Medicare doesn't cover Ozempic (or Wegovy) for weight loss Medicare Part D plans are prohibited from covering drugs “used for anorexia, weight loss or weight gain (even if used for a non-cosmetic purpose (i.e., morbid obesity)),” according to the Medicare Prescription Drug Benefit Manual.
Medicare doesn't cover Ozempic (or Wegovy) for weight loss
That means unless you have another source of coverage, you'd need to pay out of pocket for a semaglutide prescription for weight loss, whether it's branded Ozempic or Wegovy.
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.
Ozempic is approved for diabetes management, but some doctors prescribe it to be used off-label (which is when a medication is used to treat a condition other than its FDA-approved criteria) for weight loss, too.
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.
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.
On the PBS, Ozempic costs Australians about $42 a month (four weekly injections). On a private prescription, the cost is about $132 a month.
Once you begin using Ozempic, some people can find it takes several weeks to see any weight loss, yet others may see some weight loss within a week or 2. While it can be difficult, try to remain patient — change looks different for everyone.
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).
How Long Can You Stay on Ozempic (semaglutide)? 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.
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.
Following the DA communication, health professionals have now been asked to prescribe and dispense Ozempic for only those adults living with type 2 diabetes.
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.
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).
More importantly, Medicare does not cover weight-loss drugs, and many Medicaid programs – run or overseen by state agencies – do not, either.
You might be a candidate for Ozempic if you meet these criteria: You have Type 2 diabetes. Your A1C level is uncontrolled with other interventions. You have cardiovascular disease or are at a high risk of developing cardiovascular disease.
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.
Mail order prescription services like CVS Caremark, OptumRX, or Express Scripts may provide Ozempic at lower prices. They can supply a 90-day supply versus 30 days at retail, which may reduce costs depending on your insurance. However, there are delays as medication is shipped to you.
Will Ozempic or Wegovy reduce belly fat? The answer appears to be yes. That Novo Nordisk-funded study of almost 2,000 overweight or obese adults without diabetes also found their visceral fat — the type that accumulates in the belly — was reduced from baseline with semaglutide, along with their total fat mass.
You've hit a plateau
It's normal to eventually hit a point where your weight loss slows down, especially if you're not working on keeping or building up your muscle mass. Losing muscle along with fat slows your metabolism and can slow down your weight loss.
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.
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.
'Ozempic stocks are available in Australia; however, there will be limited and intermittent availability until June 2023,' the statement reads.