Introduction
Getting sick can put you in a costly situation, especially if you’re dealing with type 2 diabetes or obesity. Anti-diabetic and weight loss drugs often come with a hefty price tag because of their therapeutic benefits. Semaglutide brand Ozempic, for instance, has been a go-to drug for many people.
Semaglutide can be rather expensive. Despite its price, though, it’s become massively popular and popular for its weight loss effect.
How much does semaglutide cost and why is it so pricey? This article explores the factors influencing its cost and the role of insurance and assistance programs.
Semaglutide: An overview
It’s practically public knowledge that many people struggling to lose weight use Ozempic. But the surprising reality is that it does not exactly have FDA approval for weight management. Ozempic and its sister brand, Rybelsus, actually treat type 2 diabetes.
Their other sister brand, Wegovy, has FDA approval to treat obesity. However, since Ozempic, Wegovy, and Rybelsus have the same active ingredient, semaglutide, essentially, they all produce the same weight loss effect. Still, many doctors prescribe Ozempic off-label for its weight-loss effect.
What is semaglutide?
Semaglutide is a glucagon-like peptide-1 receptor agonist or GLP-1 Ra, for short.
In our gut is the hormone GLP-1, which prompts insulin release to lower high blood sugar levels after we eat. Semaglutide mimics this function, triggering the pancreas to do the same.
Another effect of semaglutide is that it delays gastric emptying, causing you to feel fuller for longer. With a weaker appetite, you don’t have as many cravings and eat less food, resulting in weight loss.
Subcutaneous and oral semaglutide
Aside from their different uses, Ozempic, Wegovy, and Rybelsus also vary in their formats.
Ozempic and Wegovy are subcutaneous semaglutide, meaning you administer them under the skin. Rybelsus, on the other hand, is oral semaglutide as you take it orally.
Taking semaglutide
It’s important to remember that proper dosage, administration, and storage are key to ensuring semaglutide’s efficacy.
Your healthcare provider will typically start you off on a low dosage, as your body adjusts to the drug. Eventually, these dosages will incrase to a maintenance dose, in a process called gradual dosing.
Safety and efficacy
In the STEP 5 trial, researchers looked at semaglutide’s two-year effects in adults who were overweight or with obesity. Participants lost 15 percent of body weight with semaglutide while those in the placebo group lost around 2.6 percent of body weight.
Researchers associated semaglutide with greater reductions in waistline circumference and systolic blood pressure. Versus the placebo group, participants on semaglutide also experienced improved diastolic blood pressure, blood sugar levels, total cholesterol, and triglycerides.
Another study found that participants on semaglutide lost more body fat than body mass. In addition, they ate less due to a weaker appetite and had less cravings, especially for fatty foods.
Studies have provided evidence on how semaglutide effectively lowers blood sugar levels and promotes weight loss. Moreover, research shows that it potentially positively impacts other health conditions like cardiovascular problems.
Remember that for semaglutide to work optimally, you must incorporate a nutritious diet and ample physical activity into your lifestyle.
Side effects
Gastrointestinal reactions account for 10% or more of semaglutide’s side effects. These include nausea, diarrhea, vomiting, constipation, and abdominal pain.
Other common side effects occurring in 1 to 10 percent of cases include indigestion, belching, gassiness, gastroenteritis, or gastritis. Gastroenteritis is the short-term infection and inflammation of the digestive system, while gastritis is inflammation of the stomach lining.
Note that these are mild and can be managed with the help of your healthcare provider. Semaglutide’s more serious adverse effects, meanwhile, are rare.
Semaglutide cost without insurance
According to a November 2024 report, semaglutide brands had the following pharmacy retail prices for one month’s supply:
- Ozempic: $830-870 (list price at $968.52)*
- Wegovy: $1,237-$1,340 (list price at $1,349.02)*
- Rybelsus: $848-$917 (list price at $968.52)*
Note that the prices of these may likely increase amid the high demand and shortage issues affecting weight loss drugs.
*Note: Prices are subject to change.
Semaglutide cost with insurance
If you have commercial insurance or insurance coverage for businesses, they typically cover Ozempic for type 2 diabetes. This depends on your plan and its benefits.
Insurance plans commonly follow a tier system, with generic drugs at the bottom and specialty drugs at the top. To check, you can simply call your insurance company and ask what tier Ozempic falls under and what your copay amount is. Most insurance companies follow a formulary, or a list of covered drugs.
You may also be able to avail of copay assistance from semaglutide’s manufacturer, Danish pharmaceutical company, Novo Nordisk. Basically, you pay a flat fee every time you visit your doctor or purchase a medicine.
Copay assistance is typically available for people with commercial prescription insurance. It is not available to people under federal or state health programs such as Medicare, Medicaid, or Tricare.
