How to get insurance to cover Ozempic

Ozempic is a brand-name medication approved by the FDA to treat type 2 diabetes, helping manage blood sugar levels. But, when combined with diet and exercise, it has also proven to be an effective weight loss aid.

Unfortunately, despite its benefits, getting Ozempic insurance coverage for weight loss can be challenging.

Why do you need insurance for Ozempic for weight loss?

Ozempic can be expensive when paying out of pocket, with the cost often reaching up to a thousand dollars per month. The cost of Ozempic with insurance can be much more affordable, significantly reducing the financial burden.

Ozempic cost with insurance (and without)

The current list price for Ozempic is approximately $968 per injection pen, which contains four doses, or one month’s supply. The actual cost of Ozempic for weight loss can vary depending on several factors, including:

Prescription dosage
Location
Pharmacy
Insurance coverage
Eligibility for savings cards and patient assistance programs

If your insurance plan covers Ozempic for weight loss, you could pay significantly less. The final cost will depend on your specific plan, copay, and any applicable deductibles. Novo Nordisk, the manufacturer of Ozempic, makes it simple to estimate the cost with your insurance plan thanks to their online tool.

Is Ozempic covered by insurance?

Yes. And no. While Ozempic is often covered for the treatment of type 2 diabetes, it’s not FDA-approved for weight loss.

Many doctors are willing to prescribe Ozempic off-label for weight loss, but insurance companies typically don’t cover medications prescribed for non-approved uses.

Unfortunately, many insurance plans will not cover weight loss treatments. Under the Affordable Care Act, insurance plans must offer obesity screening and counseling. They are not, however, required to cover treatment options.

If your insurance plan does cover weight loss medications like Ozempic, it will likely require the treatment to be considered medically necessary and you will need to meet certain criteria for eligibility.

Which insurance covers Ozempic for weight loss?

There is no list of insurance companies willing to cover Ozempic for off-label use. Coverage will depend on each company’s policy as well as the specific diagnosis and individual plan.

Each insurance plan will have a prescription “formulary” that lists eligible medications and whether or not they have specific eligibility requirements.

How to get insurance to cover ozempic for weight loss: step-by step guide

When it comes to Ozempic insurance coverage, you have two options:

Shop around for a new insurance plan that offers coverage
Attempt to secure coverage through your current plan

1. Finding Insurance that Covers Ozempic

If you have the ability to shop around for new insurance, you’ll want to follow these steps:

Research Insurance Providers: Look for insurance companies that offer the coverage to meet all your needs.
Review Plan Details: Check the coverage details of each plan, specifically looking for policies that include coverage for weight loss medications or off-label prescriptions.
Confirm Coverage with Insurer: Contact the insurance provider to confirm whether Ozempic is covered for weight loss. Ask about any specific requirements, such as prior authorizations or medical necessity.
Compare Costs: Evaluate premiums, deductibles, and copays for each plan to find the most affordable option that provides the coverage you need.
Check Enrollment Periods: Make sure you are within the enrollment window for switching plans, or explore if you qualify for a special enrollment period.
Switch Plans: Once you’ve found a suitable plan, follow the necessary steps to enroll and confirm your coverage before starting Ozempic.

2. How to get Ozempic covered by insurance

If you don’t have the option to change plans, you can try to negotiate with your current insurance company for coverage. You’ll need to try several different avenues, including:

Review Your Current Plan: Check your insurance policy to see if there is any coverage for weight loss medications or off-label drug use. Take note of any exclusions or requirements, like prior authorizations.
Request Prior Authorization: Have your doctor submit a prior authorization request to your insurance company, explaining the medical necessity of Ozempic for your weight loss treatment. You will need to provide medical documentation supporting the use of Ozempic for weight loss, especially if you have related health conditions like obesity or prediabetes.
Appeal Denials: If your request is denied, don’t give up. File an appeal with your insurance company, providing additional documentation and reinforcing the medical necessity of the medication.
Explore Alternative Coverage Options: If your appeal is denied, ask your insurance company about other available options, such as discounts or savings programs, that may help reduce costs. You may also want to consider alternatives to Ozempic that may be covered under your current plan.

What to do if I have an Ozempic prescription, but insurance refuses to pay?

If your insurance will not cover Ozempic even after following the above steps, then you will need to consider alternate methods. There are still ways to save on your out-of-pocket costs.

If you are on Medicare or uninsured…

You can apply for Novo Nordisk’s Patient Assistance Program. There are specific eligibility requirements, but if you meet them and are approved you may be able to get Ozempic at no cost to you.

If you are commercially insured…

Novo Nordisk also offers an Ozempic Savings Card to those who are enrolled in a commercial (or private) insurance plan. In order to be eligible, you cannot be enrolled in any government, state, or federally funded medical or prescription benefit programs (including Medicare, Medigap, VA, DOD, TRICARE, or any similar federal or state health care program.)

If approved, you could pay as little as $25 for a 1-, 2-, or 3-month supply for up to 24 months.

Whether you’re insured or not, you also have the option of using Ozempic alternatives like Mounjaro and Zepbound, Wegovy (same active ingredient, but FDA-approved for weight loss), or a compounded semaglutide.

Discuss your options with your healthcare provider

Your healthcare provider should be an important part of your weightloss journey. They can help you tailor your weight loss plan and find options that suit your needs both medically and financially.

Explore your options and speak with a weight loss doctor through Heally.