What Ozempic is used for
Ozempic is a once-weekly GLP-1 injection. Its FDA label covers improving blood sugar in adults with type 2 diabetes, reducing the risk of major cardiovascular events in adults with type 2 diabetes and heart disease, and reducing the risk of kidney disease getting worse in adults with type 2 diabetes and chronic kidney disease. It isn't approved for weight loss; Wegovy is the semaglutide brand for that.
This page explains Medicare coverage only. Questions about whether Ozempic is right for you belong with your prescriber.
Which part of Medicare covers Ozempic
You inject Ozempic yourself at home, so it's a Part D drug. Federal law excludes drugs used for weight loss from Part D, which is why plans may use prior authorization to confirm you have type 2 diabetes before they pay for Ozempic.
Is Ozempic on Medicare's negotiated-price list?
CMS selected semaglutide (Ozempic, Rybelsus and Wegovy, as one selected drug) in the second round of the Medicare Drug Price Negotiation Program. CMS says its negotiated price takes effect January 1, 2027. A negotiated price is what Medicare drug plans and pharmacies pay; it isn't your copay. What you pay still depends on your plan's cost sharing.
Ozempic, weight loss and the Medicare GLP-1 Bridge
From July 1, 2026, through December 31, 2027, CMS runs the Medicare GLP-1 Bridge, which covers certain GLP-1 drugs for weight management for eligible people with Part D at a flat monthly copay set by CMS. Ozempic isn't one of them: the Bridge covers Wegovy, Zepbound (KwikPen only) and Foundayo. Medicare.gov also says people with type 2 diabetes aren't eligible for the Bridge, because their Part D plan may cover a GLP-1 for diabetes instead. More in Does Medicare cover weight-loss drugs?
What you pay for Ozempic in 2027: the out-of-pocket cap
Your cost for Ozempic depends on your plan: its deductible, the tier it puts the drug on, and whether you use a preferred pharmacy. This site doesn't list plan costs; your plan's formulary and Evidence of Coverage do. What Medicare sets for everyone with Part D is the limit:
- 2027 out-of-pocket cap: $2,400 (it was $2,100 in 2026). Once what you pay for covered Part D drugs (deductible, copays and coinsurance) reaches the cap, you pay nothing more for covered Part D drugs for the rest of 2027.
- The maximum Part D deductible for 2027 is $700. No plan can set a higher deductible.
- Only covered drugs count. If your plan doesn't cover Ozempic and you pay cash, or you use a discount card instead of your plan, that spending doesn't count toward the cap.
Spreading the cost: the Medicare Prescription Payment Plan
The Medicare Prescription Payment Plan lets you pay your Part D drug costs in monthly bills from your plan across the calendar year instead of all at once at the pharmacy. Medicare.gov says there's no cost to participate, but it doesn't lower your drug costs; it only changes when you pay. It helps most when costs are high early in the year. To join, call your plan or use its website. More in What is the Medicare Prescription Payment Plan?
Extra Help with Ozempic
Extra Help (the Low-Income Subsidy) is a federal program that lowers Part D premiums, deductibles and copays. For 2027, CMS caps Extra Help copays for covered drugs at $5.80 for a generic and $14.40 for a brand-name drug, and some people with full Medicaid pay less. You get Extra Help automatically if you have OHP (Medicaid), a Medicare Savings Program or SSI; otherwise apply through Social Security at 1-800-772-1213 or ssa.gov/extrahelp. See Extra Help in Oregon.
Getting Ozempic covered in Oregon
Where you live in Oregon changes your choices. CMS data show no Medicare Advantage plan open to everyone in Grant, Harney, Lake, Umatilla or Union counties for 2027 (only employer group plans), and only a special needs plan in Curry County. If you live there, coverage for Ozempic usually comes from a standalone Part D plan alongside Original Medicare, unless you have employer or other drug coverage. Check your county's numbers on Oregon counties.
If you have both Medicare and OHP, OHP doesn't pay for drugs that Part D covers. The Oregon Health Authority calls this "OHP with Limited Drug": you need a Part D plan (or a Medicare Advantage plan with drug coverage) for Ozempic, and you qualify for Extra Help automatically. See OHP and Medicare.
Oregon and Washington share Part D region 30, so standalone Part D plans are offered region-wide. For 2027, Oregon has 8 standalone Part D plans from 4 companies, plus Medicare Advantage plans with drug coverage in most counties (61 open to everyone statewide). Each plan has its own formulary, so one plan's coverage of Ozempic tells you nothing about another's.
How to check whether a plan covers Ozempic
- Write down the exact drug. Name, strength and how often you take it. A plan can cover one form of Ozempic and not another.
- Look it up in each plan's formulary. Enter your drugs and ZIP code on PlanMatch or Medicare.gov's Plan Finder to see which plans list Ozempic and any rules.
- Read the rules next to the drug. Prior authorization, step therapy or quantity limits mean your prescriber may need to send the plan information before it pays.
- Check your 2027 notice. Your plan's Annual Notice of Change says whether Ozempic stays on the formulary next year. Open Enrollment runs October 15 to December 7, 2026, for coverage starting January 1, 2027.
- Get help if you want it. You can request a call from a licensed insurance agent, who can compare plans from the companies they work with, or call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) for information on all of your options.
If your plan doesn't cover Ozempic, you or your prescriber can ask for a coverage determination or a formulary exception. Once the plan has your prescriber's supporting statement, it generally must decide within 72 hours, or 24 hours if your prescriber says waiting could seriously harm your health. New members can usually get a one-time transition supply of a drug they were already taking while they ask for an exception or switch. See How do I appeal a Medicare denial in Oregon?
Sources
- National Library of Medicine — DailyMed: Ozempic prescribing information (FDA label)
- Medicare.gov — Drug coverage (Part D)
- CMS — Selected drugs and negotiated prices (Medicare Drug Price Negotiation Program)
- CMS — CY 2027 Rate Announcement (2027 Part D out-of-pocket threshold and Extra Help copays)
- Medicare.gov — Medicare GLP-1 Bridge
- CMS — Medicare GLP-1 Bridge (July 1, 2026 – December 31, 2027)
- Medicare.gov — Medicare Prescription Payment Plan
- Social Security — Extra Help with Medicare prescription drug plan costs
- CMS — Part D plan files record layout (PDP Region 30: Oregon, Washington)
- Oregon Health Authority — OHP and Medicare
Frequently asked questions
Will Medicare cover Ozempic for weight loss?
No. Part D can't cover drugs used for weight loss alone, and Ozempic isn't part of the Medicare GLP-1 Bridge. Ozempic is covered for type 2 diabetes and its related heart and kidney uses.
When does Ozempic's Medicare negotiated price start?
January 1, 2027. CMS negotiated one price for semaglutide that covers Ozempic, Rybelsus and Wegovy when a Part D plan covers them.
Does the 2027 Part D out-of-pocket cap apply to Ozempic?
Yes, when your Part D plan covers Ozempic. In 2027, once you've paid $2,400 for covered Part D drugs, you pay nothing more for covered Part D drugs for the rest of the year.
What if my plan doesn't cover Ozempic?
Ask the plan for a coverage determination or formulary exception, with a supporting statement from your prescriber, or compare plans during Open Enrollment, October 15 to December 7. New members can usually get a transition fill while they ask.
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