Medicare covers Ozempic, but your out-of-pocket cost depends on which part of Medicare you use and which pharmacy you choose

If you have Original Medicare (Parts A and B) and a prescription drug plan (Part D), Ozempic is a covered medication on most formularies. Your cost will be a copay or coinsurance amount set by your specific Part D plan — typically $35 to $250 per month, though some plans charge more. If you have Medicare Advantage (Part C), your drug coverage is built in, and costs vary by plan but often fall in the same range. The exact amount you pay depends on three things: which Medicare plan you're in, which pharmacy you use, and whether the dose you need is on your plan's preferred drug list.

Without any Medicare coverage, a month's supply of Ozempic costs $900 to $1,100 at most U.S. pharmacies. Medicare Part D plans negotiate lower prices with manufacturers, which is why your copay is much lower than the retail price. However, you may hit your plan's deductible first, meaning you pay the full pharmacy price until you've spent a certain amount out of pocket.

Key Takeaways

  • Most Medicare Part D plans cover Ozempic with a copay between $35 and $250 per month, depending on your specific plan and the dose you use.
  • Your Part D deductible (usually $505 to $550 in 2024, but varies by plan) must be met before copay amounts explore, so you may pay full price initially.
  • Medicare Advantage plans include drug coverage, and your Ozempic cost is set by that plan's formulary, not by a separate Part D plan.
  • Switching pharmacies or using a mail-order service can change your copay, so comparing prices across your plan's network is worth doing before filling.
  • If your plan doesn't cover Ozempic or charges a very high copay, you can request a coverage review or switch plans during the annual enrollment period.

How Part D deductibles affect what you pay upfront

Before your copay kicks in, you must meet your Part D plan's deductible. In 2024, deductibles range from $0 to $550 depending on which plan you choose — some plans have no deductible at all. Until you've paid that amount out of pocket, you pay the full pharmacy price for Ozempic, which is roughly $900 to $1,100 per month.

Once you've met the deductible, your copay or coinsurance applies. Coinsurance means you pay a percentage of the drug's cost (often 25 percent) rather than a flat copay. For Ozempic, most plans use a flat copay structure, but check your plan's formulary to be sure. If you fill your prescription early in the year, you may hit the deductible quickly; if you start later, you might not meet it until fall.

Copay amounts vary by plan and pharmacy

Your Part D plan's formulary lists which drugs are covered and at what tier. Ozempic is usually on Tier 3 or Tier 4 (specialty tiers), which means higher copays than common drugs like metformin. A Tier 3 copay might be $50 to $100; a Tier 4 copay might be $150 to $250. Some plans place Ozempic on Tier 2, which would lower your copay to $15 to $50.

The same plan may charge different copays at different pharmacies. A large chain pharmacy might charge $75, while a mail-order service through the same plan charges $60. Call your plan's customer service line (on the back of your Medicare card) and ask for the copay at your preferred pharmacy, or use the plan's website to compare prices before you fill. If the copay is high, ask your doctor whether a generic alternative like semaglutide (the active ingredient in Ozempic) is available through your plan at a lower tier.

Medicare Advantage plans include drug coverage

If you have Medicare Advantage instead of Original Medicare, your drug coverage is included in your plan's monthly premium. You don't buy a separate Part D plan. Your Ozempic copay is set by your Advantage plan's formulary, and it works the same way as Part D — you meet a deductible first, then pay a copay or coinsurance.

Medicare Advantage plans often have lower monthly premiums than Original Medicare plus Part D, but they may charge higher copays for specialty drugs like Ozempic. Some Advantage plans also require prior authorization, meaning your doctor must get approval from the plan before the pharmacy will fill the prescription. If your current Advantage plan charges a very high copay for Ozempic, you can switch to a different Advantage plan or to Original Medicare with Part D during the annual enrollment period (October 15 to December 7 each year).

What to do if your plan doesn't cover Ozempic or charges too much

If Ozempic is not on your plan's formulary at all, or if it's on a tier with an unaffordable copay, you have options. First, ask your doctor to request a coverage review (called a formulary exception or prior authorization). The doctor submits a letter explaining why Ozempic is medically necessary for you, and the plan reviews it. If approved, the plan may cover the drug or move it to a lower tier.

Second, you can switch to a different Part D plan during the annual enrollment period. Compare the formularies of plans available in your area — some may cover Ozempic at a lower copay. You can view and compare plans on Medicare.gov or call 1-800-MEDICARE to speak with a representative who can help you find a plan that covers Ozempic affordably.

Third, ask your doctor whether a generic semaglutide product is available. Some plans cover generic semaglutide at a lower tier than brand-name Ozempic. The medication is the same, but the copay may be significantly lower.

Manufacturer discounts and patient information programs

Novo Nordisk, the manufacturer of Ozempic, offers a patient information program for people with Medicare who meet income limits. The program may reduce your copay to as low as $25 per month, regardless of your plan's copay. To check whether you may have access to, visit the Novo Nordisk website or call 1-844-NOVO-777.

Some pharmacies also offer discount programs that work alongside Medicare. GoodRx, SingleCare, and similar services sometimes offer lower prices than your Medicare copay, though this is rare for specialty drugs. Always compare your Medicare copay to any discount card price before you fill — use whichever is lower. Your pharmacy can run both prices at the register.

Costs after you reach the coverage gap

Medicare Part D has a coverage gap (sometimes called the "donut hole") that applies once you and your plan have spent a combined $5,030 on covered drugs in 2024. Once you enter the gap, you pay 25 percent of the drug's cost until your out-of-pocket spending reaches $7,769. After that, catastrophic coverage kicks in and you pay only 5 percent.

For Ozempic, this means your copay structure changes mid-year if you reach the gap. Most people taking Ozempic for diabetes or weight loss will hit the gap by late fall. Your plan will notify you when you enter it, and your copay will increase. Some plans offer gap coverage that reduces or eliminates this increase — check your plan documents or call customer service to see whether yours does.

Frequently Asked Questions

Does Medicare cover Ozempic for weight loss?

Medicare Part D covers Ozempic only when prescribed for type 2 diabetes, not for weight loss alone. If your doctor prescribes it off-label for weight loss, Medicare will not cover it. Some Medicare Advantage plans may have different rules, so check with your plan directly. Wegovy, which is the same medication marketed for weight loss, is also not covered by Medicare.

What if I can't afford my copay even with Medicare?

Contact Novo Nordisk's patient information program at 1-844-NOVO-777 to see if you may have access to for a copay reduction. Ask your doctor's office whether they have samples you can use while you wait for information approval. Some community health centers also offer medication at reduced cost based on income.

Can I use a GoodRx coupon instead of my Medicare copay?

You cannot use GoodRx or similar discount cards at the same time as Medicare — you must choose one or the other. Compare the GoodRx price to your Medicare copay and use whichever is lower. Your pharmacy can show you both prices before you decide.

Will my copay change if I switch from Original Medicare to Medicare Advantage?

Yes, it likely will. Each Medicare Advantage plan sets its own copays and formularies. Before you switch, check the formulary of the Advantage plan you're considering to see what the Ozempic copay would be. You can compare plans on Medicare.gov or call 1-800-MEDICARE for help.

What happens to my Ozempic coverage if I move to a different state?

Your current Part D plan may not be available in your new state. You will need to choose a new plan that is offered where you're moving. Contact your current plan to confirm coverage ends on your move date, then enroll in a new plan in your new state. You can do this outside the annual enrollment period if you're moving.