Used to treat Type 2 diabetes, the GLP-1 receptor agonist, commonly known as Ozempic, helps control blood sugar levels and reduces cardiovascular risk in people with Type 2 diabetes. While navigating Medicare coverage can be nuanced, here are the main points regarding Ozempic coverage:
Medicare Part A and Part B do not cover Ozempic as it is considered a tier-three prescription.
Some Medicare Advantage (Medicare Part C) and Medicare Part D plans cover Ozempic when prescribed for diabetes, but not for weight loss alone. However, new guidelines from the Centers for Medicare and Medicaid Services (CMS) allow Medicare Part D to cover Wegovy, a higher-dose version of Ozempic, for those with heart disease and obesity.
Medicare does not currently cover medications specifically for weight loss, but proposed legislation, the Treat and Reduce Obesity Act, may change this. The article advises Medicare beneficiaries to check their plan's formulary to confirm whether Ozempic is covered. Costs vary depending on the plan and coverage stage, but the Inflation Reduction Act caps annual out-of-pocket prescription costs. Medicare beneficiaries can also reduce medication costs by contacting drug manufacturers for coupons or exploring patient assistance programs.
To find out if you qualify to be treated with Ozempic or other semaglutide medications, contact our office today.
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