What Ozempic is used for
Ozempic is a once-weekly GLP-1 injection. Its FDA label covers improving blood sugar in adults with type 2 diabetes, reducing the risk of major cardiovascular events in adults with type 2 diabetes and heart disease, and reducing the risk of kidney disease getting worse in adults with type 2 diabetes and chronic kidney disease. It isn't approved for weight loss; Wegovy is the semaglutide brand for that.
This page explains Medicare coverage only. Questions about whether Ozempic is right for you belong with your prescriber.
Which part of Medicare covers Ozempic
You inject Ozempic yourself at home, so it's a Part D drug. Federal law excludes drugs used for weight loss from Part D, which is why plans may use prior authorization to confirm you have type 2 diabetes before they pay for Ozempic.
Is Ozempic on Medicare's negotiated-price list?
Yes, from 2027. CMS selected semaglutide (Ozempic, Rybelsus and Wegovy, as one selected drug) in the second round of the Medicare Drug Price Negotiation Program, and CMS says its negotiated price takes effect January 1, 2027. A negotiated price is what Medicare drug plans and pharmacies pay when a plan covers the drug; it isn't your copay, and it doesn't change what Part D is allowed to cover.
Ozempic, weight loss and the Medicare GLP-1 Bridge
From July 1, 2026, through December 31, 2027, CMS runs the Medicare GLP-1 Bridge, a short-term demonstration that covers certain GLP-1 drugs for weight management for eligible people with Medicare drug coverage, at a flat monthly copay set by CMS. The Bridge covers Wegovy (injection or tablet), Zepbound (KwikPen only) and Foundayo. It runs outside your plan's formulary: the Part D deductible doesn't apply, no part of the Bridge copay counts toward the $2,400 cap, and Extra Help doesn't lower it.
Ozempic isn't one of the Bridge drugs, and Medicare.gov says people with type 2 diabetes aren't eligible for the Bridge, because their Part D plan may cover a GLP-1 for diabetes instead. See Wegovy for who qualifies.
What you pay for Ozempic in 2027: the out-of-pocket cap
Your cost for Ozempic depends on your plan: its deductible, the tier it puts the drug on, and whether you use a preferred pharmacy. This site doesn't list plan costs; your plan's formulary and Evidence of Coverage do. What Medicare sets for everyone with Part D is the limit:
- 2027 out-of-pocket cap: $2,400 (it was $2,100 in 2026). Once what you pay for covered Part D drugs (deductible, copays and coinsurance) reaches the cap, you pay nothing more for covered Part D drugs for the rest of 2027.
- The maximum Part D deductible for 2027 is $700. No plan can set a higher deductible, and some have none.
- Only covered drugs count. If your plan doesn't cover Ozempic and you pay cash, or you use a discount card instead of your plan, that spending doesn't count toward the cap.
Spreading the cost: the Medicare Prescription Payment Plan
Every Part D plan and Medicare Advantage plan with drug coverage offers the Medicare Prescription Payment Plan. Instead of paying the pharmacy, you get a monthly bill from your plan that spreads your costs across the calendar year. Medicare.gov says there's no cost to participate and no interest, but it doesn't lower your drug costs; it only changes when you pay. It helps most when costs are high early in the year. To join, call your plan or use its website. More in What is the Medicare Prescription Payment Plan?
Extra Help with Ozempic
Extra Help (the Low-Income Subsidy) is a federal program that lowers Part D premiums, deductibles and copays. For 2027, CMS caps Extra Help copays for covered drugs at $5.80 for a generic and $14.40 for a brand-name drug, and some people with full Medicaid pay less. You get Extra Help automatically if you have full NC Medicaid, SSI or a Medicare Savings Program, which North Carolina calls MQB (MQB-Q, MQB-B or MQB-E). Otherwise, apply through Social Security at ssa.gov/extrahelp or 1-800-772-1213 (TTY 1-800-325-0778). See Extra Help in North Carolina and MQB in North Carolina.
Getting Ozempic covered in North Carolina
North Carolina is its own Part D region (PDP Region 08), so each standalone Part D plan sold here is offered in all 100 counties. For 2027, CMS lists 11 standalone Part D plans from 6 companies in North Carolina. Every county also has Medicare Advantage plans open to everyone, from 11 in Carteret County to 57 in Guilford County. Each plan has its own formulary, so one plan's coverage of Ozempic tells you nothing about another's. Your county's numbers are on North Carolina counties.
