Ozempic is covered by most Medicare and insurance plans (source: MMIT). If you have a Medicare Part D or Medicare Advantage plan, about 85% will cover this medication.
Because it's an outpatient prescription drug, Ozempic falls under Medicare Part D. Original Medicare (Part A and/or Part B) won't cover it. Ozempic is No. 10 for the highest total Medicare Part D spending in 2021, according to data from the Centers for Medicare & Medicaid Services (CMS).
Medicare doesn't cover Ozempic (or Wegovy) for weight loss
Over 40% of U.S. adults age 60 and older are considered obese, according to 2017-2020 data from the Centers for Disease Control and Prevention. Despite the prevalence of obesity among older adults, Medicare won't cover weight loss drugs, including Wegovy.
If you have private or commercial insurance, such as insurance you receive through an employer, you may be eligible to pay as little as $25 for a 1-, 2-, or 3-month prescription (maximum savings of $150 per 1-month prescription, $300 per 2-month prescription, or $450 per 3-month prescription).
Following the DA communication, health professionals have now been asked to prescribe and dispense Ozempic for only those adults living with type 2 diabetes.
How to Get Ozempic in Australia. Ozempic is a highly sought after drug for managing diabetes and weight management, but it is important to know that it is prescription only. In Australia, this means you will need to speak with your doctor and have a prescription written up before you can start taking Ozempic.
Ozempic® is a prescription medication. Novo Nordisk provides patient assistance for those who qualify. Please call 1-866-310-7549 to learn more about Novo Nordisk assistance programs.
On the PBS, Ozempic costs Australians about $42 a month (four weekly injections). On a private prescription, the cost is about $132 a month. According to the medical news website WebMD, Ozempic can cost uninsured Americans more than a $US1000 a month and many flock to Canada to save $US700 a month.
People with private insurance will ultimately get Ozempic at a cheaper price. This could be as low as $25 for a month for a 1-, 2-, or 3-month supply, Oronsaye said. If paying out of pocket, you might be able to get it cheaper if your pharmacy takes discount cards, such as GoodRx.
Saxenda is an approved weight loss medication, and is readily available in Australia. Cost is approximately $387 a month. The knock on effect from the Ozempic shortage, is that Trulicity which is manufactured by Ely-Lilly is now in short supply.
It's one of the prescription drugs on which Medicare, the federal health care program for people age 65 and older and for younger people with certain disabilities, spends the most money each year. But Medicare doesn't cover Ozempic for weight loss — only for diabetes.
Medicare covers Ozempic for Type 2 diabetes
Because it's an outpatient prescription drug, Ozempic falls under Medicare Part D. Original Medicare (Part A and/or Part B) won't cover it.
Overseas-registered Ozempic is available
While the Australian-registered Ozempic is subsidised on the Pharmaceutical Benefits Scheme (PBS), the overseas-registered products currently are not.
For many people with diabetes, Ozempic has controlled their blood sugar (and often also helped them lose weight) more effectively than other medications. Due to the shortage of Ozempic, Australian GPs have been advised against prescribing it to treat obesity.
If you qualify for insurance coverage, Ozempic can cost as little as $25 for a monthly supply. However, without insurance, Ozempic costs around $892.06 per month, on average (NovoCare-a, 2022).
There has been a global shortage of Ozempic since early 2022 because of an unexpected increase in consumer demand because of off-label use of the drug for weight loss.
Is Ozempic available for those without diabetes? Ozempic is only approved by the FDA for the treatment of type 2 diabetes. People who don't have diabetes may be able to take Ozempic “off-label” with a prescription from their doctor. “Off-label” means for use other than what is approved by the FDA.
So, on average, with the recommended starting Ozempic dose of 0.25 mg, a 500 to 1000 calorie reduced diet, and exercise 3 times a week, you can expect to lose 3-5 pounds in the first month of treatment, which works out to about 3% of body weight for most overweight or obese individuals.
“There's a warning here: You take this drug and you lose a lot of weight. But you need to stay on it for the rest of your life. Are you willing to do that? And if you get off of it, the chances are really good you're going to go right back to where you were,” Heymsfield told Verywell.
A person can stay on Ozempic® so long as they are tolerating the medication and it is deemed appropriate by their treating provider. There is no specific time frame when someone should stop taking Ozempic as it is a medication that is intended for chronic (long-term) use.
The Therapeutic Goods Administration (TGA) has advised that limited supplies of Ozempic have now arrived in Australia. It is expected that from late next week some pharmacies will have stock.
Possible Ozempic alternatives include Bydureon (exenatide), Victoza (liraglutide), Mounjaro (tirzepatide), Tanzeum (Albiglutide), and Trulicity (dulaglutide).
Ozempic isn't approved for weight loss. But because of how it works, some people taking Ozempic lose weight as a side effect. If you don't have diabetes, taking Ozempic for weight loss is considered an off-label use. Wegovy, a higher-dose version of Ozempic, is approved to help people manage their weight.
It is not a medication for people who do not have diabetes or are at risk of type 2 diabetes. A prescription for Ozempic should only be administered following an assessment by your healthcare team to make sure that you'll benefit from its use.