Does TRICARE Cover Ozempic? Criteria, Copay, How to Appeal
TRICARE covers Ozempic for type 2 diabetes with prior authorization. Ozempic is approved for type 2 diabetes itself, plus kidney disease and heart risk in 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
- Prime and Select only
- Self-pay if denied
- $149 a month
Ozempic in brief
Its half-life is about 1 week. At 7 d, half is gone; at five half-lives (35 d), about 3% remains.
In SUSTAIN 1, people with type 2 diabetes lost 4.7 kg over 30 weeks; the placebo group lost 1.2 kg.
Monthly prices in US dollars cover 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 Tricare cover Ozempic?
| Medicine | Approved for | Status | Prior authorization |
|---|---|---|---|
| Ozempic | Type 2 diabetes itself, plus kidney disease and heart risk in people with type 2 diabetes | Covered with PA | Required |
Sources: Novo Nordisk pricing, NovoCare, TrumpRx, rx.costco.com.
The policy as it was published
- TRICARE For Life ended weight-loss coverage on August 31, 2025
View the complete policy at militaryrx.express-scripts.com.
Source: militaryrx.express-scripts.com.
Prior authorization checklist
- Diagnosis: Your chart records type 2 diabetes, or another approved Ozempic use involving heart risk and kidney disease in type 2 diabetes.
- For type 2 diabetes: Coverage with PA
- For weight loss: Prime and Select
- Send recent A1C results and records of diabetes medicines already tried.
- Who sends it: Your prescriber is responsible for filing the prior authorization, not you.
Source: militaryrx.express-scripts.com.
If you are denied: appeal
| Denial reason | What to send or ask |
|---|---|
| Prior authorization missing | Your prescriber sends the type 2 diabetes diagnosis and recent A1C results, along with the plan's form. |
| The plan wants another drug first | Ask which drugs the plan wants tried first. Send records of drugs already tried. |
| The drug is not on the plan's list | Find out which GLP-1 the plan prefers. Request a formulary exception. |
- The denial letter identifies the exact rule that was not met, so get a copy.
- Your prescriber files the appeal with chart notes that answer the rule.
- If an appeal through the plan fails, ask an independent reviewer for an external review.
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 |
 Ambetter (Centene) | Covered on formulary | Required |
 Amerigroup (Elevance Medicaid) | Covered with PA | 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. Right now, 10 states cover GLP-1s for weight loss. See every state
Other paths if 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 | Your household income is no more than 200% of the federal poverty level | Free if approved | The income limit is 200% of the poverty level. People with Medicare drug coverage: Not eligible |
Prices checked November 2026. Each price links to its source page.
Sources: Novo Nordisk pricing, NovoCare, TrumpRx, rx.costco.com.