Speak with a Licensed Insurance Agent

Search
Close this search box.

Does Medicare Cover Ozempic?

If you are eligible for Original Medicare benefits, you may be able to receive coverage for your Ozempic (semaglutide) medication. Medicare benefits cover prescription drugs, but it’s essential to understand how it all works. Your Ozempic cost with Medicare coverage may not be through Original Medicare alone.

Find Medicare Plans in 3 Easy Steps

Let us help you navigate your Medicare journey

Original Medicare (Medicare Part A and Medicare Part B) benefits are provided by the federal government. You can receive additional benefits through private insurance carriers that can you cover otherwise out-of-pocket costs. These costs include those for prescription drugs, such as Ozempic.

The use of Ozempic, a brand name for semaglutide, has become a popular option for those suffering from diabetes. While it helps with lowering blood sugar levels, the drug is also known to assist in weight loss. However, this drug is not an FDA-approved treatment for weight loss. Thus, Ozempic Medicare coverage revolves around whether your healthcare provider deems the drug medically necessary.

With the right coverage, those eligible can receive Ozempic through Medicare Part D benefits, but it’s important to understand how this breaks down for your healthcare needs. Learn more about Ozempic and Medicare, including how to stay covered and how to save money while doing so.

Is Ozempic Covered by Medicare?

As many as 93% of all Medicare prescription drug plans cover Ozempic. This means that the majority of Medicare Part D plans will provide beneficiaries with coverage. However, you’ll still need to check your plan’s formulary to determine whether or not you are covered.

Ozempic Medicare coverage is similar to other prescription drugs. While Medicare Part D is available to help cover the costs of your drugs, your plan’s formulary – or the list of drugs your plan covers – determines whether your Medicare prescription drug plan will pay for Ozempic.

Furthermore, for Medicare to cover Ozempic, the medication will have to be determined to be medically necessary by your doctor. This means you’ll need to have your doctor prescribe Ozempic to treat a qualifying condition before your benefits kick in. The same is true in the event the medication, or any medication for that matter is used to treat your healthcare in an outpatient setting while using Medicare benefits.

Ozempic Coupon for Medicare

There are often misconceptions about Ozempic coupons for Medicare beneficiaries. To be clear, Ozempic coupons with Medicare do not exist. While Ozempic coupons may be available to patients taking the medication, they are not associated with Medicare benefits.

It’s essential to understand that patients cannot be enrolled in Medicare benefits and receive such coupons. Due to the Anti-Kickback Statute, it is illegal to use an Ozempic coupon in addition to Medicare Part D coverage to pay for prescription drugs. Therefore, if you are using Medicare benefits, you cannot utilize a coupon, and if you are using coupons, you are not allowed to use your Medicare coverage.

Find Medicare Plans in 3 Easy Steps

Let us help you navigate your Medicare journey

Ozempic Savings Card for Medicare Patients

You may be able to receive an Ozempic discount card, but it depends on many factors. Some Medicare Advantage plans provide beneficiaries with discount cards that can help provide drug savings. An Ozempic discount with Medicare benefits is important for patients prescribed the medication, but it’s important to also consider your other healthcare expenses to ensure you are better protected.

Receiving a savings card to cover the price of Ozempic with Medicare but failing to take into account the full scope of your healthcare expenses can lead to missed opportunities for savings. Medicare benefits come in many forms, and while a Medicare Advantage plan may be the best option for your needs, you will not know for sure without exploring other options. Medicare Supplement (Medigap) plans help cover the expenses Original Medicare benefits leave behind. But if you choose to stay with Original Medicare and pair it with a Medicare Supplement policy, you will need a separate Medicare Part D plan.

While you can cover your cost of Ozempic on Medicare through multiple means, the most likely way to receive coverage for your prescription drugs is through Medicare Part D benefits. But the other coverages available to you enroll vary, and it’s important to look at the full scope of your healthcare needs as you cannot enroll in both a Medigap and Medicare Advantage plan at the same time.

Ozempic Medicare Patient Assistance

You may be able to enter an Ozempic assistance program with Medicare, such as the Extra Help Program. But even if you are denied coverage through these means, additional assistance is available. Known as the Novo Nordisk Patient Assistance Program (PAP), you can receive Ozempic copay assistance for Medicare even if you have Medicare Part D benefits.

It’s important to note that you’ll need to apply and qualify for the PAP in order to enjoy its benefits. This includes falling far below the federal poverty level (400% or lower). Furthermore, you can’t have assistance from both the Medicare Extra Help Program and PAP. You’ll even have to provide proof that you were rejected from the Medicare Extra Help Program, should Novo Nordisk request documentation.

Ozempic assistance for Medicare patients is a complex area to navigate. Working with a licensed Medicare agent can help ensure you’re receiving the best benefits and assistance for your needs. Having the assistance of an expert means not only finding the right coverage to cut your Ozempic cost with Medicare but understanding all available options to help keep your healthcare expenses low.

