Yahoo Lifestyle Here's How Much Ozempic Actually Costs If You Have Insurance—And It Might Surprise You
If you are considering joining the 2 million people in the U.S. taking a prescription weight loss medication such as Ozempic or Wegovy, there’s a lot to consider. These medications are not meant to replace healthy diet and lifestyle habits; they are meant to work in conjunction with them and a prescription will likely mean making some major changes to your life. It’s also important to consider their cost, especially since prescription weight loss medications are meant to be taken indefinitely and not used for short-term weight loss.
To know how much Ozempic (or a similar medication) will cost you, it’s important to know if your medical insurance will cover it and, if so, what the remaining out-of-pocket cost will be. Here, doctors who prescribe Ozempic explain how much it costs with insurance as well as without it.
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When Will Medical Insurance Cover Ozempic or Similar Medications?
As you might imagine, whether or not Ozempic is covered by insurance varies greatly depending on one’s medical history, current health and insurance provider. Dr. Rami Lutfi, MD, a bariatric and general surgeon based in Chicago and the Medical Director for Bariatric and General Surgery with Carrum Health, says that medical insurance companies will not cover Ozempic unless someone has been diagnosed with a medical condition that it can treat. “In most instances, if you do not have a BMI of 30 or more or you do not have a diagnosis of Type 2 diabetes, then it will not be approved by your insurance company,” Dr. Lutfi says.
Even if you do have a medical diagnosis, Dr. Lutfi says that some insurance carriers will not cover Ozempic. “Medicare, for example, does not typically cover it except for very specific diagnoses, such as a history of heart attacks or strokes. Medicaid doesn't cover it. Private insurance coverage varies and is rather sporadic and confusing,” he says.
Related: Thinking About Trying Ozempic? Here's What You Can Expect Week by Week
Dr. Brynna Connor, MD, a family practice physician and healthcare ambassador at NorthWestPharmacy.com, says that even if you do obtain a diagnosis, it is not a guarantee that Ozempic will be covered by your insurance; it depends on your insurance provider. “Insurance would potentially not cover a prescription weight loss medication if the medication is not on that specific insured policy's formulary,” she adds, echoing Dr. Lutfi. Dr. Connor also specifies that Ozempic is not FDA-approved for weight loss, but another medication, Wegovy, which contains the same active ingredient (semaglutide) is FDA-approved for weight loss.
The best way to know if your insurance covers Ozempic (or a similar weight loss medication) is to call your insurance company and ask.
How Much Ozempic Costs With and Without Insurance
If your insurance company covers Ozempic or Wegovy, Dr. Connor says there may be no out-of-pocket cost to the patient. “With insurance, coverage for the cost of weight loss medication Wegovy can vary from quite literally zero dollars with some insurance plans to $1,500 as it simply depends on the coverage formulary specific to the patient,” she says.
Dr. Lutfi also says that the price of Ozempic and similar medications can vary greatly, even with insurance coverage. “[It] depends on each patient’s individualized coverage plan and their deductible and coinsurance for the year. It is sometimes covered entirely by insurance. Other scenarios require a deductible or a co-pay. There are also manufacturer coupons as well as coupons through the pharmacy that can help cover the cost,” he explained.
Related: What Happens When You Stop Taking Ozempic
If it’s not covered by insurance, Ozempic can be quite pricey. “Without insurance or manufacturer coupons, the out-of-pocket cost for Ozempic can be between $1,000 and $1,200,” Dr. Lutfi noted, adding that the out-of-pocket price of other prescription weight loss medications varies greatly: “Saxenda is the most expensive weight loss medication with a retail price of between $1,200 and $1,500.”
Dr. Lutfi points out that Wegovy and Mounjaro have been more expensive than Ozempic until very recently, when Eli Lilly (the company that makes them) began discounting the price of its vials. “Some insurance companies will cover one drug but not the other, which will also play into the cost comparison. Additionally, as the dose increases so does the price,” he said.
Since the price of Ozempic and Wegovy can be quite high, some people are seeking out compounded semaglutide, which is made by compounding pharmacies and not pharmaceutical manufacturers. Even though compounded semaglutide may be cheaper and easier to get, Dr. Lutfi warns against it because it is not FDA-approved.
Dr. Connor is similarly skeptical. “I highly recommend that patients find and insist on a very reputable pharmacy that meets all of the FDA guidelines for compounding sterile medications,” she advised. “I would suggest very strongly that patients do not purchase these medications blindly over the internet without properly vetting their source.”
Dr. Lutfi emphasizes that weight loss medications can be life-changing for those who need them, but that it’s also important to have all the facts before you start taking one, including the cost. By staying informed, you can figure out if it’s a sustainable long-term solution for you.
If you have any questions about a prescription weight loss medication, talk to your doctor. Additionally, your health insurance company can answer any questions about the price you will be paying for these types of medications.
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Sources
Dr. Rami Lutfi, MD, bariatric and general surgeon based in Chicago and the Medical Director for Bariatric and General Surgery with Carrum Health
Dr. Brynna Connor, MD, family practice physician and healthcare ambassador at NorthWestPharmacy.com
