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Ozempic Medicare coverage

semaglutide

Used for Management with Incretin-based Therapies, Diabetes Type 2

Ozempic Coupon - Ozempic 1 prefilled 2mg pen of 2mg/3ml carton

Ozempic (semaglutide) is a prescription injection used with diet and exercise to help manage Type 2 diabetes in adults. It's also FDA approved to lower the risk of heart attack, stroke, and heart-related death in those with Type 2 diabetes and heart disease. In addition, it can reduce the risk of worsening kidney problems in people with Type 2 diabetes and chronic kidney disease (CKD). Ozempic (semaglutide) is a GLP-1 agonist that's injected under the skin once a week. Common side effects include nausea, vomiting, and diarrhea.

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Price with GoodRx coupon

Avg retail price
$1184.71(Save 83.20%)
Manufacturer exclusive discount
$199.00
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Medicare: Your GoodRx guide

Learn the ins and outs of Medicare with our comprehensive guide that covers eligibility, coverage, costs, and more.

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Common Medicare glossary terms
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Annual Notice of Change (ANOC):

The Medicare Annual Notice of Change (ANOC) is a letter for people enrolled in Medicare Advantage plans and anyone with Medicare Part D prescription coverage. People with Medicare Advantage or original Medicare (Part A and/or Part B) can have Part D plans. The ANOC informs enrollees about any changes to their benefits for the coming coverage year. By law, Medicare Advantage and Part D plans must send the ANOC to enrollees by September 30 — which is before the annual Medicare open enrollment period of October 15 to December 7. Even if you have the same plan, your benefits could change year to year.

Premium:

A premium is the cost of having a health insurance plan and is usually paid monthly. Medicare enrollees may pay several premiums. Most people don’t pay anything for Part A hospital insurance, but some people do depending on how long they worked and paid taxes. For outpatient and preventive coverage, the Part B standard premium is $185 a month in 2025, but people with higher incomes pay more. Your premium for Medicare Advantage plans will vary, but even so-called “zero premium” plans require you to pay your Part B premium. Part D premiums range in price, but the average is about $47 a month in 2025. If you have original Medicare and a Medigap supplement plan, you have an additional premium for that coverage.

Deductible:

A deductible is the amount you pay out of pocket before your Medicare plan begins cost-sharing. In 2025, the Part A deductible is $1,676 per benefit period. The Part B deductible is $257 for the year, but you can access certain preventive care — including some vaccines — without meeting your deductible. Medicare Advantage deductibles vary and your Part D deductible can’t exceed $590 in 2025.

Out-of-pocket limit:

Original Medicare has no annual out-of-pocket maximum. Medicare Advantage plans have out-of-pocket limits. In 2025, they are $9,350 for in-network covered services and $14,000 for in-network and out-of-network covered services combined.

Medicare Prescription Payment Plan:

Starting January 1, 2025, anyone with Part D coverage had the option to use the Medicare Prescription Payment Plan for their out-of-pocket medication costs instead of paying upfront at the pharmacy. This plan doesn’t provide savings, but allows you to spread prescription costs — including your deductible — over the year. Making payments can be particularly helpful for people who may skip or delay picking up prescriptions because of high costs early in the year. Also in 2025, the Part D out-of-pocket limit dropped to $2,000.

Initial coverage phase:

After a Medicare enrollee meets the Part D deductible (if the plan has one), the health insurance begins cost sharing. The initial coverage phase means you pay coinsurance or a copay for covered prescriptions.

Catastrophic phase:

When you reach the $2,000 out-of-pocket maximum, your Part D plan pays for 100% of covered medications for the rest of the year.

Medication ready
How to save on drugs with Medicare

Medicare Part D is the part of Medicare that helps cover prescription medications, including both brand name and generic. It also includes coverage for certain vaccines that aren’t covered by Part B, as well as some medical supplies.

Even with Medicare Part D coverage, you may still have out-of-pocket costs such as premiums, deductibles, copayments, and coinsurance. As of 2025, Medicare Part D plans include a $2,000 annual out-of-pocket cap. Once you reach this limit, your plan covers the full cost of your covered medications for the rest of the year.

Still, there are several ways to reduce your prescription medication cost. From GoodRx coupons to patient assistance programs, here are ways you can save money on the medications you need.

1. See if you qualify for Medicare’s Extra Help program

The Medicare Extra Help/Low-Income Subsidy program is a federally funded program for people covered under a Medicare Part D plan. It helps reduce enrollees’ out-of-pocket costs by limiting their deductibles and copays. To qualify, your income and assets fall below a certain limit.

If you’re eligible, you may receive:

  • No monthly premiums for Medicare Part D

  • No Medicare Part D deductible

  • Low copays for prescription medications

2. Use GoodRx coupons

You can’t combine GoodRx coupons with Medicare, but you can choose to use a coupon instead of your insurance if it results in a lower price.

