{"id":634569,"date":"2025-12-09T11:29:12","date_gmt":"2025-12-09T16:29:12","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=634569"},"modified":"2025-12-09T11:29:12","modified_gmt":"2025-12-09T16:29:12","slug":"ozempic-cost-with-medicare","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/ozempic-cost-with-medicare\/","title":{"rendered":"How much does Ozempic cost with Medicare?"},"content":{"rendered":"<p><a href=\"https:\/\/www.singlecare.com\/prescription\/ozempic\"><span style=\"font-weight: 400;\">Ozempic<\/span><\/a><span style=\"font-weight: 400;\"> (semaglutide) is a self-administered glucagon-like peptide-1 (GLP-1) injection that\u2019s only available with a prescription. Ozempic is approved by the Food and Drug Administration (FDA) to help control blood sugar levels in adults with Type 2 diabetes mellitus, to reduce the risk of heart attack, stroke, and cardiovascular death in adults with Type 2 diabetes and heart disease, and to support kidney and heart health in adults with Type 2 diabetes and chronic kidney disease. Medicare drug plans typically cover Ozempic for these FDA-approved uses only. The total out-of-pocket cost varies by plan but can\u2019t exceed $2,100 in 2026.<\/span><\/p>\n<h2 id=\"how-medicare-covers-prescription-drugs\"><span style=\"font-weight: 400;\">How Medicare covers prescription drugs<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Medicare covers prescription drugs under Part A, Part B, and Part D.\u00a0\u00a0<\/span><\/p>\n<ul>\n<li><b>Part A <\/b><span style=\"font-weight: 400;\">covers the cost of prescription drugs administered while you\u2019re in the hospital or another inpatient facility.<\/span><\/li>\n<li><b>Part B <\/b><span style=\"font-weight: 400;\">covers the cost of prescription drugs that require you to visit a healthcare provider for administration, such as osteoporosis injections or chemotherapy infusions, or that are administered through durable medical equipment like an insulin pump.<\/span><\/li>\n<li><b>Part D <\/b><span style=\"font-weight: 400;\">covers prescription drugs that you fill at your pharmacy and administer yourself.\u00a0<\/span><\/li>\n<\/ul>\n<p>Coverage of Ozempic falls under Medicare Part D. Insurance companies can decide whether to cover Ozempic as part of their formulary (or list of covered drugs), and how much to charge in copays or coinsurance, so coverage and costs vary by Part D plan.<b><\/b><\/p>\n<p><span style=\"font-weight: 400;\">If your Medicare Part D plan covers Ozempic, it will be assigned a tier number. The higher the number, the more you generally pay.\u00a0<\/span><\/p>\n<h2 id=\"does-medicare-cover-ozempic\"><span style=\"font-weight: 400;\">Does Medicare cover Ozempic?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Many <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/does-medicare-cover-ozempic\/\"><span style=\"font-weight: 400;\">Medicare Part D plans typically cover Ozempic<\/span><\/a><span style=\"font-weight: 400;\">, but coverage isn\u2019t guaranteed. Here\u2019s why:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ozempic doesn\u2019t belong to a <\/span><a href=\"https:\/\/www.medicare.gov\/health-drug-plans\/part-d\/what-drug-plans-cover\/how-drug-plans-work\"><span style=\"font-weight: 400;\">protected drug class<\/span><\/a><span style=\"font-weight: 400;\">, so insurance companies can choose not to cover it.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Insurance companies may offer some plans that cover Ozempic and others that don\u2019t.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ozempic is usually only covered if it\u2019s prescribed for an FDA-approved use. Weight loss treatment, a popular <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/how-to-get-ozempic-for-weight-loss\/\"><span style=\"font-weight: 400;\">off-label use for Ozempic<\/span><\/a><span style=\"font-weight: 400;\">, isn\u2019t covered under Medicare Part D by law.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Most Medicare plans that cover Ozempic require <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/prior-authorization\/\"><span style=\"font-weight: 400;\">prior authorization<\/span><\/a><span style=\"font-weight: 400;\">. The insurance company offering the Medicare plan will verify with your healthcare provider that you have Type 2 diabetes before approving coverage.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cException requests for Ozempic under Medicare Part D can be made if it\u2019s believed the medication is medically necessary and alternatives on the plan are not suitable,\u201d says Elizabeth Rubin-Ribak, the clinical adviser at <\/span><a href=\"https:\/\/emberstreatmentcenter.com\/about\/our-staff\/\"><span style=\"font-weight: 400;\">Embers Recovery<\/span><\/a><span style=\"font-weight: 400;\"> in Phoenix, Arizona. \u201cThis needs to be supported with detailed clinical history and evidence that <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/ozempic-alternatives\/\"><span style=\"font-weight: 400;\">alternatives<\/span><\/a><span style=\"font-weight: 400;\"> have failed or caused side effects.\u201d<\/span><\/p>\n<h3 id=\"changes-to-medicare-coverage-of-obesity-drugs-in-2026\"><span style=\"font-weight: 400;\">Changes to Medicare coverage of obesity drugs in 2026<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">On Nov. 6, 2025, President Donald Trump <\/span><a href=\"https:\/\/apnews.com\/article\/trump-wegovy-zepbound-drug-prices-15b24e03d558aa6bbcf37e52ba2d354e\"><span style=\"font-weight: 400;\">announced<\/span><\/a><span style=\"font-weight: 400;\"> that the manufacturer of Ozempic, Novo Nordisk, agreed to lower the prices that Americans pay for the drug. For Medicare beneficiaries, the deal will expand coverage to obesity, not just Type 2 diabetes. That would cover an additional 10% or so of Medicare beneficiaries, who would only be responsible for a $50 copay per month. However, no official announcement from the White House or Centers for Medicare and Medicaid Services has been made to confirm the exact number of eligible beneficiaries, what the eligibility criteria are, and when coverage will start.\u00a0<\/span><\/p>\n<h2 id=\"how-much-does-ozempic-cost-with-medicare\"><span style=\"font-weight: 400;\">How much does Ozempic cost with Medicare?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The cost of Ozempic with Medicare depends on your plan\u2019s deductible and co-insurance or copay, but federal law limits your out-of-pocket expenses.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Here\u2019s what to look for when calculating how much Ozempic costs with Medicare:<\/span><\/p>\n<ul>\n<li aria-level=\"1\"><b>Deductible: <\/b><span style=\"font-weight: 400;\">You\u2019ll pay 100% out-of-pocket for Ozempic and all other covered prescriptions until you meet your plan\u2019s deductible. Because Ozempic can be expensive <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/ozempic-without-insurance\/\"><span style=\"font-weight: 400;\">without insurance<\/span><\/a><span style=\"font-weight: 400;\"> or discounts, you may meet the deductible with your first month\u2019s supply. If you have already met your annual deductible for the year, you are no longer responsible for paying the full cost of your medications.<\/span><\/li>\n<li aria-level=\"1\"><b>Copay or coinsurance: <\/b><span style=\"font-weight: 400;\">After meeting your annual deductible, you\u2019ll pay a fixed amount (a copay) or a percentage of the total cost (coinsurance) when paying for your Ozempic prescription. The details will be outlined in your plan\u2019s Summary of Benefits document.<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-level=\"1\"><b>Maximum out of pocket: <\/b><span style=\"font-weight: 400;\">Between your deductible and your copay or coinsurance, you\u2019ll pay no more than $2,000 toward all of your covered prescriptions in 2025. In 2026, the out-of-pocket maximum increases slightly to $2,100.\u00a0\u00a0<\/span><\/li>\n<\/ul>\n<p>The <a href=\"http:\/\/medicare.gov\/plan-compare\/#\/?year=2026\">Medicare website<\/a> makes it easy to compare out-of-pocket costs across plans. Enter your ZIP code, prescriptions, and up to five local pharmacies. The site will display Medicare Part D plans in your area. Click \u201cView drugs and their costs\u201d to compare the cost of your prescriptions at different pharmacies with a particular plan.<b><\/b><\/p>\n<p><span style=\"font-weight: 400;\">The total yearly cost for Ozempic ranges, and you may pay between $315 and $2,100 (the out-of-pocket maximum), depending on your plan. However, you may pay as little as $50 per month for Ozempic, through a new pilot program, according to a recent announcement from the Trump administration.<\/span><\/p>\n<h2 id=\"how-to-save-on-ozempic\"><span style=\"font-weight: 400;\">How to save on Ozempic<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Although Medicare Part D could save you thousands of dollars on Ozempic, it can still be tough to pay the deductible and coinsurance, and Medicare won\u2019t cover it for off-label uses like <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/ozempic-weight-loss\/\"><span style=\"font-weight: 400;\">weight loss<\/span><\/a><span style=\"font-weight: 400;\"> or <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/ozempic-for-pcos\/\"><span style=\"font-weight: 400;\">PCOS<\/span><\/a><span style=\"font-weight: 400;\">. Coupons and other programs may help you save money on Ozempic, but they can\u2019t be combined with insurance like Medicare.