How Much Does Ozempic Cost With Medicare?
Ozempic (Semaglutide) costs an average of $685 per Medicare Part D claim, with total Medicare spending of $4956.0M in the latest year. No generic alternative is currently available.
Key Facts: Ozempic Cost
- Medicare Part D avg
- $685/claim
- Likely Part D tier
- Tier 3 (non-preferred brand)
- Annual cost/patient
- $4,200
- Generic available
- No
- Manufacturer
- Novo Nordisk
- Treats
- Diabetes
- Patent expires
- 2031-09-20
- YoY price change
- +72.5%
Source: CMS Medicare Part D Spending Dashboard. Tier placement inferred from typical formulary norms — confirm with your specific Part D plan.
Ozempic Medicare Coverage & Out-of-Pocket Cost
Ozempic is covered under Medicare Part D, with the program paying an average of $685 per prescription fill. Ozempic typically falls on Tier 3 (non-preferred brand) of standard Part D formularies. Typical copay: $40-$100 per fill, depending on plan formulary.
Your actual out-of-pocket cost depends on three factors: (1) formulary tier — your plan's specific placement; (2) deductible status — most plans require you to meet up to a $590 deductible (2025) before copays kick in; (3) coverage phase — initial coverage, then the donut hole was eliminated in 2025, replaced by a hard $2,000 annual out-of-pocket cap under the Inflation Reduction Act. Once you hit $2,000 in true out-of-pocket spending, the rest of your Part D drugs are free for the year.
No generic is currently available for Ozempic. Medicare beneficiaries cannot use manufacturer copay cards (anti-kickback statute prohibits them for federal program enrollees), but charity foundations such as the PAN Foundation, NeedyMeds, and the HealthWell Foundation offer copay grants for many diabetes drugs. The Medicare Extra Help (LIS) program also reduces Part D costs to near-zero for income-qualified beneficiaries (under 150% of the federal poverty level).
For cash-pay or commercial insurance scenarios, compare prices using GoodRx, SingleCare, or Cost Plus Drugs before filling — discount-program prices sometimes beat Part D copays for lower-cost generics.
Ozempic is manufactured by Novo Nordisk and prescribed primarily for Diabetes. In the most recent Medicare Part D data, 7,240,000 claims were filed for 1,180,000 unique beneficiaries, at an average cost of $685 per claim. Average annual cost per beneficiary is $4,200.
Year over year, Medicare spending on Ozempic has increased by +72.5%. No generic substitute is available, so the brand-name price reflects the full market cost. Its patent expires 2031-09-20.
Ozempic belongs to the Diabetes Medications class. Metformin reduces liver glucose production ($4/month generic). GLP-1 agonists (Ozempic, Trulicity) mimic gut hormones to stimulate insulin release and reduce appetite. SGLT2 inhibitors (Jardiance, Farxiga) block glucose reabsorption in kidneys. DPP-4 inhibitors (Januvia) enhance the body's own incretin hormones. Insulin directly replaces what the body can't produce.
Key Data
| Metric | Value |
|---|---|
| Avg Cost Per Claim | $685 |
| Total Medicare Spending | $4956.0M |
| Total Claims | 7,240,000 |
| Beneficiaries | 1,180,000 |
| Generic Available | No |
| Year-Over-Year Change | +72.5% |
Other Drugs for Diabetes
Frequently Asked Questions
Medicare Part D pays an average of $685 per claim for Ozempic. Ozempic is typically placed on Tier 3 (non-preferred brand) of standard Part D formularies. Typical copay: $40-$100 per fill, depending on plan formulary. As of 2025, total annual out-of-pocket on Part D is capped at $2,000 under the Inflation Reduction Act.
Yes. Ozempic appears in Medicare Part D claims data, with 1,180,000 beneficiaries filling 7,240,000 prescriptions in the latest year. Specific coverage depends on your plan's formulary — call the number on your insurance card or check the plan's Summary of Benefits to confirm prior authorization, step therapy, or quantity limit requirements.
Ozempic (Semaglutide) costs an average of $685 per Medicare Part D claim, with total Medicare spending of $4956.0M in the latest year. No generic alternative is currently available.
No. As of the latest FDA Orange Book data, there is no generic version of Ozempic (Semaglutide). Patent protection extends until 2031-09-20, after which generics may enter the market.
Medicare beneficiaries cannot use manufacturer copay cards (anti-kickback statute), but several options exist: (1) Apply to charity copay foundations like the PAN Foundation, NeedyMeds, HealthWell Foundation, or Patient Advocate Foundation — many cover diabetes drugs; (2) Ask your prescriber about therapeutic alternatives in the same drug class that may be on a lower tier; (3) For some drugs, paying cash via GoodRx or Cost Plus Drugs can beat your Medicare copay — always compare before filling; (4) If your income is below 150% of the federal poverty level, you may qualify for the Medicare Extra Help (Low-Income Subsidy) program, which reduces Part D costs to near-zero.
Ozempic is manufactured by Novo Nordisk. The FDA application number is NDA213051.
Ozempic (Semaglutide) is primarily prescribed for Diabetes.
Medicare Part D spending on Ozempic has increased +72.5% year over year. Total program spending reached $4956.0M in the latest reporting year.
Ozempic (Semaglutide) costs an average of $685 per Medicare Part D claim, with total Medicare spending of $4956.0M in the latest year. No generic alternative is currently available.
The data source behind this answer is CMS Medicare Part D Drug Spending data. Every figure on the page traces back to that source; the methodology page describes the inputs and the refresh cadence in full detail.
A practical caveat: the headline answer above reflects the most recent CMS Medicare Part D Drug Spending data vintage; underlying data is often revised for months after first publication, and the right reference for any specific decision is whichever vintage is current at the time of the decision. The as-of date is stamped on every page.
Source: CMS Medicare Part D Spending, 2026.