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Ozempic offers improved blood sugar control and potential weight loss benefits. However, it can be very expensive.
A 30-day supply of Ozempic costs $935, with some pharmacies selling it for up to $1100. That’s a lot of money, considering you will need it all year round.
So, you might wonder – does Medicare pay for Ozempic?
The answer is yes, but Medicare has specific criteria for Ozempic coverage. If you don’t meet the requirements, you will have to bear the full cost.
Does Medicare cover Ozempic for diabetes?
Ozempic (semaglutide) is a prescription medication used to help manage blood sugar levels in individuals with type 2 diabetes. It falls under the category of injectable diabetes medications known as GLP-1 receptor agonists.
So, yes, Medicare covers Ozempic for diabetes. However, you must be enrolled in the right plan to receive the coverage.
Does Medicare Part A сover Ozempic?
Medicare Part A covers hospital inpatient care, skilled nursing facility care, hospice care, and certain home health care. It does not cover prescription medications like Ozempic.
Does Medicare Part B cover Ozempic?
Medicare Part B may cover certain prescription medications that are administered in a clinical setting, such as a doctor’s office or outpatient facility. This is known as “Part B-covered drugs.”
Ozempic is typically self-administered by patients through subcutaneous injection. Since it is a self-administered medication, it is not covered under Medicare Part B.
Does Medicare Part C cover Ozempic?
Medicare Part C, also known as Medicare Advantage, is a private insurance plan that combines the coverage of both Part A and Part B. Many Medicare Advantage plans also offer additional benefits, which include drug coverage (Part D), dental, vision, and other services.
If you are enrolled in a Medicare Advantage plan that includes Part D, there is a possibility that Ozempic may be covered under your plan.
However, it’s important to note that specific coverage details, including which medications are included in the formulary (list of covered drugs), can vary from one Medicare Advantage plan to another.
To get the most accurate and up-to-date information about whether Ozempic is covered under your Medicare Advantage plan, you should review the plan’s documents or contact the plan provider directly.
Does Medicare Part D cover Ozempic?
Part D is the prescription drug coverage of Medicare. So, yes, Ozempic is covered under Part D plans.
However, if you have Original Medicare (Part A and Part B), you won’t automatically receive Ozempic coverage. You must enroll in a stand-alone Part D prescription drug plan from an authorized company.
Suggested Read: Medicare Part D Open Enrollment Period
Does Medicare сover Ozempic for weight loss?
Weight loss is an additional benefit of Ozempic, and some doctors might prescribe it to treat obesity issues. However, Medicare will not cover Ozempic for weight loss under any circumstances.
This is simply because Medicare has a policy not to cover medications for anorexia and weight loss/gain. So, you will not receive coverage for Wegovy either (which is an FDA-approved weight loss medication sold by the same company as Ozempic).
How much does Ozempic cost with Medicare?
In 2023, Ozempic costs $935.77 for a 30-day supply. You may find it listed for up to $1100 when buying from different retail stores. This makes around $11,000 to $13,000 annually.
Since this is out-of-budget for the majority of Americans, Ozempic’s company (Novo Nordisk) accepts different insurance options – including Medicare. However, the exact price depends on these factors:
- Your specific plan
The formulary (list of covered drugs) has tiers, which determine how much Medicare will pay for a specific drug. Since each plan provider makes the formulary differently, you must contact your insurance company to learn about Ozempic’s coverage.
Please note that expensive medications are usually placed in higher tiers of the formulary. This reduces the amount paid by Medicare.
- Deductible & co-payments
Medicare’s drug plan has an annual deductible that you must pay for the insurance to start covering your medicines. As of 2023, this amount can be no more than $505.
Once you’ve paid the deductible, you will be only required to pay the co-payment amount mentioned in your plan.
There are no restrictions on the co-payment policies of plan providers. However, once you and your plan have spent a total of $4,660 on drugs in 2023 and $5,030 in 2024, Medicare will reduce the co-payment percentage to 25% or less.
- Additional insurances
Medicare Part D allows you to pay for deductibles and co-payments using supplemental health insurance. Some of them can help reduce your Ozempic cost to as low as $25!
Learn about the types of insurance that work with Part D right here.
Are there any Ozempic discounts for Medicare patients?
Yes, there are different ways to lower the out-of-pocket cost for Ozempic. Here are some options worth exploring:
- Ozempic Savings Card for Medicare Patients
The Ozempic Savings Card is offered by the manufacturer Novo Nordisk, but only to commercially insured people. Medicare patients can not get it.
- Patient Assistance Program
The Novo Nordisk Patient Assistance Program (PAP) offers Ozempic for free to eligible participants. You don’t have to pay any registration fee or monthly premiums. However, the eligibility requirements are strict.
To qualify for the Patient Assistance Program, you must either have Medicare (any part) or no insurance. Also, your total household income should be at or below 400% of the national poverty level.
If you meet these criteria, ask your doctor to help fill out the PAP registration form.
- Coupons for Ozempic with Medicare
Besides Novo Nordisk, independent pharmacies and retail stores also offer coupons for Ozempic. For example, this Rite Aid coupon lets you buy a 30-day supply for $916.02. You can get it for much cheaper when used with Medicare.
