Does insurance cover Ozempic?

Insurance will sometimes cover Ozempic, but patients are finding it harder and harder to get approved. The brand name of the drug is Ozempic, but the medication is semaglutide. I offer this in my practice to those patients who are having trouble with weight loss and are interested in semaglutide. I closely follow your progress and can help give you the boost to reach your weight loss goals. See my website for more information.

Coverage for Ozempic varies widely among insurance providers, including Medicare and Medicaid. Many insurance plans do cover Ozempic, especially if it's being used to manage type 2 diabetes. However, it might also be covered if it's prescribed for weight loss, depending on the specifics of your plan and whether you meet certain criteria such as having a BMI of 30 or higher, or a BMI of 27 or higher with at least one weight-related health condition.
To get Ozempic approved by your insurance, you'll usually need a prior authorization from your doctor. This is a request that your doctor sends to your insurance company to approve coverage for a specific medication. The doctor will need to provide information about your medical history and the reasons why Ozempic is necessary for your treatment.
If your insurance company denies the request, you can usually appeal the decision. This process can involve submitting additional documentation or letters of medical necessity from your doctor.
For Medicare, coverage for Ozempic will depend on the specifics of your plan. Medicare Part D prescription drug plans often cover this medication, but there may be restrictions or requirements for prior authorization.
Medicaid coverage for Ozempic also varies by state, as each state's Medicaid program has different rules and coverage limitations.
In all cases, it's a good idea to contact your insurance provider directly to ask about coverage for Ozempic. They can provide the most accurate and up-to-date information about your plan's benefits and any requirements for coverage.

Hello and thank you for your question. Insurance can cover Ozempic, but it also depends on insurance criteria. Per the prescribing guidelines, a patient has to have a BMI of 30 or a BMI of 27 with one other co-morbid condition (high cholesterol high blood pressure, pre-diabetic). I would suggest you call your insurance company to see if they do in fact cover the medication and if so, you can schedule an appointment with your practitioner to further discuss.