Typically, Medicare only covers Ozempic to help manage blood sugar levels in people with type 2 diabetes. However, Medicare also covers a program to help you prevent prediabetes from becoming type 2 diabetes.
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 the side of your neck. You may develop type 2 diabetes if prediabetes is left untreated. It also raises your risk of developing several serious health conditions. However, you can take steps to reverse it.
Ozempic (semaglutide) is a prescription medication that helps manage blood sugar levels and reduces the risk of complications in people with type 2 diabetes. Your doctor will typically recommend diet changes and exercise along with Ozempic treatment.
The Food and Drug Administration (FDA) has approved Ozempic only for type 2 diabetes. Any other use, such as prediabetes, of Ozempic is considered an off-label treatment.
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 Ozempic.
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.
Ozempic is only FDA-approved to help manage blood sugar levels and reduce the risk of complications in people with type 2 diabetes, but it is not approved for prediabetes.
At present, Medicare Part D usually only covers Ozempic for type 2 diabetes. It does not pay for or cover Ozempic as a prediabetes treatment.
There aren’t any FDA-approved
Scientists are conducting more
Medicare plans
Contact your plan provider to find out if your Medicare or Medicaid plan covers Ozempic. 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 optimum 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. You should contact your Medicare plan provider directly to determine what medication they may cover. Keep in mind your out-of-pocket costs may vary.
Several other insurances, such as Humana, Wellcare, and Silverscript, may cover Ozempic. However, they may only cover them to help manage blood sugar levels in people with type 2 diabetes.
Your insurance may cover Ozempic if it is 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
- if 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. It may 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.
If you’re interested in treatments for prediabetes, talk with a 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.