Ozempic (semaglutide) might just have been the internet’s favorite medication of 2023, but social media isn’t the only thing skyrocketing its popularity—Ozempic is also highly effective. From a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists, this injectable prescription diabetes medicine initially garnered attention for its weight loss benefits. However, it’s approved solely for Type 2 diabetes, while its sibling Wegovy (also with the active ingredient semaglutide), is approved for weight management.
All that social clout, however, has caused an Ozempic shortage along with high average prices. The good news is that those prices can vary based on factors like insurance coverage and the reason for taking it. Plus, thanks to a discount from the drug’s manufacturer, you may be able to get it for as little as $25 per month. Here’s how.
How much does Ozempic cost?
As an in-demand, brand-name drug in short supply, Ozempic isn’t exactly cheap. Without insurance coverage, an Ozempic pen can cost $1,322.61 for a 28-day supply of 1-milligram (mg) dosage pens or $1,265.03 for a 28-day prescription of 0.25-mg or 0.5-mg dosage pens. But those are just averages. Ozempic’s out-of-pocket expenses depend on several factors.
Since it comes in a few different dosages, each one might have a slightly different price. Each pharmacy sets its own prices, too, which depend on its location, overhead, and affiliations. In fact, a study published in 2019 concluded that independent pharmacies and small chains typically charged higher cash (without insurance) prices than larger chains. And, like a lot of expensive prescription medications, there are ways to get Ozempic for much less.
What about insurance?
The most common way to save money on any prescription drug is by using health insurance, which can drastically drop the price. But that hinges on why the healthcare provider prescribed it. Many plans cover Ozempic prescriptions for Type 2 diabetes and not for weight loss.
However, that’s constantly changing, according to Sulagna Misra, MD, founder of Misra Wellness. She says some insurance companies who once covered Ozempic for obesity now might only cover Wegovy instead—or neither. Wegovy is a brand-name medication made by Novo Nordisk, the same manufacturer that makes Ozempic. Like Ozempic, Wegovy contains the active ingredient semaglutide. The main difference between the two is that Ozempic is currently approved for Type 2 diabetes, and Wegovy is currently approved for weight management. This may complicate insurance matters in some cases.
Further, Dr. Misra says many insurance plans now require prior authorization from the doctor before approving coverage for weight loss drugs. And some will only cover one medication after the patient has tried other drugs or even certain diets. Relatively simple paperwork errors about the brand name or prior authorization requirements can be enough to deny a claim.
Medicare, however, is a different story. A 2003 law prohibits government-sponsored plans like Medicare from covering weight loss medication. “This was due to the fact that weight loss meds and obesity were considered cosmetic and not a chronic disease state back then,” says Jonathan Kaplan, MD, founder of Pacific Heights Plastic Surgery in San Francisco. “There is federal legislation with bipartisan support for obesity medication coverage, but it’s simply too expensive.”
Even though many formularies for Medicare Part D and private insurance include Ozempic for diabetes, their copayments, deductibles, and coinsurance may vary. After insurance, beneficiaries may only end up paying a couple hundred dollars per month for Ozempic instead of over $1,000 when the drug is prescribed for diabetes.
The $25 offer for Ozempic
Insurance policies alone can provide significantly discounted prices, but Novo Nordisk may have an even better offer for insured patients. Recognizing the need for a more budget-friendly option, the manufacturer has introduced a discount card that can help patients with insurance get Ozempic for as little as $25 per month.
More specifically, it’s a maximum savings of $150 on a one-month supply, $300 for a two-month supply, or $450 for a three-month supply—on top of your insurance coverage. However, applicants have to meet a few stipulations to qualify.
Eligibility criteria for the Ozempic $25 coupon
First off, Novo Nordisk says qualified applicants must be enrolled in a private insurance plan, and that plan needs to cover Ozempic. It doesn’t apply to anyone paying completely out of pocket. But it also won’t apply if private insurance or another pharmacy benefits program covers the entire cost.
Additionally, applicants are ineligible if they’re enrolled in any state or federal program with prescription medication coverage. That includes Medicare, Medicaid, VA, DOD, and TRICARE coverage. The offer is only valid in the United States, it’s not transferable to another person, and it lasts for a maximum of 24 months. The applicant is still responsible for all copayments and other fees issued by their health insurance policy.
