Whether you’re trying to get your hands on top-brand prescription drugs or their generic counterparts, one of the most important things will be the price tag. If it’s out of your budget, how are you going to afford it? Naturally, there needs to be some kind of game plan, especially if you don’t have the luxury of health insurance.
Today’s focus will be on Ozempic. What is it? How high is the price without insurance coverage? Is there anything that you can do to make it cheaper? The answers to these questions and more are provided below.
What Exactly Is Ozempic?
Ozempic (semaglutide) is an injectable prescription medication that is used in the treatment of type 2 diabetes. It is FDA-approved, and the idea behind its use is to combine it with diet and exercise for optimal results.
The aim is to prevent any spikes in blood sugar and to slow down digestion. Therefore, there is a longer feeling of fullness after meals. Additionally, it helps to prevent certain major cardiovascular events for type 2 diabetics who have known heart conditions.
Sometimes, it is one of those prescription medications that you can get off-label just for weight loss, though this will happen at the discretion of a medical practitioner.
Upon purchase, you will get an Ozempic pen that comes with multiple doses. When you’re ready to take it, simply select a dose, and inject the medication into the stomach, thigh, or upper arm. Typically, it will only need to be taken once a week.
How Much Does Ozempic Cost Without Health Insurance Coverage?
The cost of Ozempic can vary widely depending on several factors, but it is certainly not inexpensive. Novo Nordisk, the manufacturer, set the list price at $935.77, though you might find prices even higher at different pharmacies. To secure the best deal, one option is to buy semaglutide on the Internet, where various online pharmacies offer competitive pricing.
Semaglutide is a glucagon-like peptide-1 (GLP-1) medication, which means that high demand and shortages are to be expected. Therefore, some sellers will offer it in compounded forms.
For example, you may find that some of these products use salt semaglutide, which means that the active ingredient is different from what it should be. Avoid these options, regardless of how attractive their prices may be.
The Patent Problem
One of the first thoughts that may come to mind is to simply go the generic route. After all, that’s a known approach to save money on medicine. At the time of writing, the FDA has not approved any such variation. Novo Nordisk still owns the patent on the product, which is not set to expire until 2031. You will likely not be seeing any generic form of Ozempic until the expiration date comes.
This monopoly plays into the cost of the product, as does the aforementioned demand and supply equation.
How Many Ozempic Pens Are Needed Monthly
The number of pens required will depend on the dosage that you’re taking. You will either need one or two monthly. Treatment tends to begin at the lower end of the dosage spectrum, which means each box of Ozempic will only have a single pen. It contains four weekly doses of 0.5 mg or eight weekly doses of 0.25 mg.
Eventually, you get to the maintenance dosage of 1 mg monthly. At this point, you may have two pens with two weekly doses, or there may be one pen with four weekly doses.
Potential Ozempic Prescription Savings
Now that you know generic drugs are not an option, what can you do to save on Ozempic? There are a couple of avenues covered below. Bear in mind though that there are no guarantees. Some people may be able to use an option, while others may find that it is not available to them. Even those who can go the same route may find that they are seeing different levels of savings.
Patient Assistance Program
You may be able to take advantage of the Patient Assistance Program (PAP). If you qualify for it, you can access the medication at zero cost. Of course, there are a few eligibility requirements that need to be met, which are as follows:
- You must either be a citizen or a legal resident of the United States.
- The total income earned by your household needs to be at or below 400% of the federal poverty level (FPL).
- There should be no plans to enroll in any federal, state, or government assistance offerings, such as Veterans Affairs (VA), Low Income Subsidy (LIS), or Medicaid. Assuming all other requirements are met, persons ineligible for any such assistance can qualify for Novo Nordisk’s PAP.
- You should have neither Medicare nor insurance.
The Office of the Assistant Secretary for Planning and Evaluation website can help interested parties to check if they meet FPL requirements.
Note that if you are eligible for the prohibited forms of assistance and are not enrolled, Novo Nordisk will require that a declaration be signed, which indicates that no enrollment in any such program will be attempted in the future.
It will take about two business days for you to know the outcome of your application. Only persons being treated for type 2 diabetes will be considered. If Ozempic is simply a part of a weight loss program for you, then Novo Nordisk’s PAP is not an option.
