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Author: Admin | 2025-04-28
Yes, Ozempic is usually covered under Medicare and state Medicaid programs to treat approved indications like type 2 diabetes, cardiovascular risk reduction and chronic kidney disease in type 2 diabetes, but not for weight loss, which is not approved by the FDA. Coverage can differ among participants and states, so it’s best to check directly with your plan.Does Medicare pay for Ozempic?Yes, most Medicare prescription drug plans (Medicare Part D) cover Ozempic for the treatment of approved indications like type 2 diabetes or for prevention of chronic kidney disease in people with type 2 diabetes, but not for weight loss. Coverage can change yearly, so it's best to check directly with your plan.Medicare offers prescription outpatient drug coverage (Medicare Part D) if you are 65 years of age or older or have certain disabilities. What you pay will depend upon your benefits and if you have met your yearly deductibles or hit the coverage gap.The Inflation Reduction Act (IRA) signed into law by the Biden Administration in 2022 will eliminate the coverage gap for people on Medicare in 2025. In 2025, the Medicare Part D spending cap (out of pocket costs) for patients will be set at $2,000 annually.Learn more: Will my private health insurance cover the cost of Ozempic?What if I want Ozempic for weight loss?The 2003 Medicare Part D law specifically excludes coverage of weight loss drugs.Ozempic is approved for the treatment of type 2 diabetes but not specifically for weight loss (even though it causes weight loss in this group of patients). It is also approved to reduce the risk of major cardiovascular events (like a stroke or heart attack) in adults; as well as to reduce the risk of worsening kidney disease, kidney failure (end-stage kidney disease) and cardiovascular death in adults with type 2 diabetes and chronic kidney disease.Some doctors may prescribe Ozempic “off-label” for weight loss, but your insurance probably will not cover it."Off-label" use of a drug refers to when a doctor prescribes a drug for a different purpose than those formally approved by the FDA and found in the package labeling of the drug.However, there are other options that Medicare may cover for weight loss if you qualify.In March 2024 the FDA approved Wegovy (semaglutide) for cardiovascular risk reduction in people with either obesity or overweight. Ozempic and Wegovy, both manufactured by Novo Nordisk, work the same way but have slightly different dosages and are approved for different uses. They are both GLP-1 agonists that contain semaglutide, the same active ingredient that's found in Ozempic.This means people on Medicare with documented heart disease and weight concerns may now qualify for Wegovy coverage.Contact your Medicare Part D drug plan to determine your eligibility for Ozempic or Wegovy. Your doctor’s office may be able to assist in this, as well.In some cases, you may have to follow a stepped-plan, where you have to try other treatments first, before Ozempic or Wegovy would be approved. Your doctor may also need to fill out special insurance
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