Is Ozempic Covered by Insurance When Taken for Obesity?

Taking Ozempic for weight loss is touted everywhere. From social media influencers to Hollywood’s elite, and coverage on national news outlets including the Today Show and 60 Minutes. Chelsea Handler even referenced Ozempic in one of her Oscar jokes.

The weight loss secret to the stars, you might think it’s only for the elite. While it may not be covered by your insurance, there is an affordable alternative. One your general care practitioner may not be aware of!   

What Is Ozempic?

If you aren’t paying much attention because you think it’s just another fad or an inaccessible option for anyone living outside of the limelight of Hollywood—think again!

Let’s begin with what it’s not:

•         It’s not a diet pill.
•         It’s not a fleeting fad.
•         It’s not a quick weight loss solution.

It is a non-habit-forming, non-stimulant prescription medication that appears to be safe and effective for a wide range of patients with obesity, regardless of their age, BMI, or race/ethnicity. It’s designed to be taken long-term. Once you stop taking it, you will likely regain the weight you’ve lost.

All prescription medications have side effects and not all side effects are negative, including Ozempic—also known as Wegovy. Initially only approved for Type 2 diabetes, patients experienced the positive side effect of gradual and sustainable weight loss. This led the pharmaceutical company that created Ozempic to seek FDA approval for weight loss. Approval was granted in 2021, and it’s quickly become a weight loss phenomenon.

It is also prescribed as the brand name Wegovy or the generic brand name Semaglutide.

How Often Do I Need An Ozempic Shot?

As mentioned above, it’s not a quick weight loss solution. It’s a shot that must be administered every single week. You begin with a low dose, of 0.25 milligrams per week, and work gradually up to 2.0 or 2.4 milligrams per week. 

The reason the dose is gradual is to minimize the side effects. If it makes you feel nauseous, you will stay at that dose until your body adjusts.

The reason it’s weekly is that Ozempic has a half-life of about 7 days. By taking it weekly, you ensure it’s always in your bloodstream.

While 95% of patients have little to no symptoms, about 50% of patients experience mild nausea. As your body adjusts to Ozempic for weight loss, the symptoms are likely to subside.

Additional side effects include:

•         Nausea
•         Vomiting
•         Diarrhea
•         Gastrointestinal discomfort
•         Lethargy
•         Dizziness
•         Lightheaded needs
•         Feeling excessively full

How Does Ozempic Aid in Weight Loss?

In a 60 Minutes Overtime segment, Dr. Caroline Apovian who specializes in weight management at Brigham and Women’s Hospital in Boston, detailed how this exciting new weight loss shot works in layman’s terms.

She explains that Ozempic creates analogs of naturally occurring hormones your body makes when you digest food. The hormones travel from your stomach to your brain when you eat letting your brain know when you are full. Your stomach tells your brain it’s fuller sooner.

In other words, you eat less, feel fuller, and have fewer food cravings.

Do I Have to Have Type 2 Diabetes?

Nope! As of FDA approval in 2021, Ozempic is prescribed for either Type 2 diabetes or weight loss. That being said, it’s not for everyone.

It may not be an option if:

• You are pregnant or breastfeeding.
• You have Type 1 diabetes.
• You are hypoglycemic.
• You have preexisting gastrointestinal issues.
• You or anyone in your family have a history of medullary thyroid cancer, multiple endocrine neoplasia type 2, or pancreatic cancer.

Ozempic for weight loss is specifically designed for adults whose:

• BMI is 27 kg/m².
• BMI is greater than 30kg/m².
• BMI is lower than 27 kg/m² and you are undergoing close medical supervision.

If you don’t meet the criteria above, there are other medical weight loss options to explore.

Is Ozempic Safe For Children?

With childhood obesity on the rise, we were excited to hear that the FDA recently approved Wegovy for qualified adolescents, which contains the same active ingredient as Ozempic and the generic Semaglutide. To qualify for a prescription, adolescents must be:

•         12 years or older.
•         Have a BMI at or above the 95th percentile for their age and gender.
•         Have an accompanying reduced-calorie meal plan.
•         Have an accompanying physical fitness plan.

As with adults, if adolescents don’t qualify by age, weight, or any other factor, there are other weight loss options to explore.

Is Ozempic Covered By Insurance?

