That’s a simple question with a not-so-simple answer. Yes, Medicare covers Ozempic—but only when prescribed for certain uses.
Medicare coverage
What is Medicare Part D prescription drug coverage?Does Medicare cover Ozempic?
What is Ozempic?
It’s hard to turn on the TV or surf the internet without coming across advertisements for the latest weight loss drug semaglutide. Ozempic is just one brand-name version of semaglutide, a medication prescribed to treat type 2 diabetes. (Others common brands include Rybelsus and Wegovy.) Ozempic helps reduce blood sugar, which can reach dangerously high levels in people with diabetes. It’s been FDA-approved for this use since 2017. But over time, healthcare professionals and their patients have reported a welcome side effect to this drug—weight loss.1 And drug companies are taking note.
Will Medicare cover Ozempic?
If you check the drug formulary on Medicare Part D prescription drug plans, you may see Ozempic listed. While it may be covered, it may only be covered for specific uses.
Does Medicare Part D cover Ozempic for type 2 diabetes?
Yes. Ozempic is a common and accepted drug prescribed to treat type 2 diabetes.
Does Medicare Part D cover Ozempic for weight loss?
No. At this time, the law doesn’t allow Medicare to cover medications used solely for weight loss.2
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What is the cost of Ozempic?
The list price of Ozempic (the original price determined by the manufacturer, NovoNordisk) is $968.52 per monthly injection,3 although most people don’t pay list price if they have insurance. To see what you would pay for an approved prescription for Ozempic, check your Medicare Part D plan’s formulary.
What’s ahead?
Current law doesn’t allow Medicare to cover drugs prescribed solely for weight loss. New CMS rules do allow
Bottom line? Talk to your doctor if you have concerns about your weight. Healthy changes to your diet and lifestyle may provide what your pharmacist can’t—and with no out-of-pocket cost.
Frequently asked questions
How can I get Medicare to help me with weight loss?
Each year, Medicare members are offered what’s called a Medicare Annual Wellness Visit. You pay nothing out of pocket for this visit if your doctor accepts Medicare. This appointment is a great opportunity to talk with your doctor about any health issues that concern you, like controlling your weight. Also, if you have a body mass index (
Does Medicare cover weight loss surgery?
Medicare may cover weight loss surgery if a member:4
- Has a BMI of 35 or higher
- Has at least one other health issue related to obesity
- Has tried other medical treatments for obesity with no success
Humana answers your Medicare questions
Medicare coverage
What is a Medicare Part D formulary (drug guide)?
Medicare coverage
Does Medicare cover diabetic supplies?Sources
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Medications Containing Semaglutide Marketed for Type 2 Diabetes or Weight Loss ,” U.S. Food and Drug Administration, last accessed July 11, 2024 - Juliette Cubanski and Tricia Neuman, “
Medicare Spending on Ozempic and other GLP-1s Is Skyrocketing ,” Kaiser Family Foundation, last accessed July 11, 2024 - “
Find out the cost for Ozempic ,” NovaCare.com, last accessed July 11, 2024 - “
Bariatric surgery ,” Medicare.gov, last accessed July 11, 2024