Does Medicaid cover Ozempic?

In this article:

• How much does Ozempic cost?
• Does Medicaid cover Ozempic?
• Factors influencing Medicaid coverage for Ozempic
• How to get Ozempic with Medicaid
• Ways to get discounts on Ozempic without Medicaid

In this article

• How much does Ozempic cost?
• Does Medicaid cover Ozempic?
• Factors influencing Medicaid coverage for Ozempic
• How to get Ozempic with Medicaid
• Ways to get discounts on Ozempic without Medicaid

Ozempic (semaglutide) is an injectable medication that was initially approved by the Food and Drug Administration (FDA) to treat Type 2 diabetes. It stimulates insulin production in the pancreas, lowering overall blood sugar and leading to better health outcomes. Ozempic is still relatively new to the market, but the GLP-1 agonist has gained a lot of attention. Because it often leads to weight loss, it’s become an in-demand drug for patients with Type 2 diabetes and patients looking to lose weight, even though it’s not currently FDA approved for weight loss. 

Because the drug is so popular, and there’s no generic alternative, it can be expensive without insurance. If you’re wondering whether Medicaid covers Ozempic, the answer is: It depends. Here’s what you need to know about whether your Medicaid coverage will pay for Ozempic.

How much does Ozempic cost?

How much someone ends up paying for Ozempic depends on several factors, including insurance coverage, access to discounts and coupons, and the pharmacy filling the prescription. Currently, the average retail price of Ozempic without insurance is $1,349, but that price varies by pharmacy and location. One thing that doesn’t affect Ozempic’s cost is your reason for taking it. “Whether you’re taking Ozempic for diabetes or weight loss, the price remains the same,” says Christie Kunde, Pharm.D., of Informed Rx.

You could save money on Ozempic by shopping between pharmacies to find a lower price or using manufacturer coupons, a patient assistance program, or a prescription discount card (more on that later). 

With insurance, including Medicaid, your cost will be based on factors like your prescription plan’s formulary, your copay, and your deductible. 

Does Medicaid cover Ozempic?

According to Brian Staiger, Pharm.D., of HelloPharmacist, Medicaid coverage varies on a state-by-state basis. He says Medicaid generally covers Ozempic as a treatment for Type 2 diabetes in all states, but the question is more about how easy it is to receive that coverage, including whether or not Ozempic is listed as a preferred drug in your state and whether it requires any prior authorization or includes other restrictions.

“Every state publishes its ‘preferred drug list’ online,” Dr. Staiger says, “which is likely the easiest way for individuals to find out about drug coverage under their plan.”

“You can find that preferred list of drugs one of two ways,” Dr. Staiger adds. One is by typing your state name and “preferred drug list” into the search box of your internet browser, and the other is by calling the phone number on your insurance card. 

The preferred drug list, or prescription drug formulary, for your state’s Medicaid coverage plays a big role in determining whether or not you can receive coverage for Ozempic. In addition, many states mandate that people with Medicaid join a managed Medicaid plan through an insurance carrier. Drug formularies may vary somewhat between these plans.

“If Ozempic is listed on your state’s Medicaid formulary and doesn’t require any prior authorization, you may be able to obtain it through Medicaid regardless of your diagnosis,” Dr. Kunde says. But if Ozempic requires prior authorization, it would most likely only be potentially covered for people with Type 2 diabetes. 

Factors influencing Medicaid coverage for Ozempic

Currently, the majority of states have Medicaid criteria that disallow coverage of Ozempic as a weight loss drug. This is because weight loss is an off-label use of Ozempic since it’s approved by the FDA for Type 2 diabetes and to reduce the risk of major cardiovascular events in adults with diabetes and known heart disease. In January 2025, it was also approved to reduce the risk of worsening kidney disease and cardiovascular death in adults with Type 2 diabetes and chronic kidney disease. 

RELATED: Can I take Ozempic if I’m not diabetic?

Even if you’re prescribed Ozempic for the treatment of Type 2 diabetes, there may still be some hoops to jump through in getting Medicaid coverage. According to Dr. Staiger, some states will cover Ozempic with no clinical requirements if it’s on their preferred drug list, but most still require some clinical criteria, which he says typically include:

• A diagnosis code of Type 2 diabetes
• Evidence of step therapy with the drug metformin (Step therapy involves first trying to use a lower-cost drug to treat a condition.)
• In some states, a documented A1C amount—a lab value indicating your blood sugar levels, which is often used in the diagnostic process for diabetes

So what happens if Ozempic isn’t on your state’s formulary? You may still be able to receive coverage for the drug as a diabetes treatment, but you need to meet some additional criteria first. 

“If Ozempic is nonpreferred on your Medicaid plan, you will most likely need to try and fail a certain number of preferred drugs for a certain number of days before you can receive coverage,” Dr. Staiger says, adding that the number of drugs will vary between individual states but is typically two or three. Your plan may also specify which drugs can be tried. 