Does Medicare Cover Ozempic for Weight Loss?

In general, Medicare doesn’t cover Ozempic for weight loss. Although Novo Nordisk created Ozempic for treating type 2 diabetes, it is also prescribed as a solution for weight management as an off-label drug. However, Ozempic’s Medicare coverage only applies to medically necessary prescriptions from your healthcare provider.

Because, in most cases, weight loss is not deemed medically necessary, your Medicare benefits won’t cover your prescription. If you are prescribed Ozempic for weight loss by your doctor, you will need to pay for your medication through other means. Therefore, Wegovy, another brand of semaglutide prescribed for weight loss, does not receive coverage through Medicare drug plans.

Find Medicare Plans in 3 Easy Steps

Let us help you navigate your Medicare journey

Does Medicare Part D Cover Ozempic?

Medicare Part D benefits cover Ozempic, but it’s a bit more complicated for enrollees. This is because Ozempic savings for Medicare patients are only available if the drug is part of your plan’s formulary.

Your formulary will list the drugs that your specific Medicare Part D plan will cover. Ozempic may be one of the drugs approved, but it doesn’t mean your plan will have coverage available. This can vary for a couple of reasons:

  • Drug plans vary amongst different carriers.
  • Although a majority of Medicare Part D drug plans offer coverage for Ozempic, the drugs receiving coverage will vary by location. Not everyone has access to the same coverage for the same medication.
  • There are also different drug tiers to consider, which may also affect your coverage. Ozempic is considered to be a Tier 3 drug, meaning it is a name-brand medication with no generic versions available.

In order to know whether help paying for Ozempic is available with your Medicare coverage, you can check online to view formularies from different providers. Many companies allow policyholders and guests the ability to search by ZIP Code and identify which drug plans are available in their area.

But because everyone’s healthcare needs are different, it’s also important to compare Medicare Part D benefits among various brands. This allows you to find the best overall fit for your healthcare and keeps costs low.

Understandably, this can be a difficult, time-consuming endeavor, so working with a licensed Medicare agent can help in multiple ways. Not only will you save money, but you can also save time and gain peace of mind by knowing that you’ll understand your best options are for covering your Ozempic cost on Medicare.

Does Medicare Cover Ozempic for Diabetes?

Your Medicare benefits will cover Ozempic for diabetes, but there are several stipulations that will come with your coverage. This includes the following:

  • Original Medicare benefits won’t cover Ozempic under normal circumstances. Overwhelmingly, this coverage comes from your Medicare Part D benefits or through certain Medicare Advantage plans.
  • To receive coverage for Ozempic through your Medicare benefits, your doctor will need to prescribe the medication to you as a medically necessary drug.

Unlike for weight loss, use of Ozempic is approved for treating type 2 diabetes. Therefore, so long as your healthcare provider deems the drug medically necessary, coverage should be available.

However, keep in mind that this is all in theory. Your location will largely determine whether you can receive coverage. The good news is that most Medicare Part D plans offer coverage for Ozempic, but because it varies by plan and location, checking your formulary is a must.

Find Medicare Plans in 3 Easy Steps

Let us help you navigate your Medicare journey

Is Ozempic Insulin Covered by Medicare?

Technically, Ozempic is not insulin and does not replace the use of insulin. You can receive coverage for Ozempic through Medicare Part D in most cases and insulin through both Part B and Part D coverages. The same stipulation of being medically necessary will apply to your Ozempic prescription or insulin, but if your doctor deems them as so, Medicare benefits are available to cover both.

Does Medicare Part B Cover Ozempic?

Technically, Medicare Part B can cover outpatient prescription drugs in a limited fashion. Thus, if Ozempic your healthcare provider prescribes Ozempic and deems its use as medically necessary in an outpatient setting, under certain circumstances, Medicare Part B will cover your medication.

Under normal circumstances, you will need to rely on Medicare Part D benefits. What Medicare Part D plans cover Ozempic? This will vary from carrier to carrier. Remember, Medicare Part D benefits come from private carriers rather than the federal government. Therefore, you’ll need to understand your plan’s formulary to know whether or not you are covered.

Part B of Original Medicare covers the costs of preventative and medically necessary services, doctor’s visits, outpatient care, and durable medical equipment. So again, while you may receive coverage for medication under certain parameters, cutting the costs of drugs for Medicare beneficiaries is best left to Medicare Part D benefits.

Is Ozempic Covered by Medicare Advantage?

You can receive coverage for Ozempic while enrolled in Medicare Advantage, but it will depend on your plan. Most Medicare Advantage plans include prescription drug benefits. However, you will need to understand whether your plan specifically provides coverage for prescription drugs.

