Ozempic is a brand-name GLP-1 widely prescribed for type 2 diabetes, and that diagnosis is the key to Medicare coverage. Here is how it works in 2026.
When does Medicare cover Ozempic?
Medicare Part D may cover Ozempic (semaglutide) when it is prescribed to treat type 2 diabetes and your plan lists it on its formulary. Because Ozempic is FDA-approved for diabetes, not weight loss, plans can pay for it under that diagnosis. Medicare cannot cover it when the sole purpose is weight loss. Many plans apply prior authorization, step therapy, or quantity limits, so the same drug can be easy to get on one plan and restricted on another. A free formulary check at 1-800-MEDIGAP confirms your specific coverage.
What does Ozempic cost on Medicare in 2026?
When Ozempic is covered for diabetes, you pay your plan's cost-sharing for its formulary tier, and that spending counts toward the 2026 Medicare Part D $2,100 annual out-of-pocket cap. Once you hit $2,100 in covered drug costs, you pay nothing more for covered prescriptions that year. Exact monthly cost varies by plan tier, deductible, and pharmacy. Because two plans can price the same drug very differently, comparing formularies before you enroll is the best way to lower your cost. Call 1-800-MEDIGAP for a free side-by-side review.