Typically, Medicare Part D will cover Ozempic to help manage blood sugar levels in adults with type 2 diabetes. Medicare does not cover Ozempic to treat prediabetes, which is an off-label use.
Ozempic (semaglutide) is a prescription drug approved by the Food and Drug Administration (FDA) for the following uses:
- managing blood sugar levels in people with type 2 diabetes, along with diet and exercise
- reducing the risk of complications from chronic kidney disease in adults with type 2 diabetes
- reducing the risk of heart attack and stroke in adults with type 2 diabetes and cardiovascular disease
Medicare is a federal health insurance program for people ages 65 years or older. It covers Ozempic under Medicare Part D. Other insurance providers may also cover the cost of Ozempic when it’s used for its FDA-approved indications.
This article discusses whether Medicare covers Ozempic for prediabetes, whether Medicare coverage of Ozempic is the same as Wegovy, and whether other insurances cover Ozempic.
With prediabetes, your blood sugar levels are higher than usual. But they’re not yet high enough for a diagnosis of type 2 diabetes.
Prediabetes typically has no symptoms. But some symptoms may occur, such as skin darkening in your armpits, on your back, or on the side of your neck.
If prediabetes is left untreated, it may lead to type 2 diabetes. It also raises your risk of developing other serious health conditions. However, you can take steps to reverse it.
Medicare Part D may cover the cost of Ozempic only for its FDA-approved indications listed above. It does not pay for or cover Ozempic as a treatment for prediabetes.
At present, there aren’t any FDA-approved
Potential off-label uses for Ozempic include:
- prediabetes
- weight loss
- weight management
Scientists are conducting more
Talk with your doctor if you have questions about using Ozempic off-label for prediabetes.
Medicare plans
Contact your plan provider to find out whether your Medicare or Medicaid plan covers Ozempic if you have type 2 diabetes and your doctor prescribes this medication for you.
Different types of Medicare and Medicaid plans are available. Your cost and coverage depend on your individual plan, and yours may require prior authorization to cover Ozempic.
Medicare Part B may cover a health behavior change program to help prevent prediabetes from becoming type 2 diabetes. The Medicare Diabetes Prevention Program (MDPP) is a 2-year program that aims to help you:
- make changes to your diet
- increase your levels of physical activity
- maintain a weight that is optimal for you
These changes can help you reduce your risk of developing type 2 diabetes by more than
Medicare coverage for Ozempic is not the same as Wegovy. Wegovy contains the same active ingredient as Ozempic, semaglutide, but it is FDA approved to help with weight loss.
Medicare can cover Ozempic if a doctor prescribes it to help manage blood sugar levels for people with type 2 diabetes. But in 2003, Congress passed a rule that
But if the FDA approves a weight loss drug for another medically accepted use, it can be covered by Medicare prescription drug plans. The FDA has recently
Your actual coverage may vary based on your specific Medicare plan. Contact your Medicare plan provider directly to determine what medication they may cover. Keep in mind your out-of-pocket costs may vary.
Many other insurance plans, including Medicare Advantage plans sold by private insurance companies, may cover Ozempic. However, it’s very likely these plans will only cover the cost of Ozempic for its FDA-approved uses, not for treatment of prediabetes.
It’s possible that private insurance plans may cover Ozempic prescribed off-label for prediabetes. However, coverage decisions and Ozempic costs may vary among insurance providers. It may depend on several factors, including:
- clinical guidelines
- your insurance plan and specific benefits
- prior authorization requirements for your plan
- whether you qualify for a cost-saving card program
Your cost may also depend on your dosage, your copay, and other factors. (Your copay is your share of your medication’s cost under your insurance coverage.) Talk with your plan provider if you have questions about your drug coverage.
Prediabetes is a condition that may turn into type 2 diabetes over time.
Medicare usually covers Ozempic as a prescription treatment to help manage blood sugar levels in people with type 2 diabetes and for other FDA-approved indications.
Medicare does not cover Ozempic if it is prescribed off-label for prediabetes. However, Medicare does cover a prediabetes prevention plan called the Medicare Diabetes Prevention Program (MDPP).
If you’re interested in treatments for prediabetes, talk with your doctor. They can help determine the best treatment plan for you.
Talk with your insurance provider if you have questions about your coverage of Ozempic.
Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