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Here are some options to consider.<\/span><\/p>\n<h3 id=\"ozempic-coupons-from-singlecare\"><span style=\"font-weight: 400;\">Ozempic coupons from SingleCare<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">An <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/ozempic\"><span style=\"font-weight: 400;\">Ozempic coupon from SingleCare<\/span><\/a><span style=\"font-weight: 400;\"> is a good option to consider if your Medicare plan doesn\u2019t cover Ozempic. It can\u2019t be combined with insurance like Medicare Part D.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">This coupon can bring the cost down to $825 per 1, 3 mL prefilled 2 mg\/3 mL pen (0.25 mg or 0.5 mg per dose), depending on which pharmacy you choose. Considering the typical cash price is about $1,393 for the same quantity and dosage, a SingleCare coupon could save you about 40%.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">SingleCare coupons are free and can be used every time you pick up a prescription from the pharmacy. Save the coupon to your SingleCare account, print it, or send a copy via email or text. Show it to your pharmacist during checkout to get the discount.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">You should note that any costs associated with paying for Ozempic with a SingleCare coupon or card do not count toward your annual Medicare out-of-pocket maximum.\u00a0<\/span><\/p>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/use-singlecare-app\/\"><b>How to use the SingleCare app<\/b><\/a><\/p>\n<h3 id=\"medicare-extra-help-program\"><span style=\"font-weight: 400;\">Medicare Extra Help program<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">The <\/span><a href=\"https:\/\/www.medicare.gov\/basics\/costs\/help\/drug-costs\"><span style=\"font-weight: 400;\">Medicare Extra Help program<\/span><\/a><span style=\"font-weight: 400;\"> is designed to make prescriptions more affordable for Medicare beneficiaries with limited income and resources. If you meet the financial requirements for Medicare Extra Help, your Part D premium and deductible can drop to $0. Your copay will be no more than $12.15 for covered brand-name drugs like Ozempic and $4.90 or less for generic drugs in 2026.\u00a0<\/span><\/p>\n<h3 id=\"patient-assistance-program-for-ozempic\"><span style=\"font-weight: 400;\">Patient assistance program for Ozempic<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Novo Nordisk provides this drug at no cost to eligible individuals through its patient assistance program (PAP). Unfortunately, Medicare Part D recipients will no longer qualify for Ozempic through the PAP as of 2026. If you still have time to apply for 2025, your household income must be 400% or less than the <\/span><a href=\"https:\/\/www.needymeds.org\/poverty-guidelines-percents\"><span style=\"font-weight: 400;\">federal poverty level<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If you don\u2019t have health insurance, you may still qualify for the PAP if your household income is 200% or less than the federal poverty level<\/span><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<h3 id=\"ozempic-alternatives\"><span style=\"font-weight: 400;\">Ozempic alternatives<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Ozempic is just one of several <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/glp-1-agonists\"><span style=\"font-weight: 400;\">GLP-1<\/span><\/a><span style=\"font-weight: 400;\"> (or GIP\/GLP-1) diabetes medications your healthcare provider might consider prescribing. Check your plan\u2019s formulary to see if any of these <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/ozempic-alternatives\/\"><span style=\"font-weight: 400;\">Ozempic alternatives<\/span><\/a><span style=\"font-weight: 400;\"> are covered:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/victoza\"><span style=\"font-weight: 400;\">Victoza<\/span><\/a><span style=\"font-weight: 400;\"> (liraglutide)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/trulicity\"><span style=\"font-weight: 400;\">Trulicity<\/span><\/a><span style=\"font-weight: 400;\"> (dulaglutide)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/mounjaro\"><span