You may be able to find Medicare plan options in your area that cover Ozempic (semaglutide). Learn more about Ozempic and find Medicare Advantage plans in your area that may cover prescription drugs.
Ozempic
Chemical name: Semaglutide
Ozempic typically comes in a prefilled pen and is used to help people with type 2 diabetes better control their blood sugar. As of 2023, there isn't a generic alternative for Ozempic.1
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.
Is Ozempic paid for by Medicare?
While Original Medicare (Medicare Part A and Part B) does not typically cover prescription drugs like Ozempic, Medicare Advantage (Medicare Part C) and Medicare Part D plans may cover Ozempic or similar medications that help beneficiaries manage diabetes.
According to GoodRx, 93% of Medicare prescription drug plans cover Ozempic.1
What kinds of Medicare plans cover prescription drugs like Ozempic?
Medicare Advantage plans are sold by private insurance companies and serve as an alternative way to get all your Medicare Part A and Part B coverage. In addition to those benefits, Medicare Advantage plans typically offer coverage for some extra things not covered by Original Medicare.
Medicare Advantage plans that offer prescription drug coverage are called Medicare Advantage Prescription Drug Plans (MA-PD). Most Medicare Advantage plans (88 percent) offer prescription drug coverage in 2023. 99% of beneficiaries have access to an MA-PD plan with no monthly premium, though you typically must continue to pay your monthly Part B premium.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, but coverage isn't guaranteed. Be sure to request a free plan comparison and enter your drugs to find out if plans where you live cover Ozempic.
There are certain Medicare enrollment periods each year that may be your only time to change or add Medicare drug coverage, unless you qualify for a Special Enrollment Period. A licensed agent can help you confirm your eligibility.
How much does Ozempic cost with Medicare?
The costs you may pay for Medicare drug coverage can vary per plan, but your coverage costs for drugs like Ozempic are typically subject to a four-phase system.
Deductible phase
Before any coverage of a drug like Ozempic begins, you will first have to meet your plan’s annual deductible.
Deductible amounts vary by plan, and some plans have $0 deductibles. In 2023, no plan is allowed to have a drug deductible of more than $505. 70% of standalone Part D plans charge the standard $505 deductible in 2023.2
Initial coverage coinsurance or copayment phase
Once your deductible has been met, you begin the cost-sharing portion of your coverage. During this phase, you will make a copayment each time you fill a prescription. Copayment amounts are based on tiers, with Tier 1 drugs generally having the lowest copayments and Tier 5 drugs usually having the highest.
In 2023, the average Medicare Part D plan charges a $1 copay for Tier 1 preferred generic drugs, while the average plan coinsurance for Tier 5 specialty drugs is 25%.2
Donut hole phase
If you and your drug plan combine to spend at least $4,660 on covered medications in 2023, you will exit the initial coverage phase and enter the “donut hole” phase coverage gap.
While in the coverage gap, you pay no more than 25% of the cost of your medications until you and your plan have combined to spend $7,400 on covered medications for the year in 2023.
Catastrophic coverage phase
If you and your plan combine to spend $7,400 on covered medications in 2023, you exit the donut hole phase and enter the catastrophic coverage phase. Once here, your plan will only charge a small coinsurance or copay for covered drugs for the remainder of the year.
Learn More About Medicare
Join our email series to receive your free Medicare guide and the latest information about Medicare and Medicare Advantage.
By clicking "Sign me up!” you are agreeing to receive emails from MedicareAdvantage.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.
What is the cost of Ozempic without insurance?
The retail cost of Ozempic without insurance in 2023 is around $1,000 for a 2mg pen of 2mg/1.5ml.1
In addition to various prescription drugs and insulin, Medicare Advantage prescription drug plans and Part D plans can also cover diabetes supplies such as:
99% of Medicare Advantage plans offer some type of fitness benefit, such as memberships to gyms and wellness programs like SilverSneakers in 2023.3
How do I enroll in a Medicare drug plan?
If you’re new to Medicare, you may still be in your Initial Enrollment Period. This begins three months before you turn 65 years old and ends three months after your birthday month, for a total of seven months. You may enroll in a Medicare Advantage or Medicare Part D plan during this time.
If you are not new to Medicare, your best opportunity to enroll in a plan that may cover Ozempic is most likely during the fall Medicare Open Enrollment Period, which lasts from October 15 to December 7 each year.
Contact a licensed insurance agent to shop for and compare plans available in your area, including what drugs they may cover and how much they cost.
Read our guide to Medicare Advantage Prescription Drug Plans to discover the different plans, what they cover, how you can enroll and if an MAPD plan could benefit you. Read more
Our plan finder can help you compare 2022 Medicare Part D plans and Medicare Advantage Prescription Drug plans so that you can find a plan that best fits your needs. Read more
Read reviews of 5 of the top 2022 Medicare Part D providers, along with some tips for finding the best Medicare prescription drug plan for your needs. Read more
There are a number of prescription drug assistance programs that can help patients save on the rising cost of prescription drugs. Learn about eligibility. Read more
A drug formulary is a list of medications covered by a Medicare drug plan. Here are 7 facts about Medicare drug formularies that every beneficiary should know. Read more
This guide explains 2023 Medicare Open Enrollment and other Medicare enrollment periods. Don't miss this important time to review and change your Medicare coverage. Read more
This report details where Medicare beneficiaries have access to the widest range of quality 2023 Medicare Advantage Prescription Drug plans at the most affordable prices. Read more
Learn More About Medicare
Join our email series to receive your Medicare guide and the latest information about Medicare.
By clicking "Sign me up!” you are agreeing to receive emails from MedicareAdvantage.com.
Thanks for signing up for our emails!
Your Medicare guide will arrive in your email inbox shortly. You can also look forward to informative email updates about Medicare and Medicare Advantage.
If you'd like to speak with an agent right away, we're standing by for that as well. Give us a call!
1-800-557-6059TTY 711, 24/7LICENSED AGENTS AVAILABLE NOW
You're on your way to finding a Medicare Supplement plan!
Compare your Medigap plan options by visiting MedicareSupplement.com