Does Medicare Cover Ozempic? 

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Original Medicare does not cover prescription drugs. For your medications to be covered, you must either sign up for a Medicare-approved Part D Prescription Drug Plan (PDP) or join a Medicare Advantage plan that covers prescription drugs. Each plan has a formulary, an approved drug list, where you can check to see if Ozempic is covered.

Prescription coverage costs include the:

  • Plan’s monthly premium, standard or higher, depending on income level
  • Deductible, if any
  • Copayment or coinsurance for each prescription, based on tiers of pricing (generic to brand to specialty)

If you don’t enroll in Part D when you are first eligible and do not have other creditable coverage, you may have to pay a late enrollment penalty when you sign up later on.

If you need help paying for drug coverage, you can apply for the Extra Help program. Eligibility is based on income and financial resources. You qualify for Extra Help automatically if you have full Medicaid, are registered for the Medicare Savings Program or receive Supplemental Security Income (SSI).

How much would Ozempic cost without insurance? It depends on which of the three dosage forms you require and where you purchase it. GoodRx quotes an average price of $1,043.53 for one prefilled 2 mg pen, equating to eight .25 mg or four .5 mg doses. 

Why doctors prescribe Ozempic

Ozempic is a prescription drug, self-administered using a single-patient-use pen. The drug belongs to a class of medications used to treat Type 2 diabetes. It is not prescribed for people with Type 1 diabetes. According to the American Diabetes Association, Type 1 is when your body does not produce insulin, whereas Type 2 is when your body produces insulin but does not know how to use it. 

A critical component of managing Type 2 diabetes is a lifestyle of healthy eating and physical activity. If you are an adult with Type 2 diabetes who follows a diet and exercise program, Ozempic can improve your blood sugar. If you also have heart disease, Ozempic can lower your risk of having a major cardiovascular event like a heart attack or stroke.

Ozempic injections and side effects

Ozempic is in liquid form, administered beneath the skin (subcutaneous) rather than into muscle to ensure the drug is absorbed slowly into the bloodstream. You can insert the needle into your abdomen, thigh or upper arm. The Federal Drug Administration (FDA) advises injecting the medication into a different area each week and on the same day each week. 

The FDA warns that Ozempic may cause the following serious adverse reactions:

  • Thyroid tumors
  • Pancreatitis
  • Hypoglycemia
  • Kidney damage
  • Gallbladder disease
  • Diabetic retinopathy complications

Common side effects include nausea, headache, vomiting, diarrhea and stomach problems.

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