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Ozempic Cost With And Without Insurance Compared

Ozempic (semaglutide) is a prescription medication for blood sugar regulation in adults with type 2 diabetes. It works by activating/stimulating the GLP-1 (glucagon-like peptide 1) receptor, which releases insulin, thereby reducing blood sugar levels. Several studies found Ozempic to be an effective weight loss drug for those with obesity. Although Ozempic is not FDA-approved for weight loss management, it is prescribed by physicians as an off-label medication. However, Ozempic comes with a hefty price tag, and obesity medications often aren't covered by the government or private insurance companies.

Here, we delve into the cost of Ozempic without insurance while exploring alternative insurance options that may provide coverage for Ozempic. Additionally, we discuss practical strategies to help individuals save on Ozempic expenses, ensuring access to this potentially life-changing medication.

Ozempic cost without insurance

You may be asking yourself, "How much does Ozempic cost?" The prices below reflect pricing from pharmacies in the Nashville, TN, area as of November 2023. The prices may vary based on location and other factors.

Walgreens$772.05
Publix$804.28
Kroger$805.39
CVS $807.78
Walmart$843.10
COSTCO$957.99

The prices in this table reflect 0.25 or 0.5 mg/dose. They may also reflect membership pricing.

Ozempic cost with insurance

This ultimately depends on what plan you have and if you've met your deductible. There may or may not be a co-pay, and the price will vary based on pharmacy and location as well. As it stands, Ozempic is not FDA-approved for weight loss. However, semaglutide, an ingredient in Ozempic, is approved as a weight loss drug under the brand name Wegovy. Wegovy has more semaglutide in it than Ozempic.

Is Ozempic covered by insurance?

Whether Ozempic is covered by insurance depends on the specific insurance plan and its coverage policies. States and private insurance companies will have different insurance coverages. Your insurance policy may also dictate coverage.

Most insurance providers typically cover Ozempic as long as it is prescribed for type 2 diabetes. However, you can also get it covered for other conditions, such as prediabetes.

It is recommended to check with your insurance provider or review your insurance plan's formulary (the list of medications covered by your insurance provider) to determine if Ozempic is covered and what the associated costs and requirements may be.

Does Medicare cover Ozempic?

Medicare coverage for Ozempic is available under Medicare Part D, which provides prescription drug coverage. However, coverage specifics can vary depending on your specific Medicare Part D plan. Review your plan's formulary/drug list or contact your Medicare Part D provider to determine the coverage details for Ozempic, including any cost-sharing requirements, such as co-payments or deductibles.

Unfortunately, Medicare does not cover Ozempic specifically for weight management since the FDA only approved Ozempic for the treatment of type 2 diabetes and not for weight loss.

Does Medicaid cover Ozempic?

Medicaid may also cover costs for Ozempic, but it may vary depending on the specific state's Medicaid program and its formulary/drug list. Generally, Medicaid programs cover a range of medications, including certain prescription drugs like Ozempic, but the specific coverage may be subject to limitations, restrictions, or prior authorization requirements. Contact your state's Medicaid office or consult the Medicaid formulary to confirm the coverage details for Ozempic under your specific Medicaid plan.

Medicaid also offers coverage for Ozempic treatment of type 2 diabetes across all states. However, only the states of California, Kansas, Minnesota, Wisconsin, Michigan, Pennsylvania, Virginia, Delaware, Rhode Island, and New Hampshire offer broad coverage for anti-obesity drugs based on GPL-1 agonists such as Ozempic, Wegovy, and Mounjaro.

The cost of Ozempic without insurance can vary depending on the dosage, quantity, and location where it is purchased. Without insurance, the average retail price of Ozempic can range from approximately $730 to $1,400 for a monthly supply.

Each pen is loaded with enough formula to last for a month. Since Ozempic is meant to be taken once a week, this equals four injections per month.

Comparing Ozempic alternatives

When evaluating treatment options for type 2 diabetes, understanding the comparative prices of Ozempic alternatives becomes crucial in ensuring affordability and making informed decisions. By exploring the costs of alternative medications, individuals can identify potential savings and select the most cost-effective option for their specific needs.

Here is a tabular comparison of various weight-loss drugs and their prices per month without insurance:

DrugPrice/month
Ozempic (semaglutide)$935.77
Wegovy (semaglutide)$1,349.02
Mounjaro (tirzepatide)$1,023.04
Contrave (bupropion-naltrexone)$609
Saxenda (liraglutide)$1,305
Xenical (orlistat)$554
Alli (orlistat)$60
Qsymia (phentermine-topiramate)$198
Imcivree (setmelanotide)$19,051

Can I get Ozempic covered by insurance?

