Will my insurance cover Ozempic for PCOS?
Asked by: Nikki Oberbrunner | Last update: October 5, 2025Score: 4.1/5 (46 votes)
Does PCOS qualify for Ozempic?
Ozempic is FDA-approved for individuals with type 2 diabetes, but it has an off-label use for PCOS—meaning it's not approved for the condition. Ozempic has potential benefits like weight management and hormone balance for people with PCOS.
How much does Ozempic cost for PCOS?
If you qualify for insurance coverage, Ozempic can cost as little as $25 for a monthly supply. Without insurance, Ozempic costs around $968.52 per month, on average. However, savings programs can help lower the cost of the medication if you qualify.
What BMI do you need for insurance to cover Ozempic?
Eligibility for Ozempic often involves meeting a certain Body Mass Index (BMI) threshold. Typically, insurers require: A BMI of 30 or above (obesity), or. A BMI of 27 or above (overweight)
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.
The Truth About Ozempic for PCOS Weight Loss!
How do I get my insurance to approve Ozempic?
Obtain prior authorization, if needed.
If your insurance company requires prior authorization for Ozempic, your prescriber may need to provide confirmation that you have Type 2 diabetes and that the medication is medically necessary for treatment.
What conditions qualify for Ozempic?
Patients looking to use Ozempic must have a BMI of 30 or higher to qualify for the use if they do not have diabetes, but patients with a BMI between 27 to 30 can also be eligible if they have another condition (comorbidities) such as hypertension, high cholesterol, sleep apnea or hormonal conditions that can impede the ...
Is Ozempic hard to get covered by insurance?
Official answer. Most commercial prescription plans cover some or all of the cost for Ozempic when used to treat type 2 diabetes, but it's not frequently covered for weight loss. The cost for Ozempic typically runs between $0 and $1029 per month.
How overweight do I have to be to get Ozempic?
Candidates for Ozempic treatment for weight loss include individuals who have a BMI of 30 or higher and those with a BMI of 27 or higher as well as at least one weight-related condition, such as high blood pressure, high cholesterol, or type 2 diabetes. Ozempic is not the right weight loss approach for everyone.
Will insurance cover Wegovy for PCOS?
Wegovy is FDA approved for weight loss in people who are overweight or have obesity. That means insurance may cover it for some individuals with PCOS who meet eligibility requirements. However, eligibility requirements vary by plan, and many insurance plans do not cover weight loss medications at all.
Is PCOS covered by insurance?
No insurance coverage: While some insurance policies do not cover fertility treatment, most health insurance policies will at least cover diagnosis and treatment of underlying conditions that may cause infertility, such as polycystic ovary syndrome (PCOS), endometriosis, fibroids, and certain conditions for men, such ...
Is Ozempic or metformin better for PCOS?
Metformin is a first-line treatment for most people with PCOS who are trying to get pregnant. Ozempic may be prescribed if metformin makes you sick or does not work, or it may be prescribed alongside metformin.
How do I get 3 months of Ozempic for $25?
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®.
What does a PCOS belly look like?
Common Symptoms That Might Indicate A PCOS Belly:
High Waist-to-Hip Ratio: Many women with PCOS have a waist-to-hip ratio of >0.87, which is often referred to as an apple body shape. No Noticeable Stomach Changes: Some women with PCOS may not experience any noticeable changes in their stomach size or shape.
How much does Ozempic for PCOS cost?
The average monthly price of Ozempic (1 mg dose) is $1,315.36, but using SingleCare's prescription drug discount card can lower the price to $753.85. We're committed to helping you save on prescriptions. If you've never used our discount card, it's easy!
What is the best medicine for PCOS weight loss?
In conclusion, treatment with semaglutide, at low doses, significantly reduces body weight in almost 80% of obese PCOS patients who were unresponsive to a previous lifestyle plan. It is often associated with the normalization of menstrual cycles, and these important results are obtained with very few side effects.
Can a gynecologist prescribe Ozempic for PCOS?
Ozempic isn't currently approved to treat PCOS. But early research is promising.
How long does it take to lose 30 pounds on Ozempic?
Some people lose much more weight on Ozempic than the average, with reports of up to 30 pounds lost in 26 weeks. However, it's important not to compare your results to anyone else's. As long as the scale moves in the right direction, you should be happy with any improvements you make.
How to get insurance to cover Ozempic for weight loss?
When Ozempic is covered by insurance, it's typically for Type 2 diabetes management, not weight loss. In some medically justified cases, insurance may cover Ozempic for weight loss. This may require prior authorization or proof of previous failed treatments.
What to say to a doctor to get Ozempic?
Tell your provider why you're interested in Ozempic — a good doctor won't judge you or your desire to use a weight loss medication. They'll likely ask about your medical history, go over your eligibility, and consider anything that might make you a bad candidate for Ozempic.
How do I get Ozempic if my insurance won't pay?
If you have Medicare or are uninsured, you may be able to get Ozempic for free through the Novo Nordisk Patient Assistance Program. Ozempic is one of the many medications listed as a covered product under this program.
Does Ozempic help you lose weight with PCOS?
Ozempic has also been shown to aid weight loss, which can be beneficial for people with PCOS by improving insulin sensitivity and lowering androgen levels. Dr Shazia Malik, a consultant OBGYN and UK Medical Director at a leading gynaecological health company and virtual women's health clinic Daye, concurs.
Why would insurance deny Ozempic?
That said, when Ozempic is prescribed off-label for weight loss, it is often not covered by insurance. Why? Because the Affordable Care Act doesn't mandate that health insurers cover obesity or overweight medications or surgeries.
What makes you a good candidate for Ozempic?
Ozempic was originally developed for the treatment of diabetes, so those who have diabetes are eligible for Ozempic. If you don't have diabetes, the criteria to be able to get Ozempic involves determining your BMI, as those with a BMI of 30 or higher can receive Ozempic.