Does Medicare Cover Ozempic?
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Medicare doesn’t cover any drug for weight loss alone.
Medicare Part D covers Ozempic to treat diabetes, but not as a weight loss treatment.
Similarly, Medicare covers Wegovy as a treatment to reduce the risk of certain serious cardiovascular events, but not for weight loss.
Medicare doesn’t cover Ozempic for weight loss, but it does cover it for diabetes treatment. In fact, Medicare can’t cover Ozempic, Wegovy, Zepbound, Mounjaro or any prescription drugs for weight loss. And because of legal barriers and cost, that might not change any time soon.
Here’s what to know about Medicare coverage of Ozempic and other weight loss drugs.
What is Ozempic?
Ozempic is a brand name for semaglutide, a prescription medication manufactured and sold by Novo Nordisk. As an injection, it can help control blood sugar in people with Type 2 diabetes.
The Food and Drug Administration approved Ozempic to treat Type 2 diabetes in December 2017. Currently, there isn't a generic version of the drug, and there might not be for some time — Novo Nordisk’s Ozempic patents expire as late as December 2031, according to data from the FDA.
Ozempic has gone viral for another purpose: weight loss. More people searched Google for Ozempic than for ibuprofen, insulin or Viagra in 2023, according to Google Trends data.
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Medicare covers Ozempic for Type 2 diabetes
Medicare prescription drug plans might cover Ozempic, but only to treat diabetes.
In 2022, Medicare covered Ozempic for about 780,000 Medicare beneficiaries, according to data from the Centers for Medicare & Medicaid Services (CMS).
Medicare spent over $4.6 billion to cover Ozempic in 2022, making it No. 6 for the highest total Medicare Part D spending, according to CMS data.
Because it’s an outpatient prescription drug, Ozempic falls under Medicare Part D. Coverage for Ozempic differs between plans.
If you have Original Medicare, you can buy a stand-alone Medicare Part D plan to get prescription drug coverage. If you have Medicare Advantage, most plans include prescription drug coverage. With Medicare Advantage, you cannot buy a separate Part D plan.
You’ll need to check your plan’s formulary to confirm if and how the plan covers Ozempic.
Will Medicare pay for Ozempic for weight loss?
No. Unless you have another source of coverage in addition to your Medicare Part D or Medicare Advantage plan, you’d need to pay out of pocket for an Ozempic (semaglutide) prescription for weight loss. Medicare won’t pay for Ozempic as a prescription 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. 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.
Does Medicare cover Wegovy?
In June 2021, the FDA approved another semaglutide product for weight loss. Novo Nordisk sells semaglutide for weight loss under the brand name Wegovy.
But FDA approval doesn’t guarantee Medicare coverage. As with Ozempic, Medicare doesn’t cover Wegovy as a prescription for weight loss.
However, CMS indicated that Medicare Part D can cover anti-obesity medications like Wegovy to “reduce the risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction or non-fatal stroke) in adults with established cardiovascular disease and either obesity or overweight” in guidance issued in March 2024.
Does Medicare cover Mounjaro (or Zepbound)?
Mounjaro is the brand name for tirzepatide approved as a treatment for type 2 diabetes. And like Ozempic has Wegovy, Mounjaro has a more recently approved variant specifically for weight loss. That version of tirzepatide is branded Zepbound, and it was approved for weight loss in November 2023.
As with Ozempic and Wegovy, Medicare won’t cover Mounjaro or Zepbound for weight loss.
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What you’d pay out of pocket for Ozempic, Wegovy, Mounjaro or Zepbound
Novo Nordisk’s list price for Ozempic is $968.52 per four weekly doses. For a full year, that would be nearly $12,600.
The list price for Wegovy is $1,349.02 per four weekly doses. For a full year, that would be slightly more than $17,500.
Mounjaro and Zepbound have nearly identical list prices: $1,069.08 and $1,059.87 per four weekly doses, respectively. For a full year, that would be a little less than $14,000.
Because Ozempic, Wegovy, Mounjaro and Zepbound are still under patent protection, there’s no option to buy a cheaper generic version.
Is there a weight loss drug covered by Medicare?
By law, Medicare can’t cover any drug for the purpose of weight loss alone. However, if a drug that can help with weight loss is prescribed for certain other purposes, such as certain treatments for diabetes or cardiovascular disease, Medicare plans might cover it.
June 27, 2024
Treat and Reduce Obesity Act of 2023 passes committee
The Treat and Reduce Obesity Act, which would enable Medicare to cover weight loss drugs such as Ozempic, had its first ever congressional committee hearing and vote in June. The bill was introduced in six prior congressional sessions, but didn’t get a hearing or vote.
The House Committee on Ways and Means voted to amend the bill and send it on for consideration by the full House of Representatives. To become law, the bill would need to pass both the House and Senate and be signed by the president.
Covering weight loss drugs would be costly for Medicare
Policy change would be required for Medicare to start covering weight loss drugs. Legislation to allow coverage has been introduced in each of the past seven congressional terms but never passed.
The high costs of weight loss drugs might be one barrier to change. For example, if 10% of Medicare beneficiaries with obesity took Wegovy, it would cost Medicare Part D about $26.8 billion per year, according to estimates published by researchers at the Vanderbilt University School of Medicine and the University of Chicago Department of Medicine in the New England Journal of Medicine in March 2023.
For reference, the prescription drug with the highest total Medicare Part D spending is Eliquis, an anti-stroke drug. Total Medicare Part D spending for Eliquis was over $15 billion in 2022, according to the most recent annual data available from CMS.
The estimated $26.8 billion to cover Wegovy would be significantly more than that amount, or about one-ninth of the approximately $240 billion spent for all covered Medicare Part D drugs in 2022.
What Medicare covers
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