Medicare covers the prescription drug Ozempic to treat diabetes but not to help you lose weight. Medicare generally doesn’t cover any drugs for weight loss alone. However, March 2024 guidance suggests Medicare may cover weight-loss medications when taken for an additional medically accepted indication. 

What Is Ozempic?

Ozempic is a one-dose-a-week injectable drug with the active ingr🐈edient semaglutide. Like other new anti-obesity medications (AOMs), Ozempic belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) agonists. Drug companies created GLP-1 agonists to treat diabetes.

Along with diet and exercise, Ozempic can improve blood sugar levels in adults with type 2 🎀diabetes. Ozempic can help adults with type 2 diabetes and known heart disease decrease risks of major cardiovascular issues, including strok♊e, heart attack, or death.

Studies show Ozempic also can lead to an average weight loss of up to 14 pounds among adults with type 2 diabetes. However, while Ozempic might help someone shed weight, even the manufacturer, Novo Nordisk, explains that it is not a weight-loss drug.

The U.S. Food and Drug Administration (FDA) approved Ozempic for lowering blood sugar and reducing heart attack risk fo⛎r type 2 diabetics.

Medicare Coverage for Ozempic

Many Part D and 澳洲幸运5开奖号码历史查询:Medicare Advantage plans cover Ozempic for people with type 2 diabetes or other ꦕmedically necessary reasons. Weight loss alone is not one of tho💛se reasons.

Demonstrating Ozempic's popularity, Medicare Part D spent $4.6 billion (before rebates) on the drug in 2022. That’s up from $2.6 billion in 2021.

澳洲幸运5开奖号码历史查询:Other parts of Original Medicare may cover Ozempic in some si꧑tuations. Part B might cover an Ozempic injection administered to a type 2 diabetes patient at a doctor’s office. Meanwhile, Medicare Part A might cover an Ozempic injection given to a type 2 diabetes patient at a hospital or skilled nursing facility.

Why Doesn’t Medicare Cover Weight Loss?

Medicare does cover some weight-loss treatments, including bariatric su♌rgery and behavioral co🍸unseling. However, a federal law that became effective in 2006 prohibits Medicare Part D from covering anti-obesity medications. The law was passed due to concerns over the safety of earlier weight-loss drugs.

A 澳洲幸运5开奖号码历史查询:Medicare Part D plan can’t cover any AOM for weight loss alone. In March 2024, the Centers for Medicare and Medicaid Services explained Medicare’s position. 

In esse﷽nce, anti-obesity medications with FDA approval for an additional medically accepted indication (beyond just weight loss) can be covere𝄹d under Medicare Part D. Part D sponsors can add the drug to their formulary, even mid-year. 

Examples of additional indications include treatment of diabetes or reducing the risk of major cardiovascular events such as heart attack deaths or non-fatal strokes if someone is obese, overweight, or has establish🌌ed car🥀diovascular disease.  

How to Get Medicare Coverage for Ozempic

Medicare Part D plans cover GLP-1 agonists for type 2 diabetes, including Ozempic. To potentially obtain Medicare drug coverage for Ozempic, follow these steps.

1. Research Part D plans. Ensure Ozempic is listed in the formulary (covered drug list) of a Part D or Medicaid with Part D coverage. Each plan’s monthly premiums, coverage, and 澳洲幸运5开奖号码历史查询:out-of-pocket drug costs may vary.
2. Ensure you qualify for Ozempic. Speak with your care provider about the chances of Medicare covering your prescription for Ozempic. Ask if the medication is contraindicated by any other medical conditions you may have.
3. Ensure you qualify for Medicare. To join Medicare Part D, Medicare Advantage, or another Medicare plan with drug coverage, you must be a U.S. citizen or “lawfully present” in the United States. 
4. Enroll in Original Medicare with Part D coverage or Medicare Advantage through the .
5. Ask your provider to prescribe the drug. They must do so for one of the specific conditions Medicare requires to qualify for coverage. 

Similar Drugs Covered by Medicare

Ozempic manufacturer Novo Nordisk also makes Wegovy, which is administered by self-injection but with a higher dosage. In March 2024, the FDA approved Wegovy to reduce the risk of cardiovascular death, heart attack, and st🎀roke in adults with cardiovascular disease and who are diagnosed as either overweight or obese. 

In combination with the March 2024 CMS guidance, Medicare Part D can cover Wegovy to decrease cardiovascular risks in eligible patients. It also covers Rybelsus,⛄ 𝓀which delivers semaglutide in tablet form. 

Medicare also generally covers Mounjaro, another prescript🐬ion drug that lowers blood sugar levels in people with type 2 diabetes with the active ingredient of tirzepat♛ide.

Mounjaro’s manufacturer, Eli Lilly, also makes Zepbound. In November 2023, the FDA approved Zepbound, another injectable drug containing tirzepatide. Currently, approval is for weight loss only, so Medicare doesn’t cover Zepbound. However, based on recent studies, Eli Lilly is 澳洲幸运5开奖号码历史查询:seeking Zepbound’s FDA approval to treat apnea as well. 

Frequently Asked Questions (FAQs)

The Bottom Line

Medicare typically covers Ozempic for treatment of type 2 diabetes, but not as a way to lose weight. So, before you set your heart on incorporating Ozempic into your medical routine, check with your Medicare and Pa🔯rt D provider to ensure coverage. Otherwise꧅, you could pay $1,000 monthly or more out of pocket.