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.
Without insurance, Ozempic costs around $1000 monthly, ranging from $730-1400, depending on the retailer.
Medicare and Medicaid cover Ozempic for prescription against type 2 diabetes but not for obesity and weight loss.
Several ways are available to save on Ozempic: acquiring health insurance, applying for patient assistance programs, considering similar drugs, using Ozempic savings card, or searching for discounts/coupons online.
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.
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.
Medicare coverage for 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 FDA only approved Ozempic for the treatment of type 2 diabetes and not for weight loss.
Medicaid coverage for 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.
Ozempic cost without insurance
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.
Ozempic alternatives comparison
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:
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.
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.
Can I get Ozempic for free?
Free Ozempic depends on various factors, 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.
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 at https://www.usa.gov/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 US 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.
How much does Semaglutide cost without insurance?
Without insurance, the cost of semaglutide varies per retailer. Semaglutide is marketed as Wegovy and Ozempic. Wegovy (prescribed for adults with obesity) costs around $1400, while Ozempic (prescribed for those with type 2 diabetes) costs about $1000.
What is the best injection for weight loss?
According to research, among all FDA-approved weight loss drugs, the most effective injection is semaglutide (Wegovy or Ozempic, but Wegovy may have a better effect due to higher dosage). A study conducted across multiple sites assessed the long-term effectiveness of semaglutide injections for weight loss and found that patients with obesity displayed significant and sustained weight loss for the duration of the trial.
Do you regain weight after stopping Ozempic?
Yes, it is probable to regain weight after stopping Ozempic. Research shows that most participants who stopped taking Ozempic experienced weight rebound or regained weight after Ozempic regimen. It is recommended to continue taking Ozempic or adapt a healthy, active lifestyle to maintain your weight.
- Nature Medicine. Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial.
- The New England Journal of Medicine. Once-Weekly Semaglutide in Adults with Overweight or Obesity.
- StatPearls Publishing. Glucagon-like Peptide-1 Receptor Agonists.
- The New England Journal of Medicine. Tirzepatide Once Weekly for the Treatment of Obesity.
- Center for Medicare Advocacy. A Victory for “Off-Label” Prescription Drug Coverage.
Show all references
- Journal of Pharmaceutical Policy and Practice. Pharmaceutical marketing: the example of drug samples.
- Northwestern University. New anti-obesity medication almost twice as effective as most currently approved weight-loss drugs.
- Medicare. Does Medicare Cover Ozempic?
- Medicare. Does Medicare Cover Weight Loss Medication?
- Novo Nordisk. Patient Assistance Program.