Semaglutide has emerged as a significant medication in managing diabetes and promoting weight loss, offering a new avenue for individuals seeking medical assistance in achieving their health goals. Semaglutide is the active ingredient in popular weight loss and Type 2 diabetes medications Wegovy, Ozempic, and Rybelsus. It’s a glucagon-like peptide-1 (GLP-1) receptor agonist, which means the drug mimics the effects of GLP-1 (a hormone that helps regulate blood sugar levels, appetite, and digestion, among other functions). However, the cost of semaglutide can be a substantial barrier for many. This article aims to provide a comprehensive overview of semaglutide, its various forms, associated costs, and strategies to make it more affordable.
What is Semaglutide?
Semaglutide belongs to a class of drugs known as GLP-1 receptor agonists. It functions by mimicking a natural hormone in the gut that reduces appetite, slows down digestion, and balances blood sugar levels.
Semaglutide is available in three primary forms:
- Ozempic: A once-weekly injectable, FDA-approved for treating type 2 diabetes. It has also been shown to lower the risk of heart attacks and stroke in people who have both diabetes and heart disease.
- Wegovy: A once-weekly injectable, FDA-approved for treating obesity in adults and children aged 12 and older who need to lose weight for their health. It also helps prevent heart problems in overweight people who already have heart disease.
- Rybelsus: The pill version of semaglutide, prescribed to treat type 2 diabetes.
It is important to note that all forms of semaglutide require a prescription. Consulting with a healthcare provider is essential to determine the most suitable option based on individual health needs and goals. The exact medication that your Clinician will prescribe depends on your medical history, biology, and insurance coverage. When appropriate, your Clinician may prescribe GLP-1 medications, including semaglutide (brand name Wegovy), liraglutide (brand name Saxenda), or tirzepatide (brand name Zepbound). When appropriate, your clinician may prescribe other medications with which other members have found success such as Metformin and combination Naltrexone and Bupropion.
Understanding the Costs of Semaglutide
The cost of semaglutide varies depending on the specific product, dosage, and pharmacy. The medication is available in both brand-name and compounded forms, although the compounded forms are not FDA approved. Compounded semaglutide is made by special compounding pharmacies rather than pharmaceutical companies. A monthly supply of semaglutide ranges from about $129-$1,850 without insurance. Prescription drug prices often change. These are the most accurate medication prices at the time of publishing. The listed price without insurance references the price of brand-name drugs (unless otherwise specified).
Read also: Weight Loss & Excess Skin: Surgery Costs
Brand-Name Semaglutide Costs
The list price of brand-name forms of semaglutide ranges from $998-$1,349 per package, typically a month’s supply, depending on the dosage prescribed. However, most people don’t pay the list price-the original price the drug manufacturer sets for a medication before rebates and discounts are applied.
- Ozempic: A one-month supply of Ozempic costs $997.58 before discounts. The medication costs the same amount regardless of dosage strength, whether you need 0.25 mg, 0.5 mg, 1 mg, or 2 mg.
- Wegovy: Wegovy costs $1,349.02 for a 28-day supply.
- Rybelsus: A month's supply of Rybelsus 7 mg tablets costs $997. The 14 mg tablets cost about the same, making Rybelsus similar in price to Ozempic.
Compounded Semaglutide Costs
The cost of compounded semaglutide can vary significantly, but online providers tend to advertise rates between $129-$497 per month. It’s important to note that this range generally reflects the cost of the medication itself and may not include additional fees. Be sure to factor in potential extras like membership fees, prescriber visit fees, and the cost of any necessary medical tests that may be required for a prescription. Also, keep in mind that advertised prices might be tied to first-month promotions or longer-term treatment contracts. Most importantly, talk to your healthcare provider before purchasing compounded semaglutide.
Insurance Coverage
Insurance coverage plays a crucial role in determining the out-of-pocket cost for semaglutide. However, coverage varies by policy.
Private Insurance: How much you pay depends on three factors:
- The type of insurance plan you have
- Whether Ozempic is listed under your health plan's list of covered drugs
- Your deductible
Medicare: Medicare Part D (the part that covers prescription drugs) may cover Ozempic for diabetes treatment.
Read also: Adding Turmeric to Coffee
- Medicare may cover semaglutide for diabetes, but it may not cover weight loss
- You might pay up to $590 per year before coverage starts (the deductible)
- After that, you will have to pay a portion of the cost (copay or coinsurance)
- In 2025, after meeting your deductible, you pay 25% of drug costs until you've spent a total of $2,000. Once you reach $2,000, "catastrophic coverage" starts, and your costs drop dramatically for the rest of the year.
Medicaid: Medicaid rules vary from state to state. Medicaid may cover Ozempic if it is medically prescribed for the treatment of type 2 diabetes. Call your state's Medicaid office to learn about your state’s coverage.