How to apply for the $25 Ozempic discount
The application process itself is pretty simple. Go to the Ozempic website and click the button that says “Sign Up and Save.” Or, text BEGIN to 21848 to get started.
The online form asks for standard information, like name, date of birth, and Zip code—but it also requests confirmation that you have a private insurance plan and that you’re not on any government-sponsored health plans (such as Medicare or TRICARE).
If Novo Nordisk approves the application, you can print, download, or email yourself an Ozempic savings card, which you’ll present to the pharmacist. Anyone who uses a mail-order pharmacy is eligible, too, although they’ll have to purchase the medication first and then apply for reimbursement by sending their proof of purchase and insurance plan information.
This savings card will work at just about any local pharmacy. However, some insurance providers may require prior authorization from the healthcare provider before they issue coverage.
Other ways to get affordable Ozempic
There are several other things you can do to save on Ozempic. Here are a few of the best ways.
Get a SingleCare prescription discount card
SingleCare negotiates directly with pharmacies to offer free coupons that could help save up to 80% on prescription medicines. You can’t use SingleCare and insurance together, but if a particular plan doesn’t cover Ozempic—or doesn’t cover a large percentage of the cost—a SingleCare prescription discount card could knock hundreds off the medication’s price right off the bat.
Get it from a licensed healthcare provider
Part of saving on Ozempic is ensuring you don’t get overcharged. “There are patients that go to these ‘medispas’ that don’t even have doctors on staff or on-site. And then they are getting price gouged,” Dr. Misra says. ”I have patients who were previously paying $250 dollars per injection at some of these places, and then they price-gouge them to $800 per weekly injection.” That’s why she recommends patients only get prescriptions for Ozempic or similar drugs from someone with a doctor of medicine degree (an MD) or a doctor of osteopathic medicine degree (a DO).
Consider a compounded version
For drugs on the Food and Drug Administration (FDA) shortage list, compounding pharmacies can create and sell copies, often at lower prices than the brand-name versions. Dr. Kaplan says that compounded medications can cost $500 to $600, whereas the name brand medications can cost $1,000 to $1,300—if they’re in stock and not affected by a drug shortage.
These pharmacies mix the active ingredients in a drug themselves, and “by law, these have to be an exact duplicate of the name brand drug while the name brand drugs are on the FDA shortage list,” Dr. Kaplan explains.
Look into the Medicare Extra Help program
Medicare Part D plans often cover Ozempic for Type 2 diabetes (but not for weight loss), and eligible individuals may also be eligible for additional financial savings. Medicare Extra Help provides more savings for people who need financial assistance for prescription drugs. Eligible beneficiaries are people with Medicare who have an annual income below $22,836 for an individual or $30,900 for a married couple, or resources of $17,220 for an individual or $34,360 for a married couple. If you qualify for Medicaid or a Medicare Savings Program (some of which do not have an asset test in certain states), you will qualify for Extra Help automatically.
Enroll in Novo Nordisk’s Patient Assistance Program
This Patient Assistance Program (PAP) helps uninsured people at or below 400% of the federal poverty level access Ozempic for free, as long as they meet all the eligibility requirements. Besides meeting the income requirement, qualifying patients must not be enrolled in private insurance, Medicare, or any other federal, state, or government program.
Ask questions
Sometimes, insurance companies deny claims for small, easily fixable reasons. If the insurance provider denies a claim, find out why, since there might be a simple solution. Your healthcare provider can also file an appeal to the insurance company, explaining why it’s medically necessary and why you need the medication covered by insurance.
Sources
- Variation in prescription drug prices by retail pharmacy type: A national cross-sectional study, Annals of Internal Medicine (2019)
- Social Security Act 1860D-2: Prescription drug benefits, United States Social Security Administration
- Does Medicare cover Ozempic and drugs taken for weight loss?, AARP (2023)
- Diabetes savings offer program, Novo Nordisk
- Save on Ozempic® (semaglutide) injection, Novo Nordisk
- Understanding the extra help with your Medicare prescription drug plan, United States Social Security Administration (2024)
- Patient assistance program, Novo Nordisk