How To Get Ozempic Covered by Insurance

Home Insurance Advice Health Health Insurance for Ozempic

WRITTEN BY: Craig Sturgill

UPDATED: AUGUST 25, 2023 | 2 MIN READ

Are you struggling to get health insurance to cover the cost of Ozempic, a powerful medication for managing type 2 diabetes? Ozempic, also known as semaglutide, is an FDA-approved prescription pen that can be used alongside diet and exercise. It helps prevent blood sugar spikes, aids in weight loss and promotes a feeling of satiety.

While the monthly cost of Ozempic can be as low as $25 with insurance coverage, it can skyrocket to around $892.06 without insurance. We’ll guide you on navigating the complexities of health insurance to ensure coverage for Ozempic and explore potential savings programs to reduce the financial burden.

What are the uses of Ozempic?

Ozempic, available in 0.5mg, 1mg, and 2mg doses, is an injectable prescription drug with multiple uses. Primarily, it is prescribed to improve blood sugar levels in adults with type 2 diabetes mellitus in conjunction with diet and exercise. Additionally, Ozempic reduces the risk of major cardiovascular events, such as heart attack or stroke, in adults with type 2 diabetes mellitus and pre-existing heart disease.

It is important to note that individuals with type 1 diabetes should not use Ozempic, and its safety and efficacy in children under 18 years of age have not been established. The active ingredient in Ozempic, semaglutide, belongs to the class of drugs known as GLP-1 receptor agonists. It works by stimulating insulin release and improving blood sugar control.

While Ozempic is not approved specifically for weight loss, some individuals may experience weight reduction due to improved glycemic control. Common side effects include nausea, constipation, diarrhea, indigestion, low blood sugar levels, and injection site reactions. If you encounter severe allergic reactions while taking Ozempic, consult your healthcare professional promptly.

Improving blood sugar (glucose) levels in adults with type 2 diabetes mellitus, along with diet and exercise.
Reducing the risk of major cardiovascular events, such as heart attack, stroke, or death, in adults with type 2 diabetes mellitus and known heart disease.
It is not approved for use in individuals with type 1 diabetes.
Some people are using it off-label for weight loss.
Safety and effectiveness in children under 18 years of age have not been established.

Ozempic cost with insurance

Insurance coverage for Ozempic can vary depending on your specific health insurance plan. In most cases, Ozempic is covered by Medicare and many health insurance plans when prescribed for the treatment of diabetes. However, contacting your health insurance company or speaking with your pharmacist to verify the coverage and reimbursement details for Ozempic before starting the treatment is essential.

Insurance coverage for Ozempic can vary depending on your specific health insurance plan.
Ozempic is generally available through most Medicare plans and many health insurance plans when prescribed for the treatment of diabetes.
Contact your health insurance company or speak with your pharmacist to verify the coverage and reimbursement details for Ozempic before starting the treatment.
Insurance companies use drug formularies, which may affect coverage and copays for Ozempic.
Deductibles for prescription medications may require paying the full list price for Ozempic until the coverage gap or out-of-pocket maximum is reached.
Check your health insurance company’s online portal for a “Price a Medication” link to determine if Ozempic is covered and review any restrictions or requirements.
Ozempic may not be covered for weight loss alone, but it is often covered as a treatment for type 2 diabetes or pre-diabetes.
Healthcare providers can appeal insurance denials for Ozempic based on medical necessity.
Alternative GLP-1 medications may be covered by insurance if Ozempic is not included.
The cost of Ozempic and coverage specifics depend on your insurance plan and the pharmacy you use.
Consider exploring insurance options through your state’s marketplace at healthcare.com if you don’t have private insurance.

Ozempic costs

The cost of Ozempic can be a significant factor to consider. On average, a monthly dose of the Ozempic pen is around $892.06. It’s important to note that no generic forms of Ozempic are currently available. However, there are ways to potentially lower the cost through savings programs and health insurance coverage.

Novo Nordisk, the manufacturer of Ozempic, offers an Ozempic savings card that can provide savings for up to a 90-day supply. To qualify, you typically need private or commercial insurance and a prescription for Ozempic lasting one, two, or three months. Depending on your insurance coverage, the savings can range from $150 off a one-month prescription to $450 off a three-month prescription.

Additionally, Novo Nordisk provides a patient assistance program that offers Ozempic at no cost. Eligibility criteria include being a U.S. citizen or legal resident with a total household income at or below 400% of the federal poverty line and not having insurance or access to federal, state, or government programs like Medicare, Medicaid, or VA benefits.

Using websites like GoodRx, you can find Ozempic coupons from various retailers such as Costco, CVS, Walgreens, and Walmart. These coupons can help you save on the cost of Ozempic. In some cases, ordering a 90-day supply of Ozempic may be more cost-effective per dose than shorter-term supplies.

Coverage for Ozempic by health insurance plans may vary depending on the prescribed condition, such as type 2 diabetes versus weight loss, the specific pharmacy used, and the coverage offered by your particular plan. If you don’t have sufficient coverage, consulting with your healthcare provider about alternative GLP-1 medications may be beneficial. These medications offer similar weight loss effects to Ozempic and may be available at a lower cost.

Ozempic alternatives

When considering the cost of Ozempic, it’s worth exploring alternative GLP-1 medications that offer similar benefits. Ozempic belongs to the class of drugs known as glucagon-like peptide-1 (GLP-1) receptor agonists for conditions such as type 2 diabetes, obesity, and overweight with weight-related health conditions. These medications, including Ozempic, improve glycemic control and slow digestion, reducing appetite and weight loss.

