Understand how Medicare covers Ozempic for weight loss and for diabetes

Ozempic is a drug that has sparked questions for people across the nation. While Ozempic is primarily used in treatment plans for people with diabetes, it's also commonly used as a weight loss drug. 

Medicare covers Ozempic for diabetes treatment but not for weight loss. Medicare actually does not cover any weight loss medications due to Medicare regulations, a focus on medically necessary treatments, and the limited effectiveness of existing weight loss drugs. 

Read on to learn more about how Medicare covers Ozempic for the treatment of type 2 diabetes.

Key Takeaways:

  • Medicare covers Ozempic for diabetes treatment but not for weight loss.

  • For weight loss treatment, Medicare covers obesity screenings and behavioral counseling for people with a BMI of 30 or more. 

What is Ozempic?

Ozempic is a type of semaglutide, which, when paired with a healthier diet and exercise, can improve blood sugar in adults with type 2 diabetes. It’s grown in popularity because it has also helped many people lose weight. That said, it’s important to note that Ozempic is not a weight loss drug.

Doctors often prescribe Ozempic as part of a more comprehensive plan for people with type 2 diabetes. It’s particularly helpful for those who haven't been able to control their blood sugar with other medications and lifestyle changes.

How does Ozempic work?

Ozempic is a semaglutide that controls blood sugar by mimicking the action of a natural hormone called GLP-1, which plays an important role in regulating blood sugar. 

In other words, Ozempic lowers blood sugar levels by helping to release insulin. It also reduces the amount of sugar produced by your liver. Lastly, Ozempic stabilizes blood sugar levels after eating by slowing your stomach as it empties.

Can I use Ozempic for weight loss?

As mentioned above, Ozempic has grown in popularity specifically because it has helped many people lose weight. The reason Ozempic has worked for some as a weight loss drug is because the regulation of blood sugar has an additional impact on appetite and food intake as an appetite suppressor.

Ozempic clearly states on its website that it is not a weight loss drug, and because this isn’t the intent of the drug, it won’t generally be covered by insurance if you do not have type 2 diabetes. 

Does Medicare cover Ozempic?

Medicare only covers Ozempic if the drug is used to treat diabetes. To reiterate, it will not cover the medication for weight loss. 

Medicare Part D Coverage

Ozempic is an outpatient prescription drug, so Medicare Part D would cover the diabetes medication. It’s a fairly popular drug for Medicare coverage—459,000 beneficiaries had Ozempic coverage in 2021. 

Part D plans vary from person to person. It’s important to check your formulary, a list of drugs that the plan covers, to see if your Medicare plan covers Ozempic. 

If you don’t have Medicare Part D (prescription drug) coverage, you can get one as a standalone policy with Original Medicare or bundled with a Medicare Advantage plan.

The Cost of Ozempic

When not covered by Medicare, the cost of Ozempic is pretty high. The list price for Ozempic is $935.77 for a month’s worth of weekly doses, which is $12,200 for a whole year!

Medicare and weight-loss coverage

Maintaining and losing weight after 60 can be challenging, and many find it difficult to find and stay on the right plan alone. Although Medicare does not pay for any medications for weight loss, Medicare does cover some preventive services related to weight loss. 

Medicare covers weight-loss counseling if you have a BMI of 30 or higher. These sessions include a screening and regular face-to-face meetings with a medical professional to set up plans and check-ins around diet and exercise. 

Medicare also covers some obesity-related surgical procedures including gastric bypass surgery and laparoscopic banding surgery. You must meet strict requirements around morbid obesity to get these surgeries covered.

Medicare and Ozempic

To sum it all up, Medicare helps with the cost of Ozempic if it's prescribed for treating diabetes, but not for weight loss. If you need Ozempic for diabetes, you should check your Medicare Part D coverage to see if it covers the drug. 

If you have questions or need help understanding your options, talk to one of our licensed Medicare Advisors for free, personalized advice about your unique health needs. Give us a call at (855) 900-2427 or schedule a consultation today to get started.

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