Does Medicaid pay for Ozempic or Mounjaro?
Asked by: Miss Joelle Kessler DVM | Last update: January 8, 2026Score: 4.3/5 (62 votes)
Does Medicaid cover Ozempic or Mounjaro?
GLP-1 medications prescribed off-label for weight loss, such as Ozempic (semaglutide), are usually covered by Medicaid if they're taken to treat Type 2 diabetes (their FDA-approved use). States that cover weight-loss medications under Medicaid may require prior authorizations, and they may also restrict quantities.
Does Medicaid cover any weight loss programs?
Eight state Medicaid programs appear to cover all recommended obesity treatment modalities for adults. Only 10 states appear to reimburse for obesity-related treatment in children.
Is Mounjaro covered by Medicare or Medicaid?
Currently, Medicare allows coverage through Part D plans for GLP-1 drugs that the FDA has approved for T2DM and CVD. As of August 2024, Ozempic, Mounjaro, Rybelsus, and Wegovy are considered covered Part D drugs for the treatment of those conditions.
How do you get Mounjaro covered?
- Talk to your medical team. ...
- Review your insurance plan's formulary. ...
- Obtain a prior authorization if required. ...
- Request an appeal if necessary.
Insurance companies changing coverage for weight loss drugs
How much is Mounjaro without insurance at Walmart?
How much is Mounjaro at Walmart? According to Optum Perks, a person without insurance may expect to pay approximately $1,000 for Mounjaro at Walmart. According to Optum Perks, a person without insurance may expect to pay approximately $1,000 for Mounjaro at Walmart.
Does Medicare Medicaid pay for Ozempic?
Yes, Ozempic is usually covered under Medicare and state Medicaid programs to treat type 2 diabetes, but not for weight loss. Coverage can differ among participants and states, so it's best to check directly with your plan and ask if Ozempic is on the current year's formulary and what the restrictions are, if any.
How much does Mounjaro cost without insurance?
How much does Mounjaro cost without insurance? Without insurance or coupons, Mounjaro typically costs between $1000 to $1200 for a month supply. Most commercial health insurance plans will only cover Mounjaro if it has been prescribed for type 2 diabetes.
Is Mounjaro better than Ozempic?
Several studies have shown that Mounjaro is more effective than Ozempic for blood sugar control and weight loss. In the SURPASS-2 trial, tirzepatide outperformed semaglutide in reducing A1C levels.
Will Medicaid pay for Wegovy?
The FDA has approved three GLP-1s for the treatment of obesity, Saxenda (liraglutide), Wegovy (semaglutide), and Zepbound (tirzepatide), and state Medicaid coverage of these is optional.
Does Medicaid cover belly fat removal?
Medicaid does not cover liposuction.
This is because it is classified as a cosmetic procedure. Cosmetic surgeries are not considered medically necessary. They aim to improve appearance rather than address health issues.
Will Medicaid pay for Ozempic for PCOS?
People prescribed Ozempic may be surprised to find that Medicaid does, in some cases, cover the drug. But it's not a guarantee; Medicaid only covers Ozempic if certain criteria are met, such as if you're taking it for diabetes instead of solely for weight loss.
How do I get Ozempic for $25 a month?
With the Ozempic® Savings Card, you may PAY AS LITTLE AS $25b for a 1-month, 2-month, or 3-month supply for up to 48 months. To receive offer, prescription must be for a 1-, 2-, or 3-month supply. Savings card offer applies to eligible commercially insured patients with coverage for Ozempic®.
How do I get my Ozempic covered?
If you have health insurance, you may be able to get Ozempic covered if it's being used as a treatment for Type 2 diabetes. But you may not get coverage if you don't have diabetes and want to use the medication for weight loss.
How to get Mounjaro without diabetes?
Individuals without diabetes may still qualify for Mounjaro if their healthcare provider determines it is suitable for their weight loss goals. The provider will consider overall health, weight-related medical conditions, and previous weight loss efforts.
Is Mounjaro covered by Medicaid?
Over 80 million Americans received Medicaid assistance in 2023, and it sometimes covers Mounjaro for diabetes treatment. In 2022—the year Mounjaro hit the market—Medicaid dispersed nearly $30 million to help beneficiaries pay for it, according to KFF data. Yet that's not necessarily a guarantee.
Can you lose 20 pounds in a month on Mounjaro?
According to data from randomised controlled trials, Mounjaro supports weight loss of around 4% of body weight after one month. After two months, it's around 6% of body weight.
How to get Mounjaro for free?
Ask about free samples of Mounjaro
If your prescriber doesn't have any samples on hand, they may be able to request some from the manufacturer. Eli Lilly, the manufacturer of Mounjaro, provides a request form on its website. Only prescribing healthcare professionals may request samples.
Why is Ozempic denied by insurance?
Ozempic use for weight loss is considered “off-label” and is not approved by the FDA. Insurance companies may not pay for “off-label” or unapproved uses of drugs.
What diagnosis will cover Ozempic?
Most insurance companies will only cover Ozempic for its FDA-approved indication of treating type 2 diabetes. Some plans require additional criteria to be met, such as having tried other medications for diabetes first or having a certain severity of disease.
How do I get Ozempic if my insurance won't pay?
Novo Nordisk also offers a patient assistance program that provides Ozempic at no cost. To be eligible, you must be a U.S. citizen or legal resident with a total household income at or below 400% of the federal poverty line.
Which is cheaper Ozempic or Mounjaro?
Zepbound (tirzepatide) has been set at a list price of $1,060 per month before insurance. Mounjaro (tirzepatide) usually costs between $1,020 to $1,200 per month before insurance. Ozempic (semaglutide) usually costs between $850-$1,000 per month before insurance.
Do you gain weight back after stopping Mounjaro?
Weight gain is common when you stop GLP-1 weight loss medications like Mounjaro, and studies show people can put up to 14% of their weight back on. When you stop Mounjaro, its beneficial effects stop too. Some people notice an increase in their appetite and may revert back to their previous diet.