{"id":634534,"date":"2025-12-05T16:30:09","date_gmt":"2025-12-05T21:30:09","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=634534"},"modified":"2025-12-05T16:30:09","modified_gmt":"2025-12-05T21:30:09","slug":"does-the-va-cover-ozempic","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-the-va-cover-ozempic\/","title":{"rendered":"Does the VA cover Ozempic?"},"content":{"rendered":"

Ozempic<\/span><\/a> (semaglutide) is one of the most prominent diabetes medications on the market\u2014one that millions of Americans take for Type 2 diabetes and <\/span>off-label<\/span><\/a> for obesity. As a <\/span>GLP-1 drug<\/span><\/a>, it mimics natural hormones to stimulate insulin production, regulate blood sugar levels, and manage appetite. While insurance often covers it for people with diabetes, veterans might wonder if it\u2019s included in their VA health care benefits\u2014it usually is, but that depends on several factors. We\u2019ll cover them all here.<\/span>\u00a0<\/span><\/p>\n\t\t

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\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\n

Does the VA cover Ozempic?<\/span><\/h2>\n

In some cases, yes. However, patients must meet certain criteria before coverage is issued. The VA will not cover Ozempic when prescribed solely for weight loss, as this is not an FDA-approved use.\u00a0<\/span><\/p>\n

The VA\u2019s national formulary<\/span><\/h2>\n

A <\/span>formulary<\/span><\/a> is a list that shows how a particular insurance plan covers different drugs, and the VA formulary differs from those that commercial insurance companies use. \u201cCommercial entities will often use their own P&T committees, but regional differences, benefit design strategy, and varying population needs may influence formulary decisions greatly,\u201d says<\/span> Shannon Fitzgerald, Pharm.D<\/span><\/a>, pharmacist, toxicologist, and contributor at Drugwatch.com. \u201cThe VA formulary, in contrast, is managed by the U.S. Department of Veterans Affairs (VA) and is structured on a single, national formulary that is the same across all VA facilities.\u201d<\/span><\/p>\n

The VA updates this formulary frequently and posts new versions<\/span> on its website<\/span><\/a>, along with monthly notices about additions and changes. Ozempic is listed on the national formulary, which includes a link to the coverage criteria (see below).<\/span><\/p>\n

Yet not every drug is on the national formulary. For example, Ozempic\u2019s weight-loss counterpart, Wegovy,<\/span> isn\u2019t listed<\/span><\/a>. But that doesn\u2019t mean it\u2019s impossible to get coverage. If you need a medication that\u2019s not listed on the formulary, your healthcare provider can<\/span> submit a non-formulary request<\/span><\/a>.<\/span><\/p>\n

According to Fitzgerald, this request should include reasons why<\/span> Wegovy<\/span><\/a> is medically necessary and why other weight loss drugs are not effective. She says the VA pharmacy will review this request within 96 hours, and if it\u2019s denied, the prescriber can make an appeal to the VA care team.<\/span><\/p>\n

VA requirements for Ozempic coverage<\/span><\/h2>\n

The VA won\u2019t cover Ozempic indiscriminately for everyone. Only for people who meet certain requirements. Typically, patients need <\/span>prior authorization<\/span><\/a>, which is the process by which they confirm that Ozempic is truly medically necessary. Here are<\/span> the requirements<\/span><\/a>.<\/span><\/p>\n

Diagnosis<\/span><\/h3>\n

First and foremost, they need to have a diagnosis of Type 2 diabetes mellitus. According to the Ozempic label, the<\/span> FDA has only approved it<\/span><\/a> for managing blood glucose and reducing the risk of sustained eGFR decline, end-stage kidney disease, and major cardiovascular events in people with Type 2 diabetes. So the VA needs proof that you have Type 2 diabetes before they\u2019ll cover it.<\/span><\/p>\n

Medical Necessity<\/span><\/h3>\n

A simple diagnosis, however, isn\u2019t the end of the road. As a prior authorization requirement, patients must have pre-existing atherosclerotic cardiovascular disease and\/or chronic kidney disease, and a medical determination that they\u2019re not a good candidate for empagliflozin (brand name: <\/span>Jardiance<\/span><\/a>). This would be enough evidence that the patient needs Ozempic over cheaper alternatives.<\/span><\/p>\n

Step Therapy<\/span><\/h3>\n

If the patient doesn’t have cardiovascular or chronic kidney disease, they can go through a process called<\/span> step therapy<\/span><\/a>\u2014trying certain alternatives first, and moving on to Ozempic if they don\u2019t work. Specifically, patients must try empagliflozin and the maximally tolerated dose of <\/span>metformin<\/span><\/a> (if they can take it). If neither of these medications achieves the desired results or causes significant side effects, the patient may be eligible for coverage for Ozempic.<\/span><\/p>\n

What about for weight loss?<\/span><\/h3>\n

The VA won\u2019t cover Ozempic for weight loss, but there\u2019s a chance they might cover Wegovy. A semaglutide drug from the same manufacturer, Novo Nordisk, Wegovy is FDA-approved for weight management, while Ozempic isn\u2019t. Since Wegovy isn\u2019t listed on the national formulary, it will require a non-formulary request, and if the VA approves health benefits, the patient needs to <\/span>meet the following criteria<\/span><\/a>:<\/span><\/p>\n