How to get Ozempic covered by insurance — what you need to know

Ozempic (semaglutide) is a popular injectable weight-loss medication. If you’re interested in trying it, or have been prescribed it, you may be wondering how to get Ozempic covered by insurance. In this article, we provide all you need to know about getting insurance to cover Ozempic. 

Interested in Ozempic or a similar medication? Talk to a licensed healthcare professional today. Find a provider on Klarity and have an appointment to get a prescription in as little as 24 hours.

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What is Ozempic?

Ozempic is a prescription medication U.S. Food and Drug Administration (FDA)-approved to improve blood sugar control in people with type 2 diabetes. It also reduces the risk of heart attack, stroke, death, and similar cardiovascular issues in patients with type 2 diabetes and known heart disease. 

People who take Ozempic notice weight loss as an added benefit. You can get Ozempic for weight loss if your healthcare provider thinks you’ll benefit from it, but this is an off-label use. 

Insurance coverage for Ozempic

If you have health insurance that covers Ozempic, you’ll likely pay less than the retail price for it (more on that later). To get insurance coverage, you need to qualify for Ozempic. 

Real users share how to get Ozempic covered by insurance

Ozempic reviewers provide helpful information when it comes to getting Ozempic covered by insurance, like that you likely need prior authorization. 

Reddit user Licelotonashi19 shares, “Today I finally got prescribed Ozempic…I can’t tell you how happy I was, until I received a message from my pharmacist informing me about the insurance requiring prior authorization.”

Likewise, user Korovaplus11 says, “I’m waiting on pre-authorization […]. I called [my insurance company] and gave them the national drug code so they could tell me if it’s covered or not and they told me it can be…so I’m just waiting now.”  

So, what is prior authorization?

Prior authorization and how to get it for Ozempic

Prior authorization is a process health insurance companies use to make sure a prescribed medication or treatment is medically necessary. They also use it to lower their costs. It’s typically required for newer or more expensive medications, including Ozempic. 

You may need to meet certain Ozempic prior authorization criteria to get insurance coverage. Your healthcare provider will submit paperwork justifying your use of the medication. The paperwork shares information with your insurance company, such as your medical history, current medications, and treatments you’ve already tried. A reviewer then approves or denies the request based on medical necessity.

What to do if your prior authorization for Ozempic is denied

If your insurance company denies your prior authorization request, you or your healthcare provider can submit an appeal. To appeal a prior authorization denial for Ozempic, you first need to find out why you were denied. Your insurance company is required to share this information with you and your provider. They must also provide an opportunity for your provider to discuss the denial with the reviewer who made the decision.

Once you know why your prior authorization was denied, you and your provider can begin your appeal. You’re entitled to 3 levels of appeals. The first level involves a phone call to your insurance company asking for reconsideration. If that doesn’t work, you can move on to the second and third levels. These appeals involve review by medical professionals both internal and external to your insurance company.

If your request is denied at all 3 levels of appeals, you’ll have to pay for Ozempic without insurance. You can also talk to your provider about Ozempic vs Wegovy (its weight loss counterpart) or other Ozempic and Wegovy alternatives.

How to get Ozempic without insurance

Without insurance, Ozempic costs around $1,029 for a 1-month supply, according to drugs.com and with its discount card.

There are few ways to save on Ozempic with or without insurance. The manufacturer, Novo Nordisk, sponsors an Ozempic Savings Card program. If you’re eligible, you could get Ozempic for $25 a month, or at least discounted. Novo Nordisk also has a patient assistance program to help you get Ozempic for free if you qualify.

To save anywhere from 3 to 80% on Ozempic, download or print coupons from prescription discount sites, like GoodRx, SingleCareRx, Optum Perks, and drugs.com. Present them to a pharmacy that has Ozempic in stock for savings.

Key takeaway

Ozempic is a prescription medication that’s FDA-approved to improve blood sugar control in people with type 2 diabetes. Your healthcare provider can also prescribe Ozempic for weight loss off-label. 

To get Ozempic covered by insurance, you likely need prior authorization. Work with your healthcare provider to submit a request to your insurance company. If approved, you can get  Ozempic with insurance and only pay your drug copay. 

If prior authorization is denied, you or your healthcare provider can appeal. You’ll have to pay for Ozempic without insurance if your appeal is denied. It’s expensive, but there are ways to save. You can also consider alternatives, like Wegovy. 

Talk to a provider on Klarity about Ozempic

To get an Ozempic prescription and have it covered by insurance, work with a licensed healthcare provider who can help you navigate prior authorization. Find a provider on Klarity Health today and have an appointment in 24 hours or less.*

Sources

Academy of Managed Care Pharmacy, Prior Authorization, Jul. 2019, https://www.amcp.org/about/managed-care-pharmacy-101/concepts-managed-care-pharmacy/prior-authorization

Accreditation Council for Medical Affairs, What is Prior Authorization?, Amanda DeMarco, Dec. 2020, https://www.priorauthtraining.org/prior-authorization/

American Academy of Family Physicians, Precertification, Denials, and Appeals: Reducing the Hassles, Anthony N. Akosa, MD, MBA, Jun. 2006, https://www.aafp.org/pubs/fpm/issues/2006/0600/p45.html 

CoverMyMeds, 7 Common Prior Authorization Hurdles and How to Overcome Them, Miranda Delatore, MSN, RN, NEA-BC, Mar. 2022, https://insights.covermymeds.com/healthcare-technology/prior-authorization/common-prior-authorization-hurdles-and-how-to-overcome-them

DailyMed, Label: Ozempic- semaglutide injection solution, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=adec4fd2-6858-4c99-91d4-531f5f2a2d79

drugs.com, Ozempic Price Guide, https://www.drugs.com/price-guide/ozempic

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

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

Reddit, Ozempic, https://www.reddit.com/r/Ozempic/

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.