How to Quality for an Ozempic Prescription: Steps (2024)

Many people want to know if they need a prescription for Ozempic (semaglutide) and what is the best way to get it.

While you do need a prescription for Ozempic, insurance coverage will vary and not everyone qualifies. You will need to speak with a healthcare provider, as they will determine whether Ozempic is right for you.

Ozempic is an injectable prescription medication used to manage blood sugar in people with type 2 diabetes and lower the risk of heart events like heart attack and stroke in adults with both type 2 diabetes and heart disease.

Ozempic has also been popularly discussed for its uses in weight loss. However, this use has not been approved by the Food and Drug Administration (FDA). Still, healthcare providers sometimes prescribe it off-label. Off-label use is when a drug is prescribed for non-FDA-approved uses.

This article will describe the process of receiving a prescription for Ozempic, who qualifies to take the medication, and getting Ozempic with and without insurance coverage.

To Get Ozempic, You Will Need to Qualify

Because Ozempic is a prescription drug, you will need to talk to a licensed healthcare provider to determine if you're qualified to get this medication. You can do this at an in-person appointment or sometimes online via telehealth.

The following steps outline the general process for getting an Ozempic prescription:

1. Make an appointment with a licensed provider, such as a primary care provider, nurse practitioner, physician's assistant, or endocrinologist. You may also be able to set up a telehealth visit with a licensed healthcare provider to discuss whether getting a prescription for Ozempic is right for you.
2. Before prescribing Ozempic, your healthcare provider may order some blood tests, such as your blood glucose level and your hemoglobin A1c (a measure of blood sugar control over a three-month period).
3. At your visit, your provider will take vital statistics, such as your weight and blood pressure reading. They may ask you questions about your medical and family histories.
4. If you qualify for an Ozempic prescription, your healthcare provider can send it to your preferred pharmacy.

Reasons Providers Prescribe Ozempic

Healthcare providers prescribe Ozempic to adults with type 2 diabetes. They also prescribe it off-label for weight loss.

You may qualify for an Ozempic prescription for either of the following:

Diabetes

Ozempic is used to help control blood sugar levels in adults with type 2 diabetes. It is also used to lower the risk of major heart events in people with both type 2 diabetes and heart disease, such as stroke, heart attack, or death due to heart disease. Note that Ozempic is not FDA-approved for use in people with type 1 diabetes.

For people with diabetes, it is important to control blood sugar levels to help decrease the risk of diabetes-related complications like kidney failure, eye problems, and nerve damage.

Off-Label for Weight Loss

Although Ozempic is not specifically approved for weight loss, healthcare providers may prescribe it off-label for this use. Generally, they will use guidelines to decide who needs Ozempic.

For example, it may be prescribed to an adult with obesity, defined as having a body mass index (BMI) of 30 kilograms (kg)/meters squared (m2) or more. Or, it may be prescribed to an adult with overweight, with a BMI of 27 kg/m2 or more, who has other risk factors such as high blood pressure, type 2 diabetes, or high cholesterol.

Clinical trials have found Ozempic to be very effective in controlling blood sugar levels. It is also associated with a reduction in body weight, although it is not FDA-approved for weight loss. Healthcare providers generally recommend combining Ozempic with other measures like a healthy diet and increased exercise.

For dietary advice, you may want to consult a registered dietitian or certified diabetes care and education specialist (CDCES).

Getting Ozempic With Insurance

Ideally, your insurance plan will cover your Ozempic prescription with a reasonable co-pay. However, even though you have prescription insurance, coverage will vary. If Ozempic is covered, out-of-pocket costs will vary by plan. Here are some (but not all) possible scenarios:

• Some insurance plans will cover Ozempic for diabetes but not for weight loss.
• Some insurance plans will cover Ozempic for either diabetes or weight loss.
• Some insurance plans will require prior authorization to consider covering Ozempic. In this case, your healthcare provider must provide additional information to the insurance company explaining why they should cover your prescription.

Every insurance plan is different. There are several ways to find out if Ozempic is covered:

• You can contact your health plan directly for the most recent information on coverage and pricing estimates.
• You can use Novo Nordisk's coverage lookup tool.
• You can have your pharmacy staff process your prescription. They can let you know if the medication is covered and help expedite the prior authorization process if necessary.

