Will Insurance Cover Ozempic for Prediabetes and Save You Money?

Insurance coverage for Ozempic, a medication used to treat type 2 diabetes, is also applicable for people with prediabetes.

Some insurance plans may cover Ozempic for prediabetes treatment, including Medicare Part D.

This is because the medication has been shown to reduce the risk of cardiovascular events and death in people with type 2 diabetes, which also applies to those with prediabetes.

In fact, a study found that Ozempic reduced the risk of major adverse cardiovascular events by 26% in people with type 2 diabetes, which could also benefit those with prediabetes.

Many insurance plans cover Ozempic with a copayment or coinsurance.

Prediabetes is a health condition where blood sugar levels are higher than normal but not yet high enough to be diagnosed as type 2 diabetes. It's a warning sign that you're at increased risk for developing diabetes and other related health issues.

Typically, prediabetes is identified through blood tests measuring fasting glucose levels or hemoglobin A1c, and it often occurs without noticeable symptoms.

Insurance coverage for Ozempic can vary depending on your health insurance plan and medical condition. Most major health insurance plans cover Ozempic for diabetes, but the out-of-pocket expenses may differ.

Reviewing your insurance policy is essential to understand your coverage. Look for the section on prescription drug coverage and see if Ozempic is listed on your plan's formulary.

A formulary is a list of medications covered by your insurance plan, and Ozempic might be on a higher, more expensive tier. If it's not on your plan's formulary, you may need to discuss alternative options with your healthcare provider or consider switching plans during your next open enrollment period.

Some medications, like Ozempic, require prior authorization from your insurance company before they're covered. This means you'll need to get approval from your insurance company before you can get the medication.

Here's a quick rundown of key terms to understand:

If you have commercial insurance, you may be eligible to pay as little as $25 for Ozempic using a savings card from the manufacturer.

Ozempic can be a costly medication, especially if your insurance does not cover it. Novo Nordisk offers a savings card to help bring down the cost of Ozempic, but you must be enrolled in commercial insurance that covers part of the cost of Ozempic to qualify and have a type 2 diabetes diagnosis.

You can save up to $150 per 1-month prescription, $300 per 2-month prescription, or $450 per 3-month prescription with this savings card.

GoodRx can help you navigate between copay savings cards and patient assistance programs to save money on your prescription.

Some websites, such as GoodRx, source Ozempic coupons from various retailers — including Costco, CVS, Walgreens, and Walmart — which can help you save on the cost of Ozempic.

If you order a 90-day supply of Ozempic, it may be cheaper per dose than ordering a one-month or two-month supply at some pharmacies.

Here are some estimated costs of Ozempic alternatives:

Ozempic is a once-weekly injectable medication, but it's not FDA-approved for weight loss, although it may be prescribed off-label for this purpose.

Metformin is often the first-line treatment for prediabetes and works by improving insulin sensitivity and reducing glucose production in the liver.

The current list price of Ozempic is $968.52 for a 28-day supply, which can be a significant cost for many people.

Ozempic also promotes weight loss, which can be beneficial for many individuals with prediabetes, but it may come with its own set of side effects, including nausea and potential gastrointestinal issues.

Both Metformin and Ozempic have their own mechanisms of action, benefits, and potential side effects, making it crucial to consider prior health conditions, lifestyle preferences, and accessibility when making a choice.

It's essential to consult with a qualified healthcare provider to assess individual health profiles, discuss the pros and cons of each medication, and develop a personalized treatment plan that aligns with the patient's specific needs and goals.

If you're on Medicare, particularly Medicare Part D, you might be in luck. Many Medicare Part D plans do cover Ozempic, but it often requires prior authorization.

You should check your plan's formulary to make sure Ozempic is listed and to check which tier it is in. The amount that you pay will depend on the details of your plan, your copay, and whether your deductible has been met.

Private insurance plans usually have diabetes medications, such as Ozempic, on their formulary. If you have private insurance, you also may qualify for the Ozempic savings card to lower your costs even more.

Here are some key points to keep in mind when it comes to Medicare and private plans: