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Does Medicare Cover Ozempic?

Ozempic stock image
By Daniel Petkevich
Mar 28, 2023

Medicare drug plans usually cover Ozempic, but it may depend on your specific plan.

Disclaimer: This content is for informational purposes only and should not be used as a substitute for medical advice. Consult a qualified healthcare professional before taking any prescription medication.

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Diabetes is a chronic condition that’s becoming increasingly common among seniors. Managing diabetes often involves continuous medication, resulting in significant expenses over time.
Ozempic helps control your blood sugar level. However, it can be expensive, especially if you're uninsured.
Let's look at Ozempic, how Medicare covers it, and how you can get financial assistance to help with your out-of-pocket costs.

What’s Ozempic?

Ozempic is a prescription medication used to treat type 2 diabetes.
Type 2 diabetes is a chronic condition where your pancreas doesn't produce enough insulin or your cells don't use insulin effectively, leading to high blood sugar levels.
Ozempic's active ingredient, semaglutide, imitates the

hormone GLP-1

, which helps regulate blood sugar levels in your body. When taken in conjunction with a healthy diet and regular exercise, Ozempic can reduce blood sugar levels and lower the risk of heart attack,

stroke

, or death in adults with type 2 diabetes.
Note: Ozempic has received FDA approval only for treating type 2 diabetes. Prescribing Ozempic for weight loss is considered "off-label" use, which means it's being used to treat a condition not approved by the FDA. It's important to follow your doctor's advice and use Ozempic only as prescribed.

How Does Ozempic Work?

Ozempic lowers blood sugar levels in 3 ways:
  • Stimulating the pancreas to release more insulin in response to high blood glucose levels.
  • Inhibiting the liver from producing and releasing excessive glucose into the bloodstream.
  • Reducing the rate at which food empties from the stomach after a meal.
[
Visual asset.
Ozempic's Mechanism of Action | HealthMatch
Ozempic is typically administered via an injection pen once per week into a thin layer of fat in the arms, thighs, or abdomen.

Does Medicare Cover Ozempic?

Yes. Medicare covers Ozempic, but it may depend on your specific plan.
Here's a detailed breakdown of how different parts of Medicare may cover Ozempic:
  • Medicare Part D — Most Medicare Part D plans cover Ozempic. Check your plan's formulary or ask your insurance provider to confirm your coverage
  • Medicare Advantage Plan — If you're enrolled in a

    Medicare Advantage Plan

    that includes prescription drugs and Ozempic is included in your plan's formulary, then you might get coverage for the medication
  • Medicare Part B — If you receive Ozempic in a doctor's office or at a skilled nursing facility, your

    Medicare Part B

    may provide coverage for the medication
  • Medicare Part A — If you receive Ozempic while you're admitted to a hospital or a skilled nursing facility,

    Medicare Part A

    may cover the cost of the medication

How Much Does Ozempic Cost?

The typical retail cost of Ozempic is approximately $1,000. However, this cost may vary depending on the pharmacy you purchase from, your insurance coverage and your dosage.
If you have a Medicare

prescription drug

plan, the cost of Ozempic will vary based on the coverage stage you’re currently in. Here's an outline of the various costs:

1. Deductible Stage

If you haven't met the annual deductible, you’ll be responsible for the total retail price of the drug. 

2. Post-Deductible Stage

Once your deductible is met, you’ll move into the Post-Deductible phase (also known as the Initial Coverage stage), where you’ll be responsible for a copay, and your plan will cover the remaining drug expenses.
Your co-pay can be as little as $35 per month, depending on your plan. The average co-pay is around $209 per month.

3. Coverage Gap

During the Coverage Gap phase (also known as the

Donut Hole

), Medicare has a temporary limit on what it will cover for your medication, which may result in you paying more for your prescription.

4. Catastrophic Coverage

Once you reach the Catastrophic Coverage phase, Medicare should cover most of your drug expenses. 

Can I Get Financial Assistance to Pay for Ozempic?

Ozempic can be expensive, especially if you don't have insurance. Even with coverage, the costs can still add up quickly.
Here are some ways you can get Ozempic at a lower price:

Use a Coupon

Ozempic coupons can be a cost-effective option instead of relying on Medicare, especially if your Medicare co-pay is higher than $935.42. Companies such as

GoodRx

and

SingleCare

offer free and discounted coupons for several medications.

The Novo Nordisk Patient Assistance Program

The

Patient Assistance Program

is designed to provide medications at no cost to eligible patients who do not have Medicare or any other insurance.

A Savings Card

Individuals with private or commercial insurance coverage may be

eligible

for the Ozempic Savings Card provided by Novo Nordisk. This card offers a maximum savings of up to $150 per month or $450 for a three-month supply and is valid for two years.

Medicare Extra Help

If you have a limited income, you can seek financial assistance by applying for the

Medicare Extra Help

program, also known as the Part D Low-Income Subsidy. This federal subsidy aids Medicare beneficiaries in covering out-of-pocket expenses related to their Medicare prescription drug plan. If you're

eligible

, this program will cover your Part D premiums, deductibles, and copayments.

Bulk Order

Obtaining a three-month supply of medication from certain mail-order pharmacies can be a cost-effective option compared to traditional retail pharmacies. It also provides the convenience of having the medication delivered to your doorstep every 90 days. Check with your insurance provider if you're eligible for this option.

Compare Costs

Different pharmacies provide medications at different rates. To obtain Ozempic at the lowest cost, compare the price of the medication at your nearby pharmacies.

Alternate Medication

If you're uninsured or your insurance provider denies your request for Ozempic's prior authorization, you can ask your healthcare provider to suggest less expensive alternatives to Ozempic.

Plan Wisely for the Best Coverage

Ozempic (semaglutide) is a prescription medication that mimics the hormone that helps regulate blood sugar levels. Along with a healthy diet and regular exercise, Ozempic can effectively decrease blood sugar levels.
Diabetes management requires continuous medication, which may lead to significant expenses in the long run. Fortunately, the Medicare Part D and Medicare Advantage plans that include prescription drugs help cover the cost of Ozempic. Various programs are also available to help alleviate your out-of-pocket costs if you’re uninsured or have limited income.
If you have any questions regarding Ozempic coverage or want to learn more about ways to reduce your out-of-pocket costs, call us at 1-888-376-2028. Our advisors can help find the best healthcare plan for you.

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Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

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