style=\"font-weight: 400;\">Mounjaro<\/span><\/a><span style=\"font-weight: 400;\"> (tirzepatide)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/exenatide\"><span style=\"font-weight: 400;\">Byetta<\/span><\/a><span style=\"font-weight: 400;\"> (exenatide)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/prescription\/rybelsus\"><span style=\"font-weight: 400;\">Rybelsus<\/span><\/a><span style=\"font-weight: 400;\"> (semaglutide, the same active ingredient as Ozempic, in an oral tablet)<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">\u201cThese are sometimes more affordable, depending on insurance coverage,\u201d Dr. Rubin-Ribak says. These other medications can also be effective for controlling blood sugar and reducing weight.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If your Medicare plan covers none of these medications, ask your healthcare provider about generic liraglutide for Type 2 diabetes. With a <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/liraglutide#coupons\"><span style=\"font-weight: 400;\">SingleCare coupon<\/span><\/a><span style=\"font-weight: 400;\">, you could pay about $92 for a month\u2019s supply, depending on which pharmacy you choose.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Your healthcare provider may also consider an alternative that\u2019s in a different drug class. \u201cFor diabetes, <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/metformin\"><span style=\"font-weight: 400;\">metformin<\/span><\/a><span style=\"font-weight: 400;\"> is inexpensive and remains a first-line option for many people. Older medicines like <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/sulfonylureas\"><span style=\"font-weight: 400;\">sulfonylureas<\/span><\/a><span style=\"font-weight: 400;\"> and <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/pioglitazone-hcl\"><span style=\"font-weight: 400;\">pioglitazone<\/span><\/a><span style=\"font-weight: 400;\"> are also lower cost, though they have trade-offs such as risk of low blood sugar or weight gain. <\/span><a href=\"https:\/\/www.singlecare.com\/drug-classes\/dpp-4-inhibitors\"><span style=\"font-weight: 400;\">DPP-4 inhibitors<\/span><\/a><span style=\"font-weight: 400;\"> are sometimes cheaper than GLP-1 drugs but lead to modest changes in weight,\u201d says <\/span><a href=\"https:\/\/www.linkedin.com\/in\/jennifer-warren-md-dabom-dabfm-3a940712\/\"><span style=\"font-weight: 400;\">Jennifer Warren<\/span><\/a><span style=\"font-weight: 400;\">, MD, a dual board\u2011certified physician in obesity medicine and family medicine.\u00a0<\/span><\/p>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/resources\/diabetes\"><b>Diabetes Coupons &amp; Discount Diabetic Supplies<\/b><\/a><\/p>\n<h2 id=\"bottom-line-medicare-coverage-of-ozempic-varies\"><span style=\"font-weight: 400;\">Bottom line: Medicare coverage of Ozempic varies\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Thanks to out-of-pocket limits, you won\u2019t pay more than $2,100 for Ozempic with a Medicare Part D plan in 2026. However, the out-of-pocket cost of Ozempic can be less than $500 per year with some plans. To get a precise answer about how much Ozempic costs with Medicare, it\u2019s best to look at your plan\u2019s Summary of Benefits or to compare plans on the Medicare website.<\/span><\/p>\n<p><em><small>The SingleCare prices in this article are the most accurate at the time of publishing in ZIP code 23666 as of Dec. 9, 2025. Prices vary by pharmacy. Visit our Ozempic coupon page for updated Ozempic prices near you.<\/small><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Ozempic (semaglutide) is a self-administered glucagon-like peptide-1 (GLP-1) injection that\u2019s only available with a prescription. Ozempic is approved by the Food and Drug Administration (FDA) to help control blood sugar levels in adults with Type 2 diabetes mellitus, to reduce the risk of heart attack, stroke, and cardiovascular death in adults with Type 2 diabetes [&hellip;]<\/p>\n","protected":false},"author":149,"featured_media":634573,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[15103,21067,15],"coauthors":[21074],"class_list":["post-634569","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-drug-pricing","tag-glp-1-drugs","tag-medicare","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>How much does Ozempic cost with Medicare?<\/title>\n<meta name=\"description\" content=\"Medicare caps the annual cost of covered meds at $2,100 per year. 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