Does Cigna cover Ozempic?

Ozempic (semaglutide) has become one of the most talked-about glucagon-like peptide-1 receptor agonist (aka GLP-1) medications, but getting insurance to cover it isn't always straightforward. So, does Cigna cover Ozempic? 

It depends. Coverage varies based on why you're taking Ozempic, your specific Cigna plan, and your prescription drug benefits. Most Cigna plans offered by employers include Ozempic as a covered preferred brand medication, usually with prior authorization required.

Below, we'll explain when Cigna is most likely to cover Ozempic, how to check your benefits, what you might pay out of pocket, and backup options.

Yes, Cigna may cover Ozempic, but it depends on your specific health plan. Many plans cover Ozempic for its uses approved by the US Food and Drug Administration (FDA), including managing type 2 diabetes and reducing the risk of certain heart- and kidney-related diabetes complications. Still, coverage requirements can vary.

That's because Cigna offers many different plans, and each one has its own prescription drug formulary (the list of medications your plan covers). Some plans include Ozempic, while others don't. 

Even if your plan does cover it, you may still have to clear a few hurdles before your prescription is approved. One of the most common requirements is getting prior authorization from your provider. In that case, your healthcare provider will need to show that Ozempic is medically necessary before Cigna agrees to cover it. 

Depending on your plan, you may also need to meet other requirements, such as having a diagnosis of type 2 diabetes, trying another medication first (called step therapy), or meeting certain clinical criteria.

The easiest way to find out if your plan covers Ozempic is to check your prescription drug formulary through your myCigna account, or you can call the member services number on the back of your insurance card. Your healthcare provider's office or pharmacy can often check your prescription benefits for you as well and let you know whether prior authorization is required.

Does Cigna cover Ozempic for weight loss? 

Generally, no. Most Cigna plans won’t cover Ozempic when it's prescribed solely for weight loss, because even though some providers prescribe Ozempic off-label for this purpose, it isn't FDA-approved for chronic weight management. 

Since insurance companies typically base coverage on a medication's FDA-approved uses, they're much more likely to cover Ozempic for people with type 2 diabetes than those without diabetes using it for weight loss.

Luckily, you’ve got options if weight loss is your primary concern. For instance, if your goal is to lose weight, your healthcare provider may recommend Wegovy instead. Wegovy contains the same active ingredient as Ozempic (semaglutide), but it's FDA-approved for weight management instead. (Like Ozempic, Wegovy also comes in two forms: a weekly injection and a daily oral tablet, aka the Wegovy pill.)

That said, coverage for weight loss medications varies widely, and many plans either exclude them altogether or require prior authorization before they'll cover them.

One of the easiest ways to find out if your Cigna plan covers Ozempic is to check your prescription drug benefits before filling your prescription. A quick review can help you avoid surprises at the pharmacy and let you know if there's any paperwork to complete first.

Here are a few ways to check:

• Log in to your myCigna account: Search your plan's drug formulary to see if Ozempic is included, whether it requires prior authorization, and what you can expect to pay.

• Call the member services number on the back of your insurance card: A representative can walk you through your coverage, explain any requirements, and estimate your out-of-pocket costs.

• Ask your healthcare provider or pharmacist: They can often check your prescription benefits for you and let you know if prior authorization or other steps are needed before your prescription can be filled.

If your plan requires prior authorization, don't worry — that's a common part of the process, and your healthcare provider will likely be used to submitting documentation explaining why Ozempic is medically necessary. Depending on your plan, Cigna may also ask for information about your diagnosis or any medications you've tried previously. 

If Ozempic isn't covered, ask your healthcare provider whether another GLP-1 medication that's covered by your plan might be a good fit. If they still believe Ozempic is the best option for you, they may also be able to help you appeal the decision. 

FYI, Ro’s insurance concierge can handle all of this for you when you’re a Ro Body member. And even if you’re not a member, you can still use Ro’s GLP-1 Insurance Coverage Checker. This online tool provides an easy, free way to check whether your Cigna plan covers the Ozempic pen (and other GLP-1 injections, for that matter).

Check for free

Without insurance, Ozempic can cost over $1,000 for a one-month supply, though the exact price varies by pharmacy, dose, location, and whether you can use manufacturer savings programs.

If your Cigna plan covers Ozempic, what you'll pay out of pocket depends on your specific benefits. Your prescription may be subject to a copay, coinsurance, or deductible, and medications placed on higher formulary tiers typically cost more than those on lower tiers.

If you have commercial insurance and your plan covers Ozempic, you may also qualify for the Ozempic Savings Card from Novo Nordisk (Ozempic’s manufacturer), which can lower your out-of-pocket costs to as low as $25 per month, if you meet the eligibility requirements. Just note that if you have government-funded insurance, like Medicare or Medicaid, you won’t be eligible for this specific savings offer.

If your plan doesn’t cover Ozempic and you have type 2 diabetes, you may qualify for Novo Nordisk’s self-pay offer. According to the terms and conditions, the self-pay offer is for people with insurance that does not cover Ozempic, or those who are self-paying or opting to process outside of their insurance. Pricing ranges from $149 to $499 per month, depending on your dose and whether you’re using the Ozempic pen or pill, among other requirements. 

Your healthcare provider can also help you explore other options, including alternative GLP-1 medications that may be covered or other treatments that fit your health needs and budget.

Whether you have Cigna or another provider like Blue Cross Blue Shield, if your insurance denies coverage for Ozempic, it doesn't necessarily mean you've reached the end of the road. Depending on the reason for the denial, you may have several other options.

Your first step is to find out why your prescription wasn't approved. Common reasons include:

• Ozempic was prescribed for a use your plan doesn't cover, such as weight loss.

• Your plan requires prior authorization, and it hasn't been submitted or approved yet.

• Your plan requires you to try another medication first.

• Ozempic isn't included in your plan's formulary.

Once you know the reason, you can work with your healthcare provider to decide what to do next. They may be able to:

• Submit or update a prior authorization request with additional medical information.

• Appeal the denial if they believe Ozempic is medically necessary.

• Prescribe a different GLP-1 medication that's covered by your plan.

• Discuss other treatment options that better fit your insurance coverage and health needs.

If cost is the biggest barrier, it's also worth asking about manufacturer savings programs or patient assistance programs. While not everyone qualifies, these programs can help lower out-of-pocket costs for some people with commercial insurance.

The process can feel frustrating, but insurance decisions aren't always final. If your healthcare provider believes Ozempic is the right treatment for you, they can often help navigate the appeals process or identify another option that's both clinically appropriate and more likely to be covered.

See if you qualify

Whether Cigna covers Ozempic depends on your plan, your diagnosis, and your prescription drug benefits. Here's what to keep in mind:

• Many Cigna plans cover Ozempic for type 2 diabetes and its other FDA-approved uses, but coverage is generally less common when it's prescribed off-label for weight loss. 

• When Ozempic is covered, you typically need prior authorization, step therapy, or to meet other plan-specific requirements before your prescription is approved.

• If you're seeking treatment for weight loss, your plan may be more likely to cover an FDA-approved obesity medication, such as Wegovy.

• If your prescription is denied, ask your healthcare provider about filing an appeal or whether another GLP-1 medication that's covered by your plan could be a good alternative.

• Before filling your prescription, check your formulary or contact Cigna so you know what to expect (and avoid any surprises at the pharmacy).