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Ozempic is known for being a powerful drug, and something that people often find out when they seek it out is that it is very expensive. Ozempic can bring about miraculous results, and can also cost about one thousand dollars every month. This is a steep price for most people to pay, so if you want to try this drug, you might want to know if you can get it covered by insurance.
Losing weight is one of the most difficult things a person can do, so if you can have an easier time doing it, it can be hard to let the opportunity go, especially when it's over money. But depending on what insurance you have, you won’t have to let this weight loss opportunity go for monetary reasons.
You can get ozempic at a significantly lower price and finally meet your weight loss goals. And if you don’t have insurance that covers Ozempic, it might be time to give up on it for a better option. Keep reading to find out just what insurance plan you need to be on to get Ozempic at a reduced price.
What Does Ozempic Do?
Ozempic is a drug that works by replacing the natural hormones in the body that work to regulate insulin. It works to control the body’s blood sugar when the body isn’t able to do it on its own, and through this function, also works as a major appetite suppressant. Ozempic prompts the pancreas to produce insulin and induces feelings of fullness in the user. This is how it leads to major benefits for people with diabetes and for people with a high body weight.
The active ingredient in Ozempic is semaglutide. You have the option to get the brand name Ozempic, the off label version, or versions with different brand names. Semaglutide under different brand names include Wegvoy, Rybelsus, and Saxenda. You may find that the popular brand name works best for your body and wallet, or that one of the off brand versions work best in the long run.
What Are Ozempic’s Side Effects?
Ozempic has the potential to cause one or many side effects, and all of them range from mild to debilitating. Not everyone who takes Ozempic will experience these symptoms, but a percentage of users will experience one or more of them. Some of these symptoms will go away with time and some could be there to stay. It is up to you to decide if Ozempic’s side effects are worth it for you.
The most common side effects that users experience on Ozempic are digestive symptoms. Ozempic is more likely to have an effect on your digestive system than anything else, and these symptoms aren’t likely to last. Some Ozempic users experience nausea, vomiting, diarrhea, abdominal pain, and constipation for the first few months of using it. Ozempic’s digestive symptoms mostly take place in the beginning of treatment or when upping your dosage, so it most likely won’t be chronic. Once your body gets a hang of Ozempic, unpleasant digestive symptoms should go away.
Other side effects Ozempic can cause are dizziness, fatigue, and hypoglycemia. Hypoglycemia is low blood sugar, and the glucose lowering effects of Ozempic are what can cause it. Hypoglycemia isn’t likely unless a person already has low blood sugar before taking Ozempic, but it is still something to keep an eye on. Low blood sugar can also cause dizziness and fatigue. Sugar gives your body energy, and without much of it, you can feel fatigued or dizzy.
Low blood sugar is a relatively easy problem to get rid of. Getting food or a snack into your system when you feel it coming on can help ward low blood sugar away. One thing you should do to avoid low blood sugar when taking Ozempic is to make sure you eat consistently. One side effect of Ozempic, and a large reason for the weight loss effects, is that it significantly lowers the appetite. Even when you aren’t hungry, you should still make sure to eat regularly to avoid that possibility. You won’t want to eat as much as you used to, but as long as you eat, you should do fine.
Another side effect you should expect from Ozempic is one that affects the skin. Ozempic can cause users to experience saggy skin. This saggy skin can happen because of the rapid weight loss Ozempic causes. Many people long for rapid weight loss, but something that isn’t discussed as often is the saggy skin that can result from it. Losing weight quickly can lead to saggy skin, and skin will sag most wherever it holds the most fat. Since many people store a lot of noticeable fat in their faces and in their backsides, the nicknames “Ozempic face” and “Ozempic butt” have been used to describe this side effect.
If you are unsure about Ozempic, or maybe another weight loss tactic, you can try Dr. Emil’s Carb control complex. It is made with several ingredients that contribute to weight loss, will help manage your weight, control your carb intake, and regulate your blood sugar.
Ozempic Dosage
Ozempic will take your body some getting used to, so your doctor will start you off with a low dose and raise it over time. The highest amount of Ozempic you can take per week is 2 mg per week, and the doctor will likely start you off with 0.25 mg per week. This is done to give your body time to properly adjust to the medication. Every four to five weeks, your dosage will be increased until you are taking the right amount for you. Most Ozempic users don’t need to go past 0.5 mg per week, but your body could always mesh best with a different dosage.
What Insurance Covers Ozempic?
Every insurance company operates differently and offers different drawbacks and benefits. When it comes to Ozempic, some companies cover it and some don’t. And some cover it with stipulations attached. You might find that you have the perfect insurance to get Ozempic, or you might have to switch over to get what you want. There is also a chance that your insurance covers the active substance in Ozempic under a different brand name. We’ve got all that information for anyone with one of the major insurance plans.