State Health Plan retirees: the Plan's Base Plan and Enhanced Plan are group Medicare Advantage plans that include group Part D, so your Ozempic coverage comes from the Plan's formulary. Don't join a separate Part D or Medicare Advantage plan to get Ozempic covered: the State Health Plan says that removes you from its group Medicare Advantage plan and moves you to the 70/30 Plan. Ask the Plan first. See the State Health Plan and Medicare.
If you have full NC Medicaid and Medicare, your Medicare drug coverage, not NC Medicaid, pays for Part D drugs like Ozempic, and you get Extra Help automatically. See NC Medicaid and Medicare.
If your Medicare Advantage plan ends in 2027, your plan sends a non-renewal letter, and you have a special enrollment period through February 28, 2027. To keep Ozempic covered without a gap, choose new drug coverage by December 31, 2026. See plans ending in 2027.
Hurricanes and power outages: Ozempic has storage-temperature limits on its label, so a long power outage can ruin your supply; keep your plan's pharmacy number with your emergency supplies. CMS says Medicare pays to replace prescription drugs lost, destroyed or damaged in a disaster; call your plan for a replacement fill. North Carolina's emergency-refill law (G.S. 58-3-228) is written for state-regulated health plans and the State Health Plan; in a Medicare drug plan, ask the plan itself. See early refills before a hurricane.
How to check whether a plan covers Ozempic
- Write down the exact drug. Name, strength and how often you take it. A plan can cover one form or strength of Ozempic and not another.
- Look it up in each plan's formulary. Enter your drugs and ZIP code on PlanMatch or Medicare.gov's Plan Finder to see which plans list Ozempic and any rules.
- Read the rules next to the drug. Prior authorization, step therapy or quantity limits mean your prescriber may need to send the plan information before it pays.
- Check your 2027 notice. Your plan's Annual Notice of Change says whether Ozempic stays on the formulary next year. Open Enrollment runs October 15 to December 7, 2026, for coverage starting January 1, 2027.
- Get help if you want it. You can request a call from a licensed insurance agent, who can compare plans from the companies they work with, or call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) for information on all of your options.
If your plan doesn't cover Ozempic, you or your prescriber can ask for a coverage determination or a formulary exception. Once the plan has your prescriber's supporting statement, it generally must decide within 72 hours, or 24 hours if your prescriber says waiting could seriously harm your health. New members can usually get a one-time transition supply of a drug they were already taking while they ask for an exception or switch. See How do I appeal a Medicare denial in North Carolina?
Sources
- National Library of Medicine — DailyMed: Ozempic prescribing information (FDA label)
- Medicare.gov — Drug coverage (Part D)
- CMS — Selected drugs and negotiated prices (Medicare Drug Price Negotiation Program)
- Medicare.gov — Weight loss drugs (Medicare GLP-1 Bridge)
- CMS — Medicare GLP-1 Bridge (July 1, 2026, to December 31, 2027)
- CMS — CY 2027 Rate Announcement (2027 Part D out-of-pocket threshold and Extra Help copays)
- Medicare.gov — Medicare Prescription Payment Plan
- Social Security — Extra Help with Medicare prescription drug plan costs
- CMS — Medicare Advantage and Part D Landscape files, 2027 (PDP Region 08: North Carolina)
- State Health Plan — Retiree presentation (group Medicare Advantage plans, outside Medicare plans and the 70/30 Plan)
- CMS — Replacing Durable Medical Equipment and Prescription Drugs after a Disaster
- North Carolina General Statutes — G.S. 58-3-228, extra prescriptions during a state of emergency or disaster
Frequently asked questions
Will Medicare cover Ozempic for weight loss?
No. Part D can't cover drugs used for weight loss alone, and Ozempic isn't one of the drugs in the Medicare GLP-1 Bridge. Ozempic is covered for type 2 diabetes and its related heart and kidney uses.
When does Ozempic's Medicare negotiated price start?
January 1, 2027. CMS negotiated one price for semaglutide that covers Ozempic, Rybelsus and Wegovy when a Part D plan covers them.
Does the 2027 Part D out-of-pocket cap apply to Ozempic?
Yes, when your Part D plan covers Ozempic. In 2027, once you've paid $2,400 for covered Part D drugs, you pay nothing more for covered Part D drugs for the rest of the year.
What if my plan doesn't cover Ozempic?
Ask the plan for a coverage determination or formulary exception, with a supporting statement from your prescriber, or compare plans during Open Enrollment, October 15 to December 7. New members can usually get a transition fill while they ask.
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