Does Medicare cover Ozempic?

Does Medicare Part D cover Ozempic for type 2 diabetes?

Medicare drug coverage (Part D) might cover Ozempic for type 2 diabetes, depending on your plan. Ozempic (semaglutide) injection is a glucagon-like peptide-1 (GLP-1) receptor agonist. The FDA prescribing information says Ozempic is indicated:

• Along with diet and exercise, to improve blood sugar (glycemic) control in adults with type 2 diabetes.
• To reduce the risk of major cardiovascular events in adults with type 2 diabetes and established cardiovascular disease.
• To reduce the risk of a sustained decline in kidney function (eGFR), end-stage kidney disease and cardiovascular death in adults with type 2 diabetes and chronic kidney disease.

How do I know whether my Medicare drug plan covers Ozempic?

Check your plan's drug list (formulary). All Medicare drug plans must cover a wide range of prescription drugs, but each plan has its own formulary. Each drug list includes at least 2 drugs in the most commonly prescribed categories and classes, and plans can choose which drugs they'll offer.

If you have type 2 diabetes, Medicare.gov says your Part D plan might cover your GLP-1 drug, and Medicare's GLP-1 Bridge fact sheet says to contact your Medicare drug plan, which may already cover a GLP-1 drug for you. Plans may use prior authorization, including when they only cover a drug for certain medical conditions but not others, and they may also use step therapy and quantity limits.

Does Medicare cover Ozempic for weight loss?

Not through Part D. CMS's Part D rules exclude drugs when they're used for weight loss, even for a non-cosmetic purpose like morbid obesity.

Starting July 1, 2026, Medicare covers certain GLP-1 drugs through the temporary Medicare GLP-1 Bridge program: Foundayo (tablet), Wegovy (injection or tablet) and Zepbound (KwikPen only). Ozempic isn't on that list. MedlinePlus, from the National Library of Medicine, lists Ozempic and Wegovy as brand names of semaglutide injection. See who qualifies for the GLP-1 Bridge.

Can I use the Medicare GLP-1 Bridge if I take Ozempic?

Not if your Medicare drug plan already pays for your GLP-1 drug or you have type 2 diabetes. Medicare.gov says you aren't eligible for the Bridge if you already get GLP-1 drugs covered through your Medicare Part D plan, or if you have type 2 diabetes, moderate-to-severe sleep apnea or fatty liver disease, though your Part D plan might cover your GLP-1s.

Medicare's GLP-1 Bridge fact sheet says that if you've been using a GLP-1 drug paid for by your Medicare drug plan for any reason, you need to keep getting your GLP-1 drug through your plan. The fact sheet defines GLP-1 drugs as products with the active ingredients semaglutide, tirzepatide, orforglipron, dulaglutide and liraglutide.

What do I pay for Ozempic with Medicare drug coverage?

What you pay depends on your Medicare drug plan: its monthly premium, its deductible, and the copayment or coinsurance for the tier the plan puts Ozempic on. No Medicare drug plan may have a deductible more than $615 in 2026 ($700 in 2027), and some plans have no deductible.

Generally, after the deductible you pay 25% of the cost as coinsurance for generic and brand-name drugs until your out-of-pocket spending on covered Part D drugs reaches $2,100 in 2026 ($2,400 in 2027). After that, you won't have to pay out of pocket for covered Part D drugs for the rest of the calendar year. The Medicare Prescription Payment Plan can spread your out-of-pocket drug costs across the calendar year, but it doesn't save you money or lower your drug costs.

What does Medicare's negotiated price mean for Ozempic?

Ozempic, together with Rybelsus and Wegovy, is one of 15 Part D drugs whose Medicare negotiated prices take effect January 1, 2027. CMS says Medicare drug plans, including standalone Part D plans and Medicare Advantage plans with drug coverage, must include on their formularies the selected drugs that have a negotiated price, and the drug company must make the negotiated price available to eligible people and to the pharmacies that dispense the drug.

Medicare.gov says to contact your plan for details on how negotiated prices might affect you. See which drugs have Medicare negotiated prices.