How much is Ozempic with insurance and without?

Ozempic (semaglutide) is an injectable medication approved by the U.S. Food and Drug Administration (FDA) to lower blood sugar and A1C in adults with type 2 diabetes. It can also lower the risk of heart attack or stroke in these patients if they have cardiovascular disease as well. 

Ozempic’s retail price is a hefty $1,029 per month, but costs with insurance vary. In this article, we cover everything you need to know about how much Ozempic is with insurance and without. 

To get Ozempic, schedule an appointment with your healthcare provider. Find a provider on Klarity today and have an appointment in as little as 24 hours. 

How much is Ozempic with insurance?

To get insurance coverage for Ozempic, you need a prescription. Marketplace services like Klarity can connect you with a licensed healthcare provider. Your provider can prescribe Ozempic for weight loss if you’re an adult with type 2 diabetes and they believe you’ll benefit from its effects. Ozempic can be used off-label for weight loss but weight loss is not what the FDA approved it for. Insurance companies typically don’t cover Ozempic when prescribed for weight loss alone. 

Understanding insurance drug coverage

Whether insurance covers Ozempic depends on your plan and medical condition. Health insurance plans generally cover Ozempic when it’s prescribed to control blood sugar levels and lower A1C in people with type 2 diabetes. But, they may not cover it for off-label weight loss use for people without type 2 diabetes. In fact, only 22% of employer-sponsored plans cover weight loss drugs, according to data from The International Foundation of Employee Benefit Plans (IFEBP).

If your plan covers Ozempic, your out-of-pocket costs are based on your drug copay. Your copay amount depends on the formulary (list of covered prescription drugs) and tier that your insurance company puts Ozempic in. Prescription drugs are divided into tiers based on cost and usage. Each tier has a defined copay and higher tiers are typically more expensive. With a retail price more than $1,000 per month, it’s likely your insurance company places Ozempic in a higher tier. You may be eligible for additional savings to reduce your out-of-pocket costs — more on that later.

General cost of Ozempic with insurance plans

With insurance, Ozempic costs between $200 and $300 per month on average. But, your copay may be less than $10, depending on your plan. Ozempic’s manufacturer, Novo Nordisk, has an online tool to help you determine your costs with insurance. And you can call the customer service number on your insurance card for information specific to your plan. 

Navigating prior authorization

Insurance companies often require prior authorization before covering Ozempic. This is a process health insurers use to manage costs and ensure medications are prescribed appropriately. It requires your healthcare provider to submit paperwork proving the drug is medically necessary for you. 

Prior authorization requests may be denied for many reasons. You or your provider have the right to appeal an insurance denial for weight loss medication. Reach out to your provider for help navigating prior authorization for Ozempic.

How to lower your Ozempic cost with insurance

You may be eligible for savings on Ozempic if you have insurance. Some of the best ways to save are included here.

Ozempic Savings Card

Novo Nordisk offers a Savings Card that lets eligible customers get Ozempic for $25 a month. You have to be covered by a qualifying health insurance program to be eligible. Your actual cost depends on your drug copay. The following maximum savings limits apply:

• $150 per 1-month supply
• $300 per 2-month supply 
• $450 per 3-month supply

So, if your copay for Ozempic is $300 for a one-month supply, you can save $150 on your prescription. This means you’re still responsible for $150 of your copay after the Savings Card is applied.

Discounts and coupons

Discount cards and coupons can help you save on Ozempic, especially if your copay is higher than the coupon price. Download free coupons from websites like GoodRx, SingleCareRx, drugs.com, or Optum Perks and present them to your pharmacy for savings. Some pharmacies are already tied into GoodRx and other websites. You can ask them if they have any available discounts rather than printing a coupon yourself.

FSAs and HSAs

If you have a flexible spending account (FSA) or health savings account (HSA), you might be able to use it to help cover the cost of Ozempic. You may need your healthcare provider to submit a letter of medical necessity to your account’s administrator to determine if you’re eligible to use your FSA or HSA or cover Ozempic’s cost. 

