Written on January 24, 2024 by Jordan Stachel, MS, RDN, CPT. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.
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Ozempic® is a glucagon-like peptide-1 drug that many people are curious about. Some people wonder how to get Ozempic® covered by insurance. Read this article for everything you need to know.
Ozempic® is more generically known as semaglutide. Semaglutide has been approved for many years for the management of type 2 diabetes. Many healthcare providers may recommend the use of Ozempic® to reduce the health risks associated with some of the comorbidities that can accompany unregulated levels of blood sugar. This is important, as uncontrolled blood sugar levels combined with conditions such as heart or blood vessel diseases can increase one’s risk for strokes, heart attacks, and premature death.
Ozempic® works in the body by mimicking certain satiety hormones, increasing a person’s perceived levels of fullness. As such, many find that by taking Ozempic® they naturally feel fuller earlier. This can lead them to eat less, and many may find that they lose weight as a result. In addition, Ozempic® works by prompting the pancreas to make more insulin, which allows the body to bring blood sugar levels back down to a desired range.
Many people wonder if Ozempic® can be covered by their insurance. The short answer is that it depends. If a healthcare provider prescribes Ozempic®, coverage by insurance will likely depend on an individual’s unique situation—that is, why they are taking Ozempic®, their age, and their overall clinical status.
For some, Medicare Part D will cover Ozempic® for the management of type 2 diabetes. However, Medicare Part D will not cover Ozempic® if someone chooses to take it for other reasons, such as weight loss. Because many healthcare providers believe that obesity can precede or lead to other comorbidities, like type 2 diabetes, stroke, and heart disease, many providers are prescribing Ozempic® to patients with medical obesity. However, this may not be covered through insurance.
If you have Medicare Part D, Ozempic® will likely be covered because it can be purchased from a retail pharmacy. So, if you have a Medicare Advantage plan that covers prescription drugs, getting Ozempic® covered via this plan is likely possible. To understand your unique plan and what is covered, check with your healthcare provider and insurance company. If you do not have a Medicare insurance plan, getting Ozempic® covered for reasons other than to help manage type 2 diabetes may prove to be more difficult.
Many people wonder how much Ozempic® costs, especially if they cannot get insurance to cover it. While this will vary based on several factors, there are estimated daily and annual costs. For a once-weekly dose of Ozempic®, it is estimated that the daily cost is $6.97, with an annual cost of around $2,544. This number represents the highest costs of all GLP-1 receptor agonists on the market.
If Ozempic® is used to help manage obesity and an individual does not have type 2 diabetes or other comorbidities putting their health at risk, the monthly cost of Ozempic® is estimated to be much higher. Some estimate that, for the treatment of obesity, the cost of Ozempic® could be around $1,200 per month, which translates to a $14,400 annualized cost. As you can imagine, this is not attainable for many people who are interested in trying Ozempic® to manage their weight.
Many healthcare providers will recommend Ozempic® to people who are considered medically obese. It should be noted that this diagnosis is up to a healthcare provider’s discretion. If a healthcare provider designates a person’s medical obesity as a disease, they may be more likely to recommend Ozempic® as a treatment for this disease.
Many providers will not make the distinction that medical obesity is a disease, making Ozempic® harder for people to obtain. This is a controversial topic, as Ozempic® has proven effective in helping people to lose weight. It is estimated that people may lose an average of 20% of their starting weight while on Ozempic®.
It is worth noting that if Ozempic® is used to treat individuals who are considered medically obese, side effects and other elements should be considered. Common side effects of Ozempic® can include diarrhea and nausea. In addition, medical obesity is a very complex, multifaceted condition that cannot be completely “solved” via medication. Because other psychological and physiological elements accompany medical obesity, those who seek the use of an injection to help manage this condition should also seek the support of a team of qualified healthcare providers, including a therapist, dietitian, or other personal support groups.
If you believe Ozempic® may be right for you, consult a qualified healthcare provider. If you are struggling with your weight or health and have not tried dietary and lifestyle modifications first, these are a good starting point. Try some of these helpful tips if you are interested in taking small steps toward better health outcomes [8,9,10]:
At Everlywell, we combine the best in modernized, rigorous lab testing with easy-to-access, at-home medicine. We provide a range of blood tests and services, including our weight management program, that you can access from the comfort of your home. Take control of your physiological health today with Everlywell.
Jordan Stachel, MS, RDN, CPT is most fulfilled when guiding others towards making stepwise, sustainable changes that add up to big results over time. Jordan works with a wide variety of individuals, ranging in age from children to the elderly, with an assortment of concerns and clinical conditions, and has written for publications such as Innerbody. She helps individuals optimize overall health and/or manage disease states using personalized medical nutrition therapy techniques.