Otherwise, you won’t be able to enjoy Medicare Part D benefits while enrolled in Medicare Advantage. There are several different types of Medicare Advantage plans. Here’s a breakdown of which plans provide you with benefits that can cover your Ozempic prescription:

  • Health Maintenance Organization (HMO) plans offer coverage for prescription drugs, but not all plans will offer these benefits.
  • Preferred Provider Organization (PPO) plans may operate in a different manner, but coverage for Ozempic works in a similar fashion as it does for an HMO plan. Coverage is available for most plans, so long as you enroll in a plan that provides prescription drug coverage. Be sure to check your plan’s formulary, as not all PPO plans cover the prescription.
  • Private Fee-for-Service (PFFS) plans may provide prescription drug coverage as part of your benefits. However, if these benefits are not part of your plan, you can enroll in standalone Medicare Part D benefits.
  • Special Needs Plans (SNPs) all require inclusion of prescription drug coverage. Therefore, if you enroll in an SNP, you can use your benefits for Ozempic medication as long as the drug is a part of your plan’s formulary.

As you can see, there are many stipulations involving Medicare Advantage plans and gaining coverage for Ozempic. Still, you’ll need to be sure of the type of plan you are enrolling in and understand your Medicare Part D formulary to ensure you are covered.

What is Medicare Supplement Copay for Ozempic?

Medicare Supplement plans don’t provide coverage for prescription drugs. Therefore, there is no copay for Ozempic through Medicare Supplement coverage. You’ll need to enroll in Medicare Part D to use your benefits to cover the costs of prescription drugs.

Find Medicare Plans in 3 Easy Steps

Let us help you navigate your Medicare journey

While recipients can benefit from Medicare Advantage coverage, healthcare looks different for everyone. Your needs are unique, and there are times when Medicare Advantage may not be the best fit for your health or budget.

Medigap plans help you cover the costs Original Medicare leaves behind, while still providing an avenue to cover prescription drug costs through enrollment in Medicare Part D benefits. They can also help you enjoy fewer network restrictions and better overall healthcare coverage, depending on your needs.

Planning for Medicare and Ozempic coverage is important, but healthcare is often multi-faceted. You should audit the entirety of your healthcare needs with respect to your budget both in terms of the present and future. By doing so, you can enroll in the right coverage with lasting effect.

You can’t enroll in both a Medicare Supplement and Advantage plan at the same time. So, you’ll have to choose between the two, which affects how you are covered for prescription drugs and further complicates an already complex decision. Working with a licensed Medicare agent can help you gain a deeper understanding and choose the best options for your healthcare and budget.

How to Find the Right Medicare Ozempic Coverage for You

If covering the cost of Ozempic is essential to you, then Medicare benefits are available to help. But as mentioned above, there are many different options, and not all of them will equally meet your health and budget needs. The right fit for you will help cover your prescription drugs and a variety of additional healthcare costs you may face.

This is why Medicare Part D is an important consideration for patients using Ozempic. However, looking into your other benefits, such as Medicare Supplement or Medicare Advantage plans, can’t be overlooked.

Working with a licensed Medicare agent will provide you with the insight you need, a professional level of care, and the ability to explore your options while making the right choice for you.

It’s also worth noting that your Medicare Part D formulary can change over time. You’ll receive an Annual Notice of Change and can elect to change your coverage during the Medicare Annual Enrollment Period. Having a licensed Medicare agent can help you not only enroll in the right coverage but be there for you if you need to make a switch in the future.

To receive help with Ozempic costs through Medicare coverage, give us a call at the number above, or use our online rate tool for a quick, accurate comparison today!

Sources

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. Ozempic Medicare Coverage and Co-Pay Details. GoodRx. Accessed March 2023.
    https://www.goodrx.com/ozempic/medicare-coverage
  2. Novo Nordisk Patient Assistance Program (PAP). NovoCare®. Accessed March 2023.
    https://www.novocare.com/diabetes/help-with-costs/pap.html
  3. Social Security Act §1128B. Accessed March 2023.
    https://www.ssa.gov/OP_Home/ssact/title11/1128B.htm
Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Medicare Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

4 thoughts on "Does Medicare Cover Ozempic?"

  1. I have Medicare and a supplement. My co pay for ozempic was 250.00. Is there any way I could qualify for coupons. Thanks. This was given to me for my diabetics. My kidney level is way down have to get it up or a go on the kidney machines.

    1. Hi Briana, Original Medicare and Medicare Supplement plans do not cover prescription drugs. Are you enrolled in a Medicare Part D plan?

  2. Does Medicare cover Ozempic with a diagnosis Prediabetes R73.03? I have Medicare with TriCare for life.

    1. Ozempic will be covered by your prescription drug plan. You’ll need to check your specific plans formulary for coverage information.

Comment

Your email address will not be published. Required fields are marked *

string(3) "Yes"

5.0 Satisfaction Rating

It’s free and no obligation!

Find the Most Affordable Medicare Plans in your Area

X