Diabetes Saving Card
There is also the Diabetes Savings Offer Program. Like the previous option, you will not be able to take advantage of it if you are already enrolled in Medicaid, Medicare, or any other form of federal or state health assistance.
This offer works by allowing people to save $150, $300, or $450 per one-month, two-month, or three-month prescription, respectively.
If you wish to be considered, you must have some kind of commercial insurance plan that covers a part of the Ozempic cost. For obvious reasons, if the entire amount is covered, then you are ineligible.
Again, if you’re simply using Ozempic to lose weight, you cannot make use of this option. It is only meant for type 2 diabetics who are trying to control blood sugar levels or prevent major cardiovascular events.
Prescription Cards and Coupons
To reduce the cost of medications, you will sometimes find that companies offer prescription cards and coupons. Depending on the pharmacy you choose, you may even find that it is cheaper per dose to simply order a 90-day supply of Ozempic than to order one or two months’ worth of it.
Consider Telehealth
One option that may be useful is going the telehealth route. These services tend to be a lot more affordable than getting in-person care. Since the visits cost less, the out-of-pocket Ozempic amount may not seem like such a huge barrier anymore. You can even use the appointments you’re setting to talk about what you can do to make the medication cheaper.
Ozempic is not offered over the counter, so you must speak to a licensed healthcare professional before you can get access to it. However, no one said you need to do so in person. People with high-deductible insurance coverage, alongside those with no plan, know how expensive standard doctor visits can be.
Sometimes, health insurance will cover a part of the Ozempic prescription, but they need some form of prior authorization from a healthcare provider before they do so. This is yet another benefit of going the telehealth route. You can still get assistance with your pre-authorization paperwork, which means that you can get the coverage you need.
Note that most plans will only cover Ozempic for those who have type 2 diabetes. If it is just a matter of weight loss, you may still end up paying the full price.
What Does Insurance Plan Coverage for Ozempic Look Like?
Insurance coverage policies will depend on the company. Not only will there be different criteria from one provider to the next, but the amount of assistance offered will also vary. It is always a good idea to discuss coverage early to understand what is possible.
Some insurance plans will not cover Ozempic at all, while some will need the go-ahead from a licensed health practitioner to do so. Furthermore, some will only partially cover it, while others will take care of the entire cost.
Medicaid
Depending on the Medicaid plan you have, it may cover Ozempic and other GLP-1 drugs. The best course of action is to visit the website that corresponds to your state’s Medicaid program to see if the drug is covered.
If you don’t already have Medicaid, there are eligibility requirements that you will need to meet to access it. One of the primary ones is being a low-income earner. Before some drugs are covered, you may find that prior authorization from the insurance provider is needed.
Medicare
When Ozempic is prescribed for certain diagnoses, most Medicare prescription drug plans will cover it. These include Medicare Part D and Medicare Advantage Prescription Drug (MA-PD). Note that while you may be covered, the price that you pay depends on your copay and if your deductible has been met.
A quick look at your plan’s formulary will tell you if Ozempic is covered. You will also be able to see its tier to get an idea of how expensive it will be. The higher the tier, the more costly the medication.
Can Anything Be Done to Work Ozempic into an Insurance Plan If It Is Not Covered?
If your insurance plan does not assist with Ozempic, you may be able to get coverage by working with your healthcare provider. An appeal can be submitted to the insurance provider on your behalf, which may or may not be approved. Sometimes more information will be requested, and even then, denial is still possible.
Is Ozempic the Cheapest Option?
Ozempic is one of the cheaper GLP-1 medications out there when compared to Wegovy, Mounjaro, Saxenda, Trulicity, etc. With commercial insurance, however, you may be able to get a one-month Zepbound prescription (another injectable GLP-1 option) for as low as $25.
Note, however, that Zepbound works as a cheaper option for weight loss only. If you’re trying to treat type 2 diabetes, it does not work.
The Bottom Line
Ozempic comes with a hefty price tag, starting at $935.77 and often costing even more at retail. Fortunately, there are options to help ease the financial burden, like the Novo Nordisk PAP, which could provide some savings. Insurance coverage may also be available depending on your provider. However, until generic versions are introduced, paying full price might be your only option if these alternatives aren’t suitable. If you’re looking to explore other sources, you can find semaglutide for sale, which might offer more affordable options.