Here’s how to download a GoodRx coupon:

  1. Go to the GoodRx website, or download the GoodRx app on your phone.

  2. Search for your prescription medication.

  3. Enter your prescribed dose and quantity, then set your location.

  4. Compare prices across different pharmacies in your area.

  5. Click “Find the lowest prices” or press “Enter.”

  6. You can have the coupon sent by text or email, or print it out.

  7. To apply the discount, show the coupon at the pharmacy when you fill your prescription. Ideally, this is done at drop-off before the prescription is filled.

3. Consider the Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan is a new program that can help make paying for medications more manageable. It’s open to anyone with a standalone Part D plan or those with Medicare Advantage plans that offer prescription medication coverage.

There is no cost to participate in the Medicare Prescription Payment Plan and participation is voluntary. Instead of paying for the total cost of your medications up front at the pharmacy, the payment plan allows you to spread the cost into smaller payments during the year. If you join, you will continue to pay your premium every month as well as an additional monthly amount on your payment plan. It’s a good idea to review how the Medicare Prescription Payment Plan works to determine if it’s right for you.

4. Compare Part D plans during open enrollment

Medicare open enrollment, which takes place every year from October 15 to December 7, is your chance to switch plans if another option offers better prescription medication coverage or lower costs. Plan costs and coverage details can change each year, so it’s important to review your options.

Here are some steps to help you compare plans:

  1. Make a list of all your medications and what dosages you take.

  2. Enter the names of your prescription medications to see which plans offer the best coverage.

  3. Look at premiums, deductibles, and medication costs for each plan. Plans usually change their formularies, premiums, and copays annually.

  4. Check if your preferred pharmacy is in each plan's network.

5. Get a 90-day supply

Opting for a 90-day supply instead of a monthly refill of your medication might help reduce your long-term out-of-pocket costs. Many insurance plans offer lower copays or bulk pricing for 3-month prescriptions.

If your medication is covered under your plan, see if your insurer’s mail-order or specialty pharmacy provides savings on a 90-day supply. If they do, ask your prescriber to write a prescription for a 90-day quantity to take advantage of these potential savings.

6. Ask about the generic version of your medication

Some medications have a generic version, and they generally cost less than the brand-name prescriptions. Generic medications are just as safe and effective as brand-name medications, so it’s an option worth considering to reduce your cost. Ask your prescriber about switching to a generic version of your medication to save money.

7. Consider lower-cost alternative medications

There may be other medications that help manage your condition, and they may cost less. If your medication is costly or not covered by your insurance, talk to your prescriber about lower-cost alternatives that might be a good option for you. Alternatives might have better insurance coverage or lower costs.

8. Learn more about patient assistance programs

Patient assistance programs (PAPs) offer free or low-cost medications to uninsured and low-income consumers. These programs, which primarily offer savings on brand-name medications, are usually run by private pharmaceutical companies or nonprofit organizations. You must meet certain qualifications and complete paperwork to receive savings from PAPs. However, some PAPs exclude Medicare recipients, so it’s important to review the program’s rules and requirements carefully.

9. Check state-funded resources

Depending on where you live, your state may offer programs to help you navigate prescription medication costs. A good place to start is your local Department of Aging. This U.S. Department of Health and Human Services office can help you find the best Medicare plan for the coverage you need.

Some states even have their own cost-saving programs for older adults. For example, Pennsylvania runs PACE and PACENET. These programs help eligible residents get prescription medications at reduced costs.

Alternatively, you can find out if your state has a State Pharmaceutical Assistance Program by using Medicare’s search tool. These programs are state-run and help qualifying residents pay for prescription medications.

10. Use a health savings account to pay for prescription medications

Although you can’t contribute to a health savings account (HSA) after enrolling in Medicare, you can still use any remaining funds in your account to pay for qualified medical expenses. An HSA allows you to use tax-free dollars to pay for eligible prescription medications. The money in your account does not expire so you can use your funds at any time to reduce your out-of-pocket medication costs.