Medicare help programs

Medicare recipients with limited income may qualify for savings on Ozempic if it’s prescribed for type 2 diabetes. The Medicare Part D Extra Help Program helps cover deductibles and copays for prescription drugs. You can apply for the Extra Help program online. With Extra Help, you’re responsible for up to $11.20 for each brand name drug you use, including Ozempic.

How much is Ozempic without insurance?

The retail cost of Ozempic is around $1,029 per month without insurance according to drugs.com. Your cost depends on the pharmacy you choose. Websites like SingleCareRx, Optum Perks, and NeedyMeds can help you find the lowest prices among pharmacies in your area. These websites also provide coupons and discount cards for Ozempic to be used at your pharmacy of choice.

How you might get Ozempic for free

You might be able to get Ozempic for free with the Novo Nordisk Patient Assistance Program. It provides medication at no cost to patients who qualify. Eligibility requirements include that you: 

• Be a U.S. citizen or legal resident
• Have a total household income at or below 400% of the federal poverty level
• Have medicare or no health insurance
• Not be enrolled in or qualified for any other government program, such as Medicaid or a veteran using VA health care benefits
• Have a prescription for a medication manufactured by Novo Nordisk

Key takeaway

Ozempic (semaglutide) is a prescription drug FDA-approved to lower blood sugar and A1C in adults with type 2 diabetes. It can also be used off-label as a weight loss injection. 

Health insurance doesn’t always cover Ozempic for weight loss alone. You likely need to have type 2 diabetes as well as obesity or overweight to get coverage for it. If your plan does cover it, your copay could be less than $10 per month or more than $200. You may be able to lower Ozempic’s cost with insurance using the Ozempic Savings Card or other discount programs.  

Without insurance, you’re responsible for paying Ozempic’s hefty retail cost. Available coupons and discount cards let you save on your prescription. And, if you meet the eligibility requirements for the Novo Nordisk Patient Assistance Program, you might be able to get Ozempic for free whether you use it to help control blood sugar if you have type 2 diabetes or for weight loss or both. 

If you’re concerned about paying for Ozempic, reach out to your healthcare provider. They can help you navigate insurance coverage, assistance programs, and alternate medications. 

Get a prescription for Ozempic in as little as 24 hours

On Klarity, find a licensed healthcare provider who specializes in weight management. Your provider can write you a prescription for Ozempic or another medication if you need it. Find a provider on Klarity today.  

Sources

Drugs.com, Ozempic Prices, Coupons, and Patient Assistance Programs, https://www.drugs.com/price-guide/ozempic 

International Foundation of Employee Benefit Plans, Employers Covering Prescription Drugs for Weight Loss, Anne Patterson, Mar 2023, https://blog.ifebp.org/employers-covering-prescription-drugs-for-weight-loss/

Medicare.gov, Help with drug costs, https://www.medicare.gov/basics/costs/help/drug-costs

NeedyMeds, Drug Pricing Calculator, https://www.needymeds.org/drug-price-calculator#google_vignette

NovoCare, Diabetes Savings Offer Program, https://www.novocare.com/eligibility/diabetes-savings-card.html?_ga=2.197658413.30006016.1713452198-2091635243.1713452198

NovoCare, Find out if your insurance covers Ozempic, https://www.novocare.com/diabetes/products/ozempic/check-coverage.html

NovoCare, Patient Assistance Program, https://www.novocare.com/diabetes/help-with-costs/pap.html

NovoMedLink, Diabetes, Ozempic Dosing and Administration, https://www.novomedlink.com/diabetes/products/treatments/ozempic/dosing-administration/dosing-and-prescribing.html

Ozempic, Ozempic Savings Card, https://www.ozempic.com/savings-and-resources/save-on-ozempic.html

U.S. Social Security Administration, Apply for Medicare Part D Extra Help Program, https://www.ssa.gov/medicare/part-d-extra-help

The information provided in this article is for educational purposes only and should not be construed as medical advice. Always seek the guidance of a qualified healthcare professional with any questions or concerns you have regarding your health.

How we reviewed this article: This article goes through rigorous fact-checking by a team of medical reviewers. Reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the author.