Does Medicaid Cover Ozempic Month Cost?

Does Medicaid Cover Ozempic?

Medicaid is one of the most prominent medical insurance programs in the United States. Each year, millions of Americans benefit from Medicaid coverage which is applicable on both prescription and life-saving medications. Ozempic on the other hand is a Diabetes Type II medication approved by the FDA back in 2017. Apart from maintaining the body’s blood sugar levels, Ozempic provides the added benefit of weight loss by lowering the overall calorie intake. This leads to Ozempic being commonly used as an off-label weight loss medication. However, does Medicaid cover Ozempic in any capacity?

Breaking down the actual costs

According to Mr. Novo Nordisk, the manufacturer of Ozempic, the list price of the medication is fixed at $935.77. Remember, the list price must not be confused with the retail price as the list price shows the cost of the drug without any insurance coverage or discount offers. The retail price is greatly influenced by the pharmacy you’re getting your medication from. On average, expect to pay around $1200 to $1400 for the medication without any insurance coverage. Also, the price of the drug is not influenced by your reason for taking it, you can use Ozempic for either weight loss of Diabetes Type II treatment, but the price is going to be the same.

Fortunately, this cost can be significantly lowered by a medical insurance program, manufacturer’s coupon, or a patient assistance program. How much cost will be waived off by these programs depends upon factors like your copay, your prescription, the requested dosage, etc.

Answering the big question

The answer is yes, ozempic is generally covered by Medicaid in all US states. However, the more important thing to consider is how easy it is to get Ozempic coverage in your case. This depends upon the fact that whether or not Ozempic is listed as a preferred drug and requires prior authorization in your state.

You can check the list of preferred drugs in your state online as this list is published by each state. If you can find Ozempic on the list with no prior authorization required, you can directly get Medicaid coverage for Ozempic regardless if you’re using it as a Diabetes Type II treatment medication or for weight loss. However, if the medication does require prior authorization, you’ll most probably be able to apply for Medicaid coverage only if you’re using Ozempic for Diabetes Type II treatment.

Factors influencing Medicaid coverage for Ozempic

  • A Diabetes Type II medical prescription.
  • A documented A1C amount report which indicates you blood sugar levels in a documented form.
  • In some US states, you may need to provide evidence of undergoing step therapy with the drug metformin. The step therapy involves first trying a low-cost medication for treatment.
  • The fact that Ozempic is listed as a preferred drug and/or requires prior authorization in your state.

Here’s how you can get Ozempic with Medicaid

The whole process of applying for ozempic coverage via Medicaid can be quite lengthy and confusing if you’re doing this for the very first. Here’s a step-by-step breakdown of applying for Ozempic coverage with Medicaid,

  1. Usually, Medicaid coverage for Ozempic is only applicable if you’re diagnosed with type II diabetes. So, the first step is to get a Diabetes Type II prescription.
  2. Now, check if Ozempic is listed as a preferred drug in your state. If it is, check if there are any additional requirements such as prior authorization, or step therapy. If ozempic isn’t listed as a preferred drug, you need to try and fail at least two other Diabetes drugs.

In the end, all that is left to do is to meet any set conditions or try nonpreferred drugs before you can apply for Ozempic-specific Medicaid coverage.

Final Note

Medicaid does infact cover Ozempic, mostly if you’re diagnosed with Diabetes Type II. On average, Medicaid coverage lowers the overall copay to $8 in most US states for prescription-based drugs. Even though no concrete data is available that states the average amount you’ll be paying for Ozempic after Medicaid, based on the average prescription medication coverage offered by Medicaid, the amount will be nominal or at the lower average end.

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