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Frequently asked questions about Ozempic

Frequently asked questions about Ozempic

No, Ozempic itself isn’t available as a pill. Ozempic is a brand-name injectable Type 2 diabetes medication that contains semaglutide. But there are oral (pill) versions of semaglutide, the same active ingredient in Ozempic. For several years, Rybelsus, which is also used for Type 2 diabetes, was the only oral semaglutide product available. As of January 2026, there’s now also an oral Wegovy pill, FDA approved specifically for weight loss. The main difference between oral semaglutide pills and injections is how and when you take them. Injections like Ozempic and the Wegovy pen are administered once weekly and don’t have strict timing requirements around food, drinks, or other medications. Oral semaglutide pills like Rybelsus and the Wegovy pill are taken once daily, first thing in the morning on an empty stomach, with no more than 4 oz of plain water. You’ll need to wait at least 30 minutes before eating, drinking other liquids, or taking other medications. In addition to the Wegovy pill, other oral weight-loss pill options include Qsymia (phentermine / topiramate ER), Contrave (naltrexone / bupropion), and Xenical or Alli (orlistat). While these medications haven’t been compared directly, the Wegovy pill may lead to greater weight loss than other oral options. Another oral medication that works like Wegovy is orforglipron, which may be approved in 2026.Learn more

The main difference between Wegovy and Ozempic, which both contain semaglutide, is their approved uses. Ozempic is FDA approved to treat Type 2 diabetes in adults, and to lower the risk of major adverse cardiovascular events (MACE) in people with Type 2 diabetes and heart disease. It's also approved to lower the risk of kidney disease worsening, kidney failure, and cardiovascular death in people with Type 2 diabetes and chronic kidney disease. Wegovy is approved for weight loss in certain adults and adolescents ages 12 and older, and to lower the risk of MACE in adults with heart disease and a larger body size. Wegovy is also available in higher doses of semaglutide compared to Ozempic.Learn more

The cost of Ozempic pens is $199* per month with GoodRx. This cost is available to eligible self-paying patients through a collaboration with Novo Nordisk, at over 70,000 retail pharmacies nationwide, with GoodRx. *Limited time offer: Only available for 2 monthly fills between 11/17/2025 – 3/31/26. For each fill after, pay $349/month for Ozempic® 0.25mg, 0.5mg or 1mg, and $499/month for Ozempic® 2mg. For eligible patients only. Learn more

Each new Ozempic pen should contain four doses. Specifically, this includes the 0.5 mg, 1 mg, and 2 mg maintenance doses. Each pen should last 4 weeks (about 1 month). Learn more

Nausea is the most common semaglutide side effect. Up to 20% of people receiving Ozempic for Type 2 diabetes reported nausea during clinical trials. And nausea was even more common with Wegovy for weight loss. Vomiting tends to be less common than nausea. You’re more likely to experience nausea and vomiting with higher semaglutide doses. Here are tips for managing nausea from semaglutide: Eat smaller, more frequent meals. Eat slowly and stop eating when you start to feel full. Avoid or minimize high-fat foods. Remain upright after you eat. Stay hydrated since dehydration can worsen nausea. Opt for low-fat, bland foods that are easy on your stomach. Try a home remedy, such as ginger. If these changes don’t seem to help, talk to your healthcare team about medication options. They may recommend an over-the-counter (OTC) or prescription nausea medication for relief. But if your nausea is accompanied by severe pain in your upper and middle abdomen, get medical attention right away. This could be a sign of pancreatitis, which has been reported with semaglutide.Learn more

People with Type 2 diabetes who received the 1 mg Ozempic dose lost about 10 lbs after 30 weeks (7 months) in a clinical trial. The 2 mg (highest) dose has been shown to result in about 15 lb of weight loss after 40 weeks (9 months). But it’s not unusual for people taking Ozempic to report losing even more weight. Keep in mind Ozempic (semaglutide) isn't approved for weight loss, but some people lose weight during treatment. Learn more

Ozempic (semaglutide) is a Type 2 diabetes medication. But some people report changes in their appetite and cravings after starting Ozempic, which can cause them to lose weight. This is thought to be due to how Ozempic affects areas of the brain responsible for regulating appetite and fullness. It may also lessen cravings or preferences for certain foods, such as fatty, energy-dense foods that can add extra calories. In fact, Ozempic’s effect on body weight is one of the reasons it may be prescribed in the first place. Even a small amount of weight loss can help make blood glucose levels easier to manage. And you may notice improvements in your blood pressure and cholesterol, too.Learn more

Ozempic (semaglutide) is an injectable medication that treats Type 2 diabetes in adults. Common Ozempic side effects include nausea, vomiting, diarrhea, and stomach pain. Constipation, headaches, and bloating are also possible. These side effects are often worse when starting Ozempic and after dose increases. For many people, they improve over time. While less common, more serious side effects such as pancreatitis, gallbladder problems, and acute kidney damage have been linked to the medication.Learn more

Ozempic (semaglutide) is an injectable Type 2 diabetes medication, but it's not insulin or a substitute for insulin. It works in several different ways to lower blood glucose (sugar) levels. These include telling your pancreas to release insulin after you eat, reducing glucose production in the liver, and slowing the movement of food out of the stomach. Ozempic's effects can work synergistically with insulin, so you may be prescribed both of them together.Learn more