For example, in the state of Virginia—where Ozempic is a non-preferred drug—Dr. Staiger says Medicaid coverage for Ozempic won’t be considered unless you have an A1C of at least 6.5% and have first tried two preferred GLP-1 drugs, such as Victoza and Trulicity. But in Ohio, he adds, you need to have tried and failed three preferred drugs for at least 120 days before nonpreferred drugs like Ozempic will be considered.

The eligibility requirements may be different in your state, so it’s important to check your specific insurance plan.

Ozempic versus Wegovy

“It’s worth noting that some state Medicaid programs do cover weight loss drugs—just not Ozempic,” Dr. Kunde says. 

“In states where weight loss medications are covered, individuals seeking to use it for weight loss should consider requesting Wegovy (semaglutide) instead of Ozempic,” she advises. “Both medications contain the same active ingredient, semaglutide, [but while] Ozempic is FDA approved for Type 2 diabetes, Wegovy is FDA-approved specifically for weight loss.”

In other words, if you’re hoping to use a semaglutide injection for weight loss, live in a state where Wegovy is covered, and receive Medicaid coverage, ask your healthcare provider whether Wegovy may be an option instead.

RELATED: Wegovy vs. Ozempic

How to get Ozempic with Medicaid

It’s easy to feel overwhelmed by the process of seeking health insurance coverage for Ozempic, so we’ve broken it down into steps for you based on our experts’ advice.

• Obtain proof of a diagnosis of Type 2 diabetes.
• See if Ozempic is preferred or nonpreferred on your state’s Medicaid plan.

1. 1. 1. If it’s a preferred drug, check if there are other clinical criteria needed, such as step therapy with metformin or an A1C test result. Also, check if prior authorization is needed; if not, you can proceed with getting an Ozempic prescription from your provider. If a prior authorization request is required, your provider will need to submit that request to your plan first.
      2. If Ozempic is not on your state’s formulary, you may need to try and fail at least two other preferred diabetes drugs first. Check with your plan to see how many drugs are required and if they need to be specific drugs. 

• Meet any nonpreferred drug and prior authorization criteria required by your state’s plan. Once you have performed the required steps, you can proceed with getting an Ozempic prescription from your healthcare provider.

Again, all of these steps are highly state-dependent. Check with your Medicaid plan or ask your provider for assistance if you’re not sure how to proceed.

Cost of Ozempic with Medicaid

What you can expect to pay for Ozempic with Medicaid coverage varies by state. While all 50 states currently offer prescription drug coverage to Medicaid members, costs are different based on whether or not a drug is on your state’s formulary, among other factors. Typically, Medicaid prescription medication copays cost less than $8 as long as they meet your state’s requirements for coverage. In some cases, there may be no copay at all. 

Factors that can influence your Medicaid drug copay amount include preferred drugs versus nonpreferred, brand name versus generic drugs, the cost of Medicaid reimbursement for a drug, and whether the drug requires prior authorization or not. Sometimes, drug copays may be waived if the patient is under a certain age or if the medicine falls into a specific category (like smoking cessation or family planning drugs). 

We can’t tell you how much Ozempic will cost on your state’s Medicaid plan, but we can give you a few examples of how drug pricing varies based on these factors. In the chart below, we compare Medicaid prescription drug copays in New York, Indiana, and Vermont.

Sample Medicaid prescription drug copays*
State	Copay Benefit
New York (NYRx)	$3 for non-preferred brand-name drugs $1 for generic drugs, preferred brand-name drugs, and some other drugs
Indiana	Between $3 and $10, depending on generic vs. brand name and the specific Medicaid plan you’re on
Vermont	$1 for prescriptions with Medicaid reimbursement costing less than $30 $2 for prescriptions with Medicaid reimbursement costing $30 or more but less than $50 $3 for prescriptions with Medicaid reimbursement costing more than $50

*Listed copays are just examples and may vary by plan.

Ways to get discounts on Ozempic without Medicaid

If your insurance won’t cover the cost of Ozempic, there are still ways to avoid paying full price. Dr. Kunde says there are many online coupons that can be accessed by signing up for a savings program. If you have a SingleCare prescription discount card, for example, you can compare the cost of Ozempic at local pharmacies and fill your prescription at the one with the best coupon. With a SingleCare coupon for Ozempic, you could pay $811 per month instead of $1,349.

Novo Nordisk has a patient assistance program for Medicare beneficiaries and people without insurance who are at or below 400% of the federal poverty level, but it isn’t available to Medicaid beneficiaries. Additionally, the Ozempic savings card is only available to people with private or commercial insurance.

If you’re concerned about paying out of pocket for Ozempic, speak with your healthcare provider. They may be able to recommend other ways to save on your Type 2 diabetes medication or prescribe an Ozempic alternative.