Maybe. One of the biggest frustrations our patients have is that even if their general care practitioner prescribes Ozempic for weight loss—it’s rarely covered by insurance. At a cost of up to $1,400 per month, it’s not accessible for most who need it. Not to worry, as Valley Medical Weight Loss and Med Spa offers the generic alternative Semaglutide for $50 per shot!

Before we dive into our $50 cash option, let’s review insurance options. The Wegovy website advises that if you are prescribed Wegovy for Type 2 diabetes, it is likely covered by insurance. For weight loss, it varies greatly by the plan. In some instances, you may be able to upgrade or add on coverage, which may be less expensive than paying cash for a generic alternative.

Coverage is likely as follows:

Employer insurance or private insurance—check to see if it’s covered by your plan. If it’s not, don’t give up hope just yet. Submit a request for coverage to your insurance company with the information provided by your healthcare provider. Sometimes insurance companies will make an exception. This sample letter template may be helpful.

Medicare—standard Medicare does not cover weight loss prescriptions. However, some Medigap and Medicare Advantage plans do.

Medicaid—coverage varies by state, so you will need to check to see if you are covered.  

Veterans Association—the VA provides coverage for obesity management. You may need to contact your local Veterans Administration provider to discuss your options.

Tricare—obesity medications are covered for some, but not all. You will need to contact your Tricare Network provider or Military Treatment Facility to discuss eligibility.

Government employee insurance—coverage varies by state and individual plans for city, state, and federal workers.

Affordable Care Act—check your insurance provider. If it’s not covered, you may be eligible for a plan add-on or upgrade. 

If it’s not covered, you can pay cash for generic Semaglutide.

What Is Semaglutide?

Semaglutide is the exact same medication as Ozempic for weight loss, it’s just the generic brand name. A generic prescription is a medication that is approved by the FDA and sold at a lower cost than the brand-name medication. Generic medications contain the same active ingredients as their brand-name equivalents and have the same effects, safety, and strength.

Generic drugs are less expensive than brand-name medications, in this case significantly less expensive!

At Valley Medical Weight Loss and Med Spa, we provide weekly injections of up to 2.0 milligrams of Semaglutide for $50 per week. You can also purchase prepaid packages of 10 injections for $450.

For your convenience—no appointment is necessary! We know how busy your schedule is, which is why we are a walk-in-only clinic. The shot only takes a few minutes, so walk-in any time:

• Mon, Tue, Thu, or Fri between 9:00 am to 4:30 pm.
• Saturdays from 8:00 am to 1:30 pm.

Even if you can’t make it in at the exact same time each week, come in on the same day each week.  

How Is Obesity Defined?

Last, but not least, let’s take a quick moment to discuss what obesity is. From a purely clinical standpoint, Harvard Medical outlines weight in relation to our body mass index (BMI). This is a calculation of what your weight is depending on your height and weight.

•         A healthy BMI for adults is between 18.5 and 24.9.
•         Overweight is defined as a BMI between 25.0 and 29.9
•         Obese is defined as a BMI of between 30 and 39.9.
•         Morbidly obese is defined as a BMI of 40 or higher.
•         Children are still growing, so BMI is determined by age and gender. 

Clinical definition aside, during her 60 Minute Overtimes segment, Dr. Apovian explained the most common misconception about obesity. “The biggest misconception about weight and obesity is that somehow your weight is under your control,” said Dr. Apovian, “Obesity is a disease of the pathways that regulate your energy balance.”

With this understanding, we hope you will stop beating yourself up. In addition, there are other factors that make it more difficult to lose weight beyond nutrition and physical activity.

Losing weight is more challenging:

•         As you age
•         When you aren’t sleeping well
•         Your anxiety and stress level is high*
•         Depending on your genetic composition
•         You have a medical condition that increases weight
•         You are taking a prescription that makes weight loss challenging

*The increased fight or flight hormone cortisol in your body may lead to weight gain when you feel stressed or anxious. On the flip side, some people lose weight when stressed or anxious. Whether you lose or gain weight, getting anxiety and stress under control is essential for whole-body health.

Conclusion

Whatever the cause of your acute or chronic weight gain, taking Ozempic for weight loss can help. Check with your insurance first to see if it’s covered and if it’s not, pay cash for Semaglutide instead!

At just $50 per shot or $450 for a prepaid package—you too can access the Hollywood elite’s weight loss secret!

Reach out today to learn more about our weekly weight loss Semaglutide shots!