Insurance plans may cover Wegovy if it’s prescribed for weight loss and you meet certain criteria. Depending on the insurance plan, your healthcare provider may need to submit prior authorization before your plan covers it. For example, some plans from Cigna and Aetna may require prior authorization. Currently, Medicare plans typically don’t cover Wegovy for weight loss, but they may cover it for cardiovascular risk reduction. Some Medicaid plans may cover Wegovy, depending on the state.
Strategies to Reduce Semaglutide Costs
Despite the potentially high costs, several strategies can help reduce the financial burden of semaglutide treatment.
Savings Programs and Discount Cards
- Manufacturer Savings Programs: If you have commercial insurance that covers Rybelsus, you may pay as little as $10 per month for a 1, 2, or 3-month subscription. Novo Nordisk, the manufacturer, offers discount cards for Ozempic, Wegovy, and Rybelsus that can lower your monthly costs if you have private or employer-sponsored insurance and meet eligibility requirements.
- Wegovy Savings Offer: If your insurance plan does not cover Wegovy, you can get Wegovy doses for $499 per month through the Wegovy savings offer by ordering from the Novocare pharmacy.
- Patient Assistance Programs: If you do not have commercial insurance, look into patient assistance programs.
Insurance Strategies
- Verify Coverage: Begin by contacting your insurance company to verify your coverage.
- Prior Authorization: Certain insurance plans (such as ones from Blue Cross Blue Shield and United Healthcare) may cover Ozempic but require prior authorization for coverage, meaning the prescriber needs to provide information such as blood tests or documentation to prove a treatment is medically necessary. Depending on the insurance plan, your healthcare provider may need to submit prior authorization before your plan covers it.
- Medical Necessity: Similar to getting coverage for Ozempic, Wegovy, or Rybelsus, getting insurance coverage for compounded semaglutide often requires showing that it’s medically necessary and proving that no other commercially available alternatives are appropriate or available (e.g., affected by a shortage). Your healthcare provider will need to provide documentation to support your request for coverage.
Other Considerations
- Compounded Semaglutide: While exploring cost-saving options is understandable, the FDA and healthcare providers encourage FDA-approved medications such as Wegovy, Ozempic, and Rybelsus instead since they meet strict safety and quality standards. Lack of FDA approval: Compounded medications don’t go through the same FDA approval process as commercially available drugs. This means they haven’t met the same standards for manufacturing and safety, making insurance companies less likely to cover them. Limited ingredient coverage: Some insurance plans may only cover the cost of specific ingredients within a compounded medication. Exclusion of self-administered medications: Insurance plans may exclude coverage for compounded medications that patients can administer themselves, like self-injected compounded semaglutide.
- Alternative Medications: Semaglutide is only one type of GLP-1 agonist medication. “There are also other options worth considering,” says Melanie Abeyta, nurse practitioner and owner of Harmony Aesthetics Center in Los Angeles, California. The FDA has approved other GLP-1 drugs for Type 2 diabetes and weight loss. Mounjaro (tirzepatide), which is a GIP/GLP-1 agonist, and Victoza (liraglutide), a GLP-1 agonist, are used to treat Type 2 diabetes while Zepbound (tirzepatide) and Saxenda (liraglutide) are used for weight loss. Metformin is a common medication that healthcare providers may recommend for managing Type 2 diabetes instead of (or in addition to) GLP-1 medications. “Outside of GLP-1s, medications such as metformin, SGLT-2 inhibitors (such as Jardiance) or even certain off-label medications such as low-dose naltrexone may also support weight management or blood sugar control when used as part of a comprehensive approach,” Abeyta says.
The Future of Semaglutide and Compounding
Now that the semaglutide shortage is over, pharmacists and physicians have been ordered to stop compounding, distributing, and dispensing compounded semaglutide. For those licensed by the state, the deadline is April 22, 2025. Similar to semaglutide, compounded tirzepatide became an option when the FDA added tirzepatide to its drug shortage list in December 2022. This allowed compounding pharmacies to offer compounded tirzepatide and provide an alternative to the drug in shortage. State-licensed compounding pharmacists and physicians have been given until April 22, 2025, to wind down compounding, distributing, and dispensing compounded tirzepatide.
Conclusion
Semaglutide has revolutionized the management of diabetes and weight loss, offering significant health benefits. However, the cost can be a barrier. By understanding the different forms of semaglutide, exploring insurance options, and utilizing available savings programs, individuals can make this medication more accessible and affordable. Consulting with healthcare providers and insurance companies is crucial to navigate the complexities and make informed decisions about semaglutide treatment.
Read also: Optimizing Fat Intake for Keto Success