Ozempic (Semaglutide) Medicare Coverage

Ozempic is a drug used to lower blood sugar and A1C in people with type 2 diabetes. Ozempic is one of several types of drugs that can help lower the risk of major cardiovascular events such as strokes, heart attacks and death.¹ 

Medicare beneficiaries with type 2 diabetes may want to find out if Ozempic is covered by Medicare. In this review, we outline Medicare drug coverage options and how Ozempic may be covered by a Medicare drug plan.

Medicare drug plan availability and coverage may vary, so it’s important to speak with a licensed insurance agent or compare plans online to find out which Medicare plans near you may cover Ozempic.

How much does Ozempic cost with Medicare?

Ozempic coverage and costs may vary based on the specific plan you have, as well as what coverage stage you're in.

Contact your plan carrier or consult your plan formulary for more cost information.

Does Medicare cover Ozempic?

According to GoodRx, 94% of Medicare Advantage plans and Medicare Part D plans covered Ozempic in 2023.¹

• Medicare Advantage plans or Part D plans that cover Ozempic include copay amounts that can range widely from one plan to another. Plan members may also be responsible for meeting a deductible before the plan’s drug coverage kicks in.
  
  
• Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). 89% of 2023 Medicare Advantage plans included prescription drug coverage.²
  
  
• Medicare prescription drugs plans each have their own formulary, or drug list, that details what prescription drugs are covered by the plan and how they are covered.

Drug coverage may vary based on plan availability. You may be able to find Medicare Advantage plan options in your area that cover Ozempic. We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

You can also compare Part D prescription drug plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

Does Medicare have any coverage restrictions on Ozempic?

Some Medicare drug plans may have restrictions on the amount of a drug that may be filled at one time.

Plans may also have a network of participating pharmacies where the plan must be used or preferred pharmacies where plan members may save on out-of-pocket costs for covered drugs.

Additional information

Ozempic manufacturer Novo Nordisk lists the following possible side effects when taking the drug:

• Nausea
• Diarrhea
• Stomach pain
• Vomiting
• Constipation 

This article is for informational purposes only. It is not healthcare advice, treatment, or diagnosis. It is not an endorsement of or recommendation for this medication. Speak to your doctor or healthcare provider about your specific healthcare needs, including your prescription medications. Only take medication as directed by your doctor.

Coverage and costs of prescription medications will vary by Medicare plan. Not all plans are available in all areas.

Written by Hayden Gharibyar, Pharm.D.