Under this coverage, you could pay $25 for a three-month supply of Ozempic. Just make sure you have a prescription for one, two, or three months’ of Ozempic for treating type 2 diabetes.
If you are also eligible, Novo Nordisk can offer a savings card. It can save you $150 for a one-month prescription, $300 for a two-month prescription, and $450 for a three-month prescription. All within a 24-month validity period.
If you don’t have insurance
If you don’t have insurance and cannot afford semaglutide, you may seek aid via Novo Nordisk’s patient financial assistance. Under this program, you can avail of free or discounted medicines. Note that you will have to meet certain lower-income requirements.
According to Novo Nordisk’s Patient Assistant Program page, those interested must:
1) be a US citizen or legal resident,
2) come from a household with a total income equal to or below 400 percent of the federal poverty level,
3) not have Medicare or insurance, and
4) not be enrolled in or qualify for any federal, state, or government program like Medicaid.
Another solution is to use an online coupon so you can save money, or join a clinical trial for semaglutide. Visit clinicaltrials.gov to check out available trials in the US.
Medicare coverage
Yes, most Medicare plans cover Ozempic for type 2 diabetes, but not for weight loss purposes. Note that this coverage can change on a yearly basis, though. Medicare is the US’ federal health insurance for citizens aged 65 or older. If covered, you only have to pay 25 percent of the cost.
Once you accumulate a certain out-of-pocket expenditure covered by your prescription plan, you’ll enter “catastrophic coverage.” This prompts Medicare to pay for most of your medicines for the rest of the plan year.
Medicaid coverage
Medicaid, a health insurance program run by the US government, typically covers most GLP-1 Ras such as semaglutide. The only condition is that it should treat type 2 diabetes. Medicaid provides medical assistance for eligible low-income persons and families, pregnant women, as well as people with disabilities.
Medicaid’s prescription coverage will depend on state guidelines, which commonly does not cover weight loss drugs. Some states, however, may provide coverage and just ask for additional requirements.
Checking if your insurance covers Ozempic or Wegovy
If you’d like to check if your health insurance covers your semaglutide injection, you can simply visit the Ozempic and Wegovy websites. Simply answer a questionnaire, share your patient information, and look up your health insurance provider.
You can also review your health insurance policy documents or consult your insurance agent.
Non-coverage of semaglutide injections
Insurance companies don’t typically cover weight loss drugs as obesity is perceived as a cosmetic issue rather than a chronic disease. Weight loss medications also have hefty price tags, with a month’s supply easily going beyond $1,000 a month.
In 2023, only one in every four employers covered GLP-1 weight loss drugs. These employers, however, are tightening the criteria for their eligibility.
Another hindrance to coverage of semaglutide injections is a 2023 law that prevents Medicare from covering weight loss medications.
Reason behind the price tag
Novo Nordisk has a patent on semaglutide which will end in 2032. Until then, it has the privilege of dictating the drug’s price, according to non-profit Institute for Clinical and Economic Review.
When the patent ends, semaglutide can be manufactured by other companies at lower-priced generic versions.
The Danish company also has to create a profit and recover the costs of running clinical trials. These can reach hundreds of millions of dollars.
Supply issues
Towards the latter part of 2023, there was a major shortage in Wegovy and Ozempic amid the clamor for the drugs. The shortage problem will likely persist for several more years. The high demand, coupled with supply issues, also contributes to semaglutide’s high pricing.
Novo Nordisk admitted a “short-term stock-out” of Wegovy in the US through December due to the demand surpassing supply capacities.
Affordable alternatives
Amid the clamor for semaglutide, consumers are turning to other anti-diabetic and weight loss drugs that are priced lower.
Compounded forms of semaglutide offer the same therapeutic benefits but with the addition of other ingredients such as vitamins. These cost around $350-500 a month without insurance.
The FDA has approved some drugstores to custom-mix variations of semaglutide and its competitor active ingredients tirzepatide and dulaglutide. However, these were affected by a supply issue in 2022.
There have been reports citing adverse effects from the compounded versions. Novo Nordisk and its rival drugmaker Eli Lilly have also reported impurities in the compounded medications.
Conclusion
Semaglutide is life-changing for many people suffering from type 2 diabetes or obesity, but these benefits come at a price. Semaglutide remains inaccessible to many people because of its hefty price tag, likely to stay the same for 10 years. Thankfully, those eligible may be able to have their health insurance cover part of the cost.
Others can seek financial assistance programs or join clinical trials to receive semaglutide at a discounted price or for free.
There are also more affordable alternatives via semaglutide competitors such as compounded semaglutide. Experts warn against using these, however, as they may contain impurities and pose a risk to a patient’s health.
As with any treatment plan, consult your healthcare provider for the most cost-efficient options.
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