Does Medicare Cover Rybelsus?
Like Wegovy and Ozempic, Rybelsus is a medication that doctors prescribe to treat diabetic symptoms. While doctors may also recommend Rybelsus for weight-loss, it’s only FDA approved to treat the symptoms of diabetes.
90-95% of Medicare prescription plans cover Rybelsus, but only for the treatment of diabetes. Medicare won’t cover Rybelsus (or any medication) if you need it for weight loss or management.
Key takeaways:
Most Medicare drug plans cover Rybelsus for diabetes treatment.
Medicare won’t pay for Rybelsus if you need it for losing weight.
With Medicare coverage, you’ll typically pay between $26 to $32 for a 30-day supply of Rybelsus. If you qualify for Extra Help, you’ll pay about $10 for a 30-day supply.
What is Rybelsus?
Rybelus belongs to a class of medications called GLP-1. These medications contain the active ingredient semaglutide, which helps people with diabetes regulate blood sugar levels.
Rybelsus is a brand name drug, and there is no generic version of this prescription. This means that it tends to be more expensive than other drugs. We’ll talk about the average cost of Rybelsus with and without Medicare later on in this article.
What else is Rybelsus used for?
In some cases, healthcare providers can recommend Rybelsus for weight loss. The ingredient semaglutide slows the process of your stomach emptying, which helps with appetite control. However, it’s unlikely that insurance will pay for Rybelsus for this purpose.
Does Medicare cover Rybelsus?
Medicare covers most diabetes medications and supplies, including Rybelsus. However, the important note here is that Medicare will only cover Rybelsus if your doctor prescribes it for diabetes treatment. Otherwise, you’ll have to pay for the drug yourself, which could be costly.
Does Medicare cover Rybelsus for weight loss?
Medicare doesn’t cover Rybelsus or any drug for weight loss. That’s because Medicare considers weight loss medications to be cosmetic treatments. Given the serious consequences of obesity (like heart disease and diabetes), Medicare does have coverage for other obesity-related treatments, like:
Obesity screenings and counseling
However, you must meet certain eligibility requirements to receive coverage for these services. Usually, Medicare covers obesity-related services if you have a certain BMI, you have diabetes, and/or other weight loss strategies have not worked in the past. Qualifications depend on the
How much does Rybelsus cost with and without Medicare?
Rybelsus is pretty expensive if you have to pay for the full cost. This isn’t out of the ordinary, though. Most diabetes medications are in the ballpark of how much Rybelsus costs—between $1,100 to $1,240 for 30 tablets.
If you have Medicare Part D, it’s highly likely that your plan covers Rybelsus. Individual out-of-pocket costs vary, but people on Medicare typically pay a copay of $26 to $32. If you qualify for Extra Help, Rybelsus may be around $10.32 for a 30 day supply. Be sure to check your drug plan to understand your specific costs.
Medicare and diabetes coverage
Medicare has comprehensive coverage for diabetes medications, supplies, and doctor visits. If you have diabetes, your plan helps pay for:
Screenings and counseling
Supplies like glucose monitors, lancets, and test strips
Insulin and insulin pumps
Therapeutic shoes and inserts
Diabetes medications
Make sure you take advantage of everything your plan has to offer for diabetes treatment. Chapter Medicare Advisors are only a phone call away if you need help or have questions about any aspect of your plan. Call us at 855-900-2427 or schedule a time to chat to get answers today.