Does Kaiser Permanente Cover Ozempic?
Kaiser Permanente does cover Ozempic, and it covers it for diabetes and for weight loss with some stipulations. In order for Kaiser to approve your Ozempic prescription, you have to meet some minimum criteria. You have to be 18 or older, following a diet and exercise program, and have the right BMI.
You can get a prescription with a BMI of 30 and up, or with a BMI of 27-29 if your weight is comorbid with hypertension, diabetes, and hyperlipidemia. Kaiser also requires that patients with a BMI of 27-29 to have tried and failed to use certain remedies beforehand. You have to have tried two out of these four medications: phentermine, diethylpropion, Qsymia, and Contrave. If two out of four of these didn’t work for you, or you have an allergy to one of them, Kaiser will cover your Ozempic. Kaiser will cover Ozempic for 3 months for anyone who meets the above criteria.
Though an extra stipulation for having Ozempic covered with Kaiser is to be a Kaiser NorthWest member. Only Kaiser NorthWest members can get Ozempic covered for weight loss. Kaiser NorthWest covers the northwestern region of the country, rather than the whole western region that Kaiser normally covers.
There are different requirements for patients who need Ozempic for diabetes. If you are diagnosed with type II diabetes with ASCVD, Kaiser will cover your prescription if you have no family history of medullary thyroid carcinoma or MEN 2. If you are diagnosed with diabetes without ASCVD, Kaiser will cover you if you have an intolerance with drugs like pioglitazone, one a daily dose of insulin, and if you are 13 and up.
Does Aetna Cover Ozempic?
Atena covers Ozempic for people in certain states. It covers it for people in New Jersey, Maryland, Florida, and Kentucky. In Pennsylvania and Florida, it is even covered for kids. Atena will cover Ozempic for people in these states, but there is a stipulation that Ozempic must be used in combination with diet and exercise to lower the glycemic index of a patient with diabetes, or to reduce the risk of major cardiovascular issues like cardiovascular disease and strokes.
Aetna won’t cover Ozempic for anyone with a history of pancreatitis, because studies have not yet been done on those types of patients. They also won’t approve it for use for anyone with type I diabetes. To get Aetna to cover Ozempic, on top of being diagnosed with type II diabetes, you also have to prove that the drug metformin didn’t work for you. You must take metformin, an anti-diabetes medication, for at least 60 days before Aetna will approve you for Ozempic.
Another factor that will lead Aetna to approve your Ozempic is if you either have an established cardiovascular disease, or if you have multiple cardiovascular risk factors. Another criteria is that you need to require combination therapy and have a hemoglobin A1c of 7.5 percent or more. Once you meet any combination of criteria for Aetna to cover your Ozempic, you will have it covered for one year.
Does Blue Cross Blue Shield Cover Ozempic?
Blue Cross Blue Shield covers Ozempic under specific circumstances. It will depend on your location and the specific Blue Cross Blue Shield plan you have whether your Ozempic is covered. BCBS will need your medical information from your primary care provider to determine if you fit the medical requirements for Ozempic coverage. That can include people with type II diabetes or people with a risk of cardiovascular illness due to excess weight.
Blue Cross Blue Shield also offers patients other cost saving measures. It covers some generic forms of Ozempic rather than just the name brand. Generic versions come with a different name but work about as well, and come with a significantly reduced price tag. Generic versions of Ozempic are Semaglutide. Semaglutide is the active ingredient in Ozempic and will work as well with a cheaper price. Whereas Ozempic can cost over 1,000 dollars per month, Semaglutide can cost anywhere from 100 to 300 dollars per month.
Another cost saving measure that BCBS offers is a mail order pharmacy. Their mail order pharmacy offers discounts if you use them for your prescription drugs rather than any local pharmacy. They also offer prescription assistance programs that can provide customers with additional savings on their Ozempic prescription.
Does Medicaid Part D Cover Ozempic?
Medicare Part D covers Ozempic, but only when used for type II diabetes. Since Ozempic isn’t FDA approved for weight loss purposes, Medicaid counts using it for weight loss as an off label use. They don’t cover medication that is used off label, but as long as you have a prescription to treat type II diabetes, you can easily have your Ozempic covered by Medicaid Part D.
Medicaid Part D is the part of Medicaid that covers prescription drugs. Part A covers hospital, nursing home, and hospice stays, Part B covers doctor’s appointments, outpatient care, and ambulance services, and Part C covers additional benefits like dental and vision. Depending on your plan, Medicaid can cover all or most of the cost of your Ozempic prescription.
If you are insured by any one of these companies, you are likely to get coverage for Ozempic as long as you meet their criteria. Now that you know what the criteria is for these major insurance companies, you can now decide whether to stick with your insurance or switch it up for better chances of coverage. Pairing up with the right insurance company will help you get the right kind of treatment.
