Is Ozempic Covered by Insurance? Criteria, Copay, Appeal

Does insurance cover Ozempic?

Ozempic coverage by plan

Plan	For type 2 diabetes	For weight loss	Prior authorization
Medicare	Covered by Part D plans	Bridge program only	Required
Medicaid	Covered	Varies by state	Required
Aetna	Covered on formulary	Employer option	Required
Cigna (Evernorth / Express Scripts)	Covered on formulary	Plan dependent	Required
UnitedHealthcare (Optum Rx)	Covered on formulary	Plan dependent	Required
Blue Cross Blue Shield	Covered on formulary	Plan dependent	Required
Kaiser Permanente	Covered on formulary	Plan dependent	Required
TRICARE	Covered with PA	Prime and Select only	Required
Ambetter (Centene)	Covered on formulary	Excluded	Required
Amerigroup (Elevance Medicaid)	Covered with PA	Follows state Medicaid	Required
CVS Caremark	Covered on formulary	Plan sponsor choice	Required
Express Scripts	Covered on formulary	Plan sponsor choice	Required
Optum Rx	Covered on formulary	Plan sponsor choice	Required
Humana	Covered by Part D plans	Bridge program only	Required
VA (Veterans Health Administration)	Covered	Covered with criteria	Required
GEHA	Covered	Covered with PA	Required
ACA Marketplace plans	Common	Rare	Required
Navitus	Covered on formulary	Plan sponsor choice	Not listed

Published policy

• Express Scripts, Ozempic: The formulary lists Ozempic at
• ACA Marketplace plans: 82% of 2024 federal Marketplace drug plans included coverage for Ozempic
• Medicare Part D can cover it, either for diabetes or for cardiovascular disease

Sources: humana.com, medicare.gov, CMS, aetna.com.

Prior authorization checklist

• Another approved use of Ozempic appears in your chart: Type 2 diabetes, or, among people with Type 2 diabetes, heart risk and kidney disease.
• Recent A1C results.
• Drugs for diabetes that you have tried before

Sources: aetna.com, static.cigna.com, uhcprovider.com, horizonblue.com.

If you are denied: appeal

1. Collect the denial letter. It tells you exactly which rule was not met.
2. Your prescriber files the appeal with chart notes that address the rule.
3. If the plan's appeal does not succeed, ask for an external review by an independent reviewer

Differences by State and plan

The same insurer may answer yes in one state or employer plan and no in another.

• TRICARE coverage for Type 2 diabetes requires PA:
• Express Scripts, Ozempic: The formulary lists Ozempic at

Each state sets its own Medicaid rules. at present, 10 states provide coverage for GLP-1s prescribed for weight loss: North Carolina, Minnesota, Wisconsin, Tennessee, Delaware, Michigan, Kansas, Mississippi, Missouri and Virginia. State-by-state comparison

Sources: militaryrx.express-scripts.com, express-scripts.com.

If coverage says no: other routes

Prices checked November 2026. Each price links to its source page.

Sources: Novo Nordisk pricing, NovoCare, TrumpRx, rx.costco.com.