What tier drug is Ozempic? Understanding Cost and Coverage

October 12, 2025 •

5 min read

With the monthly retail cost of Ozempic reaching close to $1,000 without insurance, understanding its classification within your health plan's drug tiers is essential for managing your expenses. Generally, Ozempic is considered a higher-tier medication, which significantly impacts your out-of-pocket costs. Navigating these tiers can feel complex, but it is a vital step toward making this medication more affordable.

Quick Summary

Ozempic is typically a Tier 3 medication on most insurance formularies, including many Medicare Part D plans, leading to higher patient copayments. Cost and coverage are affected by the specific plan, deductible, and whether prior authorization or step therapy is required. Savings options, such as manufacturer coupons and patient assistance programs, are available to help lower costs for eligible individuals.

Key Points

Ozempic's Typical Tier: Most insurance plans, including Medicare Part D, classify Ozempic as a Tier 3 (non-preferred brand-name) drug, resulting in higher copayments.
Prior Authorization and Step Therapy: Coverage often depends on meeting criteria for prior authorization and completing step therapy, where a cheaper drug must be tried first.
Coverage for FDA-Approved Use Only: Insurance, especially Medicare, will not cover Ozempic when prescribed solely for weight loss; coverage requires an FDA-approved indication like type 2 diabetes.
Manufacturer Savings Cards: Commercially insured patients with coverage may be eligible for a Novo Nordisk savings card, potentially lowering the monthly cost to as little as $25.
Patient Assistance Programs: The Novo Nordisk PAP offers Ozempic at no cost to eligible low-income, uninsured, or Medicare patients who meet specific financial and medical criteria.
Discount Cards: For uninsured or cash-paying patients, discount cards like GoodRx or SingleCare can reduce the high retail price, but they cannot be used with insurance benefits.
Cost Varies Significantly: The final price for Ozempic is highly variable and depends on your specific insurance plan, coverage status, and eligibility for assistance programs.

The Basics of Drug Tiers

Prescription drug tiers are a way for insurance companies to categorize medications and determine your out-of-pocket costs. Your copayment or coinsurance will depend on which tier a drug falls into. While the exact system varies by insurer, a typical structure includes several tiers, with costs increasing at each level.

Tier 1: Preferred Generics. These are typically the lowest-cost option, with the lowest copayments.
Tier 2: Preferred Brand-Names. These are brand-name drugs that the insurer prefers. They have a medium-level copayment.
Tier 3: Non-Preferred Brand-Names. These drugs have a higher copayment and may require prior authorization.
Tier 4/Specialty Tier: Some plans have additional tiers for high-cost, specialty, or complex medications, which typically have the highest patient responsibility.

What Tier Drug Is Ozempic?

Ozempic is a brand-name, non-preferred drug, so it is not a Tier 1 (generic) medication. For most insurance plans, Ozempic is placed on a higher tier, most commonly Tier 3. This means that patients can expect to have a higher copayment or coinsurance compared to generic drugs. For individuals with Medicare Part D, Ozempic is almost always found on Tier 3 of the plan's formulary, although some plans may differ. A few commercial or employer-sponsored plans may place it on Tier 2, but this is less common and still results in a higher cost than generics.

Factors Affecting Your Ozempic Cost

The final price you pay for Ozempic is determined by several factors beyond its tier placement. These criteria, which vary by insurance plan, can create additional hoops for patients to jump through.

Prior Authorization

Many insurers require prior authorization (PA) for Ozempic before they will cover it. This means your doctor must provide documentation to the insurance company to prove that the medication is medically necessary for an FDA-approved use. Without prior approval, you may have to pay the full list price for the medication.

Step Therapy

Some plans implement step therapy, also known as "fail first". This requires you to try and fail on a cheaper, generic medication (like metformin) before the plan will agree to cover Ozempic. This process ensures that patients and the plan exhaust lower-cost options first before moving on to more expensive brand-name drugs.

FDA-Approved vs. Off-Label Use

Insurance coverage for Ozempic often depends on the prescribed diagnosis.

Covered Indications: Ozempic is FDA-approved for treating type 2 diabetes and, more recently, for reducing the risk of cardiovascular events in adults with type 2 diabetes and established heart disease.
Off-Label Use: Because Ozempic also promotes significant weight loss, it is often prescribed off-label for this purpose. However, most insurance plans will not cover the medication for weight loss alone. This is particularly true for Medicare, which is legally prohibited from covering drugs for weight loss exclusively. If your Ozempic prescription is only for weight loss, you will likely pay the full cash price.

Comparison of Ozempic Cost and Coverage

The table below illustrates how different insurance plans and assistance programs can affect your out-of-pocket costs for a 1-month supply of Ozempic.


