\t<\/div>\n\t\t\t\t
\n\t\t\t\t\ti<\/span>\n\t\t\t\t\tPrice with signup<\/a>\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t
\n\t\t\t\tGet free coupon<\/a>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\tSee Ozempic prices at all pharmacies<\/a>\n\t\t<\/div>\n\n\t\t<\/span><\/p>\n

\u201cOutside of insurance, several factors can influence Ozempic’s cost. These include the pharmacy’s pricing, the patient’s geographical location, and any applicable pharmaceutical company discount programs or patient assistance programs,\u201d Dr. Foxman says.\u00a0<\/span><\/p>\n

When BCBS covers Ozempic, the out-of-pocket costs will vary based on the drug tier it falls in. According to <\/span>a 2023 survey of 2,133 companies<\/span><\/a> about their employer-sponsored health insurance, the average copay was $11 for first-tier drugs, $36 for second-tier drugs, $66 for third-tier drugs, and $125 for fourth-tier drugs.\u00a0<\/span><\/p>\n

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