For those with Medicare prescription plans, coverage will also vary. You can also look into the Low Income Subsidy (LIS)/Extra Help program and see if you are eligible to qualify. Coverage for Medicaid varies by state.

You can check Novo Nordisk's website for savings coupons. For people with certain types of insurance coverage, the manufacturer offers a savings coupon with which people can pay as low as $25 for up to a three-month supply.

Getting Ozempic Without Insurance

If your insurance does not cover Ozempic or if you do not have prescription insurance, you can still purchase the medication as long as you have a prescription. However, Ozempic is not inexpensive. Without insurance or discounts, a one-month supply (of any dosage) costs about $969.

If you do not have insurance or do not have insurance coverage for Ozempic, there are some ways to save:

• See if you qualify for the Novo Nordisk Patient Assistance Program (PAP).
• Contact Novo Nordisk for other financial assistance options.
• Ask your healthcare provider if they have any samples of Ozempic.
• Use a prescription discount card at a participating pharmacy.

Be Wary of Deals That Seem Too Good to Be True

The best way to get Ozempic is to get a prescription from a licensed healthcare provider and fill your prescription at a reputable local or online pharmacy. Watch for deals that seem too good to be true, as these may be scams, which can be potentially unsafe. Do not use companies that offer Ozempic without a prescription.

If you are looking for an online pharmacy, you can search for a licensed pharmacy on the FDA's website. According to the FDA, a legitimate online pharmacy will fulfill certain requirements, such as:

• Requiring a prescription from a licensed healthcare provider
• Having a physical address and phone number in the United States.
• Employing licensed pharmacists who can answer your questions
• Holding a current license with a state board of pharmacy

You may also see advertisem*nts for compounded semaglutide products (those that have been combined with another drug, mixed, or altered). The FDA does not recommend using these products, noting some concerns such as:

• Compounded semaglutide products are not reviewed by the FDA for safety and efficacy.
• Some compounded semaglutide products contain slightly different ingredients than the FDA-approved medicine.
• The FDA has received adverse event reports from people who have used compounded semaglutide.
• The FDA has found counterfeit semaglutide online, meaning these products may contain the wrong ingredient(s), too little or too much, no active ingredient, or other harmful ingredients.

When to Consider Ozempic Alternatives

When should you consider an Ozempic alternative? Only your healthcare provider can help you determine which medication is best for you, considering various factors, such as coexisting health conditions (comorbidities) and other medications you may be taking.

That being said, there are various alternatives you can discuss with your healthcare provider.

Alternatives to Ozempic for type 2 diabetes include:

• Rybelsus (semaglutide), a once-daily tablet (may be preferred by people avoiding injectable drugs)
• Mounjaro (tirzepatide), a once-weekly injection
• Trulicity (dulaglutide), a once-weekly injection
• Metformin, a commonly prescribed oral medication taken daily (a first-line diabetes drug due to its safety, effectiveness, and low cost)

Alternatives to Ozempic for weight loss include:

• Wegovy (semaglutide): This once-weekly injectable drug is FDA-approved for weight loss. The starting doses are the same, but Wegovy goes up to a slightly higher dose than Ozempic. Wegovy, like Ozempic, is made by Novo Nordisk. The website offers a coverage lookup tool and various ways to save on Wegovy for those with or without insurance. In clinical studies, participants lost an average of 15% of body weight or an average of about 34 pounds.
• Zepbound (tirzepatide): This is a once-weekly injection that is FDA-approved for weight loss in individuals who qualify based on BMI and risk factors. In clinical studies, people who took tirzepatide at the highest doses lost up to 21% of body weight.
  

Summary

Ozempic is a prescription medication primarily used to manage type 2 diabetes and is sometimes prescribed off-label for weight loss. To acquire Ozempic, you need a prescription from a licensed healthcare provider, which can be obtained through an in-person or telehealth visit.

Insurance coverage for Ozempic varies, so it's important to check with your provider and explore financial assistance options if needed. Always obtain Ozempic from a healthcare provider to ensure safety and efficacy.