Some of the alternative GLP-1 medications, such as Trulicity (dulaglutide), Bydureon (exenatide), and Victoza (liraglutide), may be available at a lower cost compared to Ozempic. It’s important to discuss with your healthcare provider to determine the best option for you and your goals.

Here are some alternative GLP-1 medications that you can consider:

Bydureon or Byetta (exenatide)
Victoza or Saxenda (liraglutide)
Tanzeum or Eperzan (albiglutide)
Trulicity (dulaglutide)
Mounjaro (tirzepatide)

It’s worth noting that with many GLP-1 medications, including Ozempic, side effects may be more common and intense in the first few weeks of treatment but tend to subside thereafter. To determine the most suitable option, consult your healthcare provider and discuss each medication’s potential benefits and side effects.

Considering the costs associated with Ozempic alternatives is important for making an informed decision. Here are some average weekly costs for a few alternative GLP-1 medications:

Adlyxin (lixisenatide): The average weekly cost for Adlyxin is around $300 for one daily dose.
Bydureon BCise (exenatide): This medication has an average weekly cost of approximately $190 for one weekly dose.
Byetta (exenatide): Byetta has an average weekly cost of about $190, with two daily doses.
Victoza (liraglutide): The weekly cost for Victoza ranges from $210 to $310 for one daily dose.
Trulicity (dulaglutide): Trulicity has an average weekly cost of $300 for one weekly dose.
Rybelsus (semaglutide): It is worth noting that Rybelsus is another form of semaglutide, the same active ingredient as Ozempic. The average weekly cost for Rybelsus is around $310 for one daily dose.

Please remember that these prices are estimates and subject to change. Consult with your healthcare and insurance providers to determine the most accurate and up-to-date costs for the specific GLP-1 medication you are considering.

Brand-Drug Name (Chemical Name)	Average Weekly Cost	Dosage Frequency
Adlyxin (lixisenatide)	$300 (1 dose daily)	Daily
Bydureon BCise (exenatide)	$190 (1 dose weekly)	Weekly
Byetta (exenatide)	$190 (2 doses daily)	Daily
Victoza (liraglutide)	$210-310 (1 dose daily)	Daily
Trulicity (dulaglutide)	$300 (1 dose weekly)	Weekly
Rybelsus (semaglutide)	$310 (1 dose daily)	Daily

How to save money on Ozempic

The cost of Ozempic can be a significant financial burden for individuals without adequate insurance coverage or high copays, with an estimated annual cash price of around $10,000 ($850 per month) without insurance. However, there are several strategies to help reduce the cost of Ozempic and explore alternative options:

Check your insurance coverage: Determine if your plan covers Ozempic and the associated costs. Some insurance plans may offer lower copays or full coverage for this medication.
Explore savings programs: If you have private or commercial insurance, you may qualify for the Ozempic savings card, which can significantly reduce out-of-pocket expenses. Visit the manufacturer’s website for eligibility criteria and updated terms and conditions.
Compare pharmacy prices: Medications like Ozempic can vary significantly among different pharmacies. Compare prices to find the pharmacy offering the lowest prescription cost.
Utilize coupons and discount cards: Look for Ozempic coupons or prescription drug discount cards, which can provide additional savings on the medication. These resources are online or through various pharmaceutical assistance programs.
Consider alternative treatment options: Consult with your healthcare provider about lower-cost alternatives to Ozempic. Other GLP-1 agonist medications are available that may offer similar benefits at a more affordable price.
Patient assistance programs and Medicaid: Check if you qualify for patient assistance programs offered by the manufacturer or other organizations that may provide assistance or even free medication. If eligible, consider enrolling in Medicaid, as some Medicaid plans may cover the cost of Ozempic.

FAQ

How can I lower the cost of Ozempic if my insurance doesn’t cover it or has high copays?

There are a few options you can explore. Firstly, check if you qualify for the Ozempic savings card the manufacturer offers, which can significantly reduce out-of-pocket costs. Additionally, compare prices at different pharmacies to find the lowest cost, and consider using coupons or prescription drug discount cards. Finally, discuss alternative treatment options with your healthcare provider that may be more affordable.

Is there a generic version of Ozempic available?

No, there is currently no generic version of Ozempic available. It is a brand-name medication.

Are there any patient assistance programs available for Ozempic?

The manufacturer offers a patient assistance program for eligible individuals who meet specific criteria. It assists in obtaining the medication at no cost. You can inquire about this program and check if you qualify.

Can I use Ozempic for weight loss purposes?

While Ozempic isn’t specifically for weight loss, some healthcare providers may prescribe it off-label for weight management due to its effects on appetite and glycemic control. However, it’s important to consult with your healthcare provider to determine the most suitable treatment option for your specific needs and goals.

Are there any alternative medications to Ozempic that are more affordable?

Yes, alternative GLP-1 agonist medications are available that may be more cost-effective. These include Trulicity (dulaglutide), Bydureon (exenatide), and Victoza (liraglutide). Discuss with your healthcare provider to explore these alternatives and determine the best option for you.

Find affordable health insurance coverage

Don’t let the cost of medications hold you back from accessing the healthcare you need. Take control of your health and finances by exploring your options for health insurance coverage. Fill out our online rate form today to compare health insurance costs in your area.

By doing so, you can find affordable plans that may help offset the expenses of prescription medications and ensure you receive the care you deserve. Don’t miss out on potential savings – start your journey towards better health and financial well-being now!

Methodology:

AgileRates extracted and analyzed data from the following to provide data in this article.