Is Ozempic Covered by Insurance? Discover How To Get It for $25 a Month (or Even Less!)
These tips help you avoid paying a fortune out of pocket when using a semaglutide for weight loss.
If you’ve been trying to reach a healthier weight, you may be considering semaglutide medications like Ozempic and Wegovy. Semaglutide mimics a hormone called glucagon-like peptide-1 (GLP-1), which plays a role in appetite regulation and blood sugar control. But because these medications can be pricy and are intended for long-term use, cost can be a major concern. So how much does Ozempic cost, and is it covered by insurance? Here’s what you need to know, plus simple tricks to help bring down the out-of-pocket cost.
How much does Ozempic cost?
Taking GLP-1 receptor agonists can lead to rapid weight loss. In fact, a study published in Diabetes, Obesity & Metabolism found that participants who took 2.4 mg of semaglutide for 68 weeks lost up to 20 percent of their body weight. (For a 160-pound person, that’s around 30 pounds in 16 months.)
To achieve these weight loss results, you have to take semaglutide regularly. And that can be expensive. So how much does Ozempic cost, exactly? If you’re paying out of pocket, the list price for a four-week supply of Ozempic costs $968.52. The list price for a four-week supply of Wegovy is $1,349.02.
Needless to say, those numbers are daunting—especially when you consider that the results of the study above were based on 68 weeks of treatment. The total cost over the course of 68 weeks could add up to more than $16,000 for Ozempic and nearly $23,000 for Wegovy.
“These medications are expensive,” says Sulagna Misra, MD, BCMAS, founding physician at Misra Wellness. “Cost is definitely a barrier for patients to receive treatment.” The good news? Most people don’t have to pay the full list price because discounts are available and insurance may help cover the cost of Ozempic and other semaglutide medications.
Is Ozempic covered by insurance? 3 key factors
Both Ozempic and Wegovy may be covered by insurance, but the amount of coverage will depend on your health insurance plan and your medical needs. Here are a few factors that can affect whether or not insurance will help pay for an Ozempic or Wegovy prescription.
Type of insurance plan
According to a study published in the Journal of the American Medical Association Health Forum, the majority of Ozempic and Wegovy prescriptions are covered by commercial insurance. Ozempic may also be covered under Medicare Part D and Medicaid. However, it can be challenging to get Wegovy covered under these programs due to coverage prohibitions for weight loss drugs (more on that below).
‘On label’ vs. ‘off label’ use
Ozempic and Wegovy both have the same active ingredient (semaglutide). But Ozempic is FDA-approved to treat type 2 diabetes by improving blood glucose control and reducing the risk of cardiovascular disease. Wegovy, on the other hand, is FDA-approved for weight management.
Some doctors may prescribe Ozempic “off-label” to lose weight, which means they prescribe it to someone without type 2 diabetes who wants the side effect of weight loss. But many insurance companies are cracking down and refusing to cover off-label Ozempic prescriptions, Dr. Misra says.
Medical necessity
To qualify for insurance plan coverage, you’ll need to show that the medication is necessary to maintain or improve your health. Without a diagnosis of type 2 diabetes, insurance typically won’t cover Ozempic, Dr. Misra says.
For Wegovy, the medical criteria are either a BMI of 30 or higher or a BMI of 27 or higher along with at least one obesity-related complication (such as high blood pressure, type 2 diabetes or abnormal cholesterol levels). (You can calculate your BMI, or body mass index, here.)
“We also use abdominal waist circumference as a tool, as visceral fat correlates with increased cardiovascular disease,” Dr. Misra says. “Women with a waist of circumference 35 inches or higher, and men with a waist of circumference 40 inches or higher may be candidates for treatment.”
In some cases, Wegovy may be prescribed to help treat polycystic ovary syndrome (PCOS). Women with PCOS may develop insulin resistance or experience weight gain, which can be mitigated with a semaglutide medication. That said, many insurance plans still don’t cover weight loss medications. And if yours does, you may need to get special approval to cover a semaglutide prescription for PCOS.
How to save on Ozempic when it’s not covered by insurance
You can find out whether your insurance plan typically covers semaglutides by filling out a short questionnaire at the manufacturer’s website (here for Ozempic and here for Wegovy). If your coverage comes up short, you still have a few options to reduce your costs. Here’s what might help:
Check out patient assistance programs
Discounts are available directly through the manufacturer of Ozempic. The Novo Nordisk Patient Assistance Program provides medication (such as Ozempic and Rybelsus, an oral semaglutide) at no cost to those who meet certain qualification criteria.
Some of the qualifying criteria include having Medicare or no insurance and having a household income at or below 400% of the Federal Poverty Level. You can find out what amount is based on your family size at NeedyMeds.
If you don’t meet that criteria, you may still be able to request samples from your physician, though availability is often limited due to supply shortages.
Apply for the Ozempic Savings Card
Don’t qualify for free Ozempic and/or your insurance plan doesn’t cover enough of the cost? See if you qualify for the Ozempic Savings Card. This is available to people with private or commercial insurance (such as through your employer) who have a one-, two- or three-month Ozempic prescription.
People who qualify for this program can get Ozempic for as little as $25 a month. That said, there are limitations. You’re capped at a savings of $150 for a one-month prescription, $300 for a two-month prescription and $450 for a three-month prescription. Your exact savings depends on your specific insurance plan coverage.
If you don’t qualify for the Ozempic Savings Card, you may still be able to save money using a prescription discount card like GoodRx, SingleCare or RxSaver. These help bring the cost of meds like Ozempic and Wegovy for people with insurance and without. Simply check the websites to compare prices and savings at pharmacies near you.
Consider compounding pharmacies
You may also be able to get semaglutide medications through a compounding pharmacy, which is a type of pharmacy that mixes ingredients to create custom medications. Compounding pharmacies can make semaglutide more affordable and accessible to patients who are worried about supply shortages or lack of insurance coverage.
“Supply and continuity of treatment is a major contributing factor when making a decision about treatment options,” Dr. Misra says. “Some physicians strongly feel that at least compounding is generally an affordable option, and one that lessens anxiety around treatment.”
However, she cautions that the FDA doesn’t approve the medications produced by compounding pharmacies. Ask your doctor for recommendations, and verify that the pharmacy is accredited by the Pharmacy Compounding Accreditation Board. You can search for a PCAB-accredited compounding pharmacy in your area here. Select “PCAB Compounding Pharmacy” as the program, then narrow down to your location.
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