Does Amerigroup Cover Ozempic? Criteria, Copay, How to Appeal
Amerigroup covers Ozempic for type 2 diabetes with prior authorization. Ozempic is approved for type 2 diabetes; heart risk and kidney disease among people with type 2 diabetes, not weight loss, so the plan judges it on those uses.
- For type 2 diabetes
- Covered with PA
- Prior authorization
- Required
- For weight loss
- Follows state Medicaid
- Self-pay if denied
- $149 a month
Ozempic overview
Its half-life is about 1 week. After 7 d, half is gone, and about 3% remains after five half-lives (35 d).
In SUSTAIN 1, people with type 2 diabetes lost 4.7 kg over 30 weeks, compared with 1.2 kg on placebo.
Monthly prices in US dollars include list prices and self-pay offers. Each comes from the maker's price page.
Sources: FDA label (DailyMed), healthsystemtracker.org, prnewswire.com 1 2.
Does amerigroup cover Ozempic?
| Medicine | Approved for | Status | Prior authorization |
|---|---|---|---|
| Ozempic | Type 2 diabetes; heart risk and kidney disease among people with type 2 diabetes | Covered with PA | Required |
Sources: Novo Nordisk pricing, NovoCare, TrumpRx, rx.costco.com.
The published policy
Managed care under Medicaid, delivered through Amerigroup
View the full policy: provider.amerigroup.com
Prior authorization checklist
- Diagnosis: Your records show either type 2 diabetes or another approved use of Ozempic: heart risk and kidney disease among people who have type 2 diabetes.
- PA form for prior authorization, located at
- Records needed: your recent A1C results, plus the diabetes medicines you have tried before.
- Who files it: your prescriber submits it, not you.
Source: provider.amerigroup.com.
The appeal, if you are denied
| Denial reason | What to send or ask |
|---|---|
| Prior authorization missing | Your prescriber sends the plan's form with your type 2 diabetes diagnosis and recent A1C results. |
| The plan wants another drug first | Send records of drugs you have already tried after asking the plan which ones it wants tried first. |
| The drug is not on the plan's list | Request a formulary exception and ask which GLP-1 the plan prefers instead |
- The denial letter names the rule that was not met, so make sure you get a copy.
- Your prescriber submits the appeal, including chart notes that answer that rule.
- If the plan's appeal fails, ask for an outside review by an independent reviewer.
Differences by State and plan
| Plan | For type 2 diabetes | Prior authorization |
|---|---|---|
| Medicare | Covered by Part D plans | Required |
| Medicaid | Covered | Required |
 Aetna | Covered on formulary | Required |
 Cigna (Evernorth / Express Scripts) | Covered on formulary | Required |
 UnitedHealthcare (Optum Rx) | Covered on formulary | Required |
 Blue Cross Blue Shield | Covered on formulary | Required |
 Kaiser Permanente | Covered on formulary | Required |
| TRICARE | Covered with PA | Required |
 Ambetter (Centene) | Covered on formulary | Required |
 CVS Caremark | Covered on formulary | Required |
| Express Scripts | Covered on formulary | Required |
| Optum Rx | Covered on formulary | Required |
 Humana | Covered by Part D plans | Required |
| VA (Veterans Health Administration) | Covered | Required |
 GEHA | Covered | Required |
| ACA Marketplace plans | Common | Required |
 Navitus | Covered on formulary | Not listed |
Each state sets its own Medicaid rules, and 10 states now cover GLP-1s for weight loss. See each state
Different routes when coverage says no
| Route | Who it is for | What you pay | Limits and dates |
|---|---|---|---|
| NovoCare Pharmacy: Ozempic pill (from 1.5 mg) | Self-pay, no insurance needed | $149 a month | Not listed |
| TrumpRx listing (pen, starting) | Self-pay only, not with insurance | $199 a month | The offer runs from November 17, 2025 through December 31, 2026 |
| Novo Nordisk PAP | Household income at most 200% of the federal poverty level | Free if approved | The income limit is 200% of the poverty level. Not open to people who have Medicare drug coverage |
Prices checked November 2026. Every price links back to the page where it appears.
Sources: Novo Nordisk pricing, NovoCare, TrumpRx, rx.costco.com.