Coverage for Ozempic by insurance can vary depending on your specific insurance plan and its formulary. To determine if your insurance covers Ozempic, it is best to contact your insurance company directly or review your insurance plan. Most likely, Ozempic will only be covered by your insurance/you will only be able to get a prescription if you've been diagnosed with type-2 diabetes. Though Ozempic may assist with weight loss, it is NOT approved for weight loss and only approved for treating type-2 diabetes.

In some cases, Ozempic may require prior authorization (PA), which means your healthcare provider needs to give specific information to your insurance company to demonstrate the medical necessity of the medication. Additionally, your insurance plan may have cost-sharing requirements such as co-payments, coinsurance, or deductibles that you would need to consider.

How to get Ozempic

As Ozempic is a prescription medication, you need a doctor's approval to purchase it. There are a few ways you can go about this. One option is to visit your doctor and discuss your condition and treatment in person. Another increasingly popular method is to schedule an online meeting with a doctor via a telehealth service. With online consultations, you can book a meeting with a licensed medical professional from the comfort of your home using your smartphone or computer.

If you're thinking about getting your prescription online, hearing about the process may interest you. In a nutshell, it's very straightforward. First, schedule an appointment with a doctor via the telehealth service of your choice. During your virtual visit, you and your doctor will cover your medical history, previous treatments, and other concerns, just like you would in an in-person meeting. Lastly, taking everything into consideration, the doctor will prescribe Ozempic if they ascertain it is necessary and suitable for you.

While many telehealth platforms offer insurance coverage, it is always best to contact them directly and discuss the details. Some may not have this option, and others may have options not fit for your specific situation.

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Can I get Ozempic for free?

Free Ozempic depends on various factor, including your insurance coverage, financial assistance programs, and eligibility criteria.

Some doctors might provide free prescription drug samples from pharmaceutical companies. This practice may aid low-income patients who could not afford these drugs otherwise.

Additionally, participating in clinical trials can provide access to medications like Ozempic at no cost. Clinical trials are research studies that evaluate the safety and effectiveness of new treatments. However, participation in clinical trials often involves specific eligibility criteria and commitments, so discuss this option with your healthcare provider.

How to save on Ozempic

Ozempic can be expensive, but there are several ways to help offset the cost. Companies such as NiceRX, GoodRX, and Singlecare.com offer coupons and similar programs that offer significant savings, potentially as low as a $49/month purchase price (NiceRX). Additionally, some pharmacies offer savings programs such as Walgreens' Prescription Savings Club and COSTCO Membership Prescription Program.

Here are some tips to help save on your prescription.

Apply for patient assistance programs

Pharmaceutical companies have patient assistance programs to provide cost-free medications to individuals unable to afford to purchase their prescribed drugs. For Ozempic, the manufacturer, Novo Nordisk, provides their own PAP program to low-income patients who qualify.

Acquire health insurance

Individuals who do not have a health insurance policy can apply for government policies such as Medicare and Medicaid if they qualify, enroll in state marketplace programs, purchase private health insurance, or obtain health insurance through an employer.

Ask your doctor to recommend an insurance plan for your treatment. You can check how to apply for government-sponsored health insurance.

Use the Ozempic savings card

Novo Nordisk offers an Ozempic savings card that works with commercial or private insurance companies to provide Ozempic for as little as $25 per prescription for up to two years. To be eligible, you must be a U.S. citizen or permanent resident, be 18 years of age or older, have a valid prescription for Ozempic, and have commercial or private insurance.

Search for discounts and coupons online

Some authorized entities provide discount cards and coupons for drugs. These companies work with manufacturers and local pharmacies to provide discounts to patients. For example, GoodRx and NeedyMeds offer discounts for various prescription medicines, including Ozempic.

Consider similar drugs

You may consider getting a generic version of the drug if your health insurance doesn't cover your needed prescription. Generic drugs contain the same active ingredient as the brand-name drug but cost less.

Unfortunately, no generic alternative to Ozempic is available in the United States, mainly because it is still a relatively new drug. However, for those wanting to lose weight, see our table above for similar weight-loss drugs and their prices. Alli (orlistat) is an over-the-counter alternative and is the least expensive option.

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