Scenario	Insurance Type	Tier Placement	Estimated Monthly Cost	Notes
Full Price	None (Uninsured)	N/A	~$998+	Cost can vary by pharmacy. Recently, the manufacturer offered a reduced cash price.
Commercial Insurance	PPO/HMO (Employer-Sponsored)	Tier 2 or 3	~$35–$150+	Dependent on your deductible, copay, and whether prior authorization is needed.
Commercial with Savings Card	PPO/HMO (Commercially Insured with Coverage)	Tier 2 or 3	As low as $25	Requires commercial insurance that already covers Ozempic. Max savings may apply.
Medicare Part D	Medicare Prescription Plan	Tier 3	~$10–$50+	Depends on your plan and coverage stage. Must be prescribed for FDA-approved use.
Patient Assistance Program (PAP)	Uninsured or Medicare	N/A	Free	For eligible low-income individuals who meet strict criteria. Not for commercially insured patients.
Prescription Discount Card	Cash Payment	N/A	~$499–$965+	Not usable with insurance benefits. Cannot be combined with copay cards.

How to Reduce the Cost of Ozempic

While Ozempic's high tier and cost can be prohibitive, there are several avenues to explore for financial relief.

Use Manufacturer Savings Programs

For commercially insured individuals whose plans cover Ozempic, the manufacturer, Novo Nordisk, offers a copay savings card. This card can bring your monthly cost down significantly, potentially to as low as $25 for a 1-, 2-, or 3-month supply. Eligibility requires a commercial insurance plan that covers Ozempic and a prescription for an FDA-approved use. Novo Nordisk also offers a direct-to-consumer online pharmacy option for uninsured patients, reducing the cash price significantly.

Consider the Patient Assistance Program

The Novo Nordisk Patient Assistance Program (PAP) provides free Ozempic to qualifying individuals who are uninsured or have Medicare and meet specific income criteria. Applicants must have a total household income at or below 400% of the federal poverty level and must not be eligible for other federal prescription programs. The medication must also be prescribed for an FDA-approved indication.

Use Prescription Discount Cards

For those paying with cash, prescription discount cards from services like GoodRx can significantly lower the retail price. These cards cannot be combined with your insurance but can sometimes offer a better price than your insurance copay. It is important to compare prices and options carefully.

Explore Alternative Medications

If Ozempic remains unaffordable, discuss alternative medications with your doctor. Other GLP-1 agonists exist, and some may have different tier placements or costs depending on your plan. For type 2 diabetes, cheaper generic drugs like metformin are often tried first due to insurance requirements for step therapy.

Opt for a 90-Day Supply

Many insurance plans and mail-order pharmacies offer discounts for filling prescriptions for a 90-day period instead of the standard 30-day supply. This can lower your cost per dose and reduce the number of pharmacy visits.

Check with Nonprofit Organizations

If you are struggling to afford Ozempic, nonprofit organizations like the Patient Access Network Foundation and the HealthWell Foundation may offer copay assistance programs for eligible patients. These programs often have income-based criteria and require you to have insurance that covers the medication.

Conclusion

While Ozempic is a highly effective medication for managing type 2 diabetes, its high cost often places it in a higher drug tier (typically Tier 3) on most insurance formularies. The specific out-of-pocket expense depends heavily on your insurance plan, deductible, and whether the drug is prescribed for an FDA-approved condition. Navigating prior authorization and step therapy requirements is often a necessary part of the process. Fortunately, a variety of cost-reduction strategies are available, from manufacturer savings cards and patient assistance programs to prescription discount cards and exploring alternative treatments. Patients should work closely with their healthcare provider to identify the most suitable and affordable path to access this important medication.

Visit the official Ozempic® website for details on manufacturer savings programs.

Frequently Asked Questions

No, Ozempic is typically not a Tier 1 or Tier 2 drug. As a non-preferred brand-name medication, it is most often placed on a higher tier, usually Tier 3, by most insurance plans.

Ozempic is a brand-name drug with a high list price, not a generic. Insurance companies place expensive brand-name medications on higher tiers, such as Tier 3 or a specialty tier, which requires patients to cover a larger portion of the cost through copayments or coinsurance.

No, by law, Medicare will not cover Ozempic for weight loss alone. Coverage through Medicare Part D is only available if the medication is prescribed for an FDA-approved use, such as the treatment of type 2 diabetes.

The out-of-pocket cost for Ozempic with insurance varies widely depending on your specific plan, tier placement, deductible, and copay structure. For eligible commercially insured patients using a manufacturer's savings card, the cost can be as low as $25 per month. Without a savings card, it could be hundreds of dollars until your deductible is met.

Yes, if you meet the eligibility criteria, you may be able to get Ozempic for free through the Novo Nordisk Patient Assistance Program (PAP). This program is for low-income, uninsured, or Medicare patients who cannot afford the medication and meet specific financial requirements.

Commercially insured patients can use the Novo Nordisk savings card, which can lower their monthly cost to as little as $25. They must have commercial insurance that already covers Ozempic and meet other eligibility criteria.

No, you cannot combine a prescription discount card (like GoodRx) with your insurance benefits. You would either use your insurance copay or pay the discounted cash price using the card, whichever is cheaper.