Does Insurance Cover Wegovy® (semaglutide), Ozempic®, (semaglutide) or Compounded Semaglutide? Understanding Your Options  

For those considering Wegovy® (semaglutide), Ozempic® (semaglutide), or compounded semaglutide for weight loss or as a treatment option for type 2 diabetes management, gaining clarity on the financial implications is important. This overview examines costs with insurance as well as out-of-pocket expenses for those without coverage. Ivím Health aims to provide a comprehensive picture of the financial aspects of this GLP-1  therapy and help you make an informed decision about your treatment options. 

What is Semaglutide? 

Semaglutide is an innovative medication that has significantly impacted the landscape of weight loss and diabetes treatment. Semaglutide is presently only available as prescription brand name products, Wegovy® and Ozempic®. Compounded semaglutide belongs to the same class of drugs known as GLP-1 receptor agonists. GLP-1 receptor agonists, including medications like semaglutide, are a group of therapeutics that function by mimicking a naturally occurring hormone to regulate glucose levels and appetite.  

Ozempic® and  Wegovy® are registered trademarks of Novo Nordisk.  Ivím Health has no affiliation with Novo Nordisk.  The compounded semaglutide products available as part of Ivím Health’s Weight Loss Program are not made by Novo Nordisk or any company affiliated with Novo Nordisk 

Semaglutide works by: 

• Slowing down digestion, helping you feel full longer 

• Reducing appetite, so you eat less 

• Improving how your body processes blood sugar 

It’s available under brand names Wegovy® for weight management and Ozempic® for type 2 diabetes. The effectiveness of semaglutide has made it increasingly popular, but with that popularity comes questions about semaglutide cost. 

Semaglutide Cost Without Insurance 

Without insurance, the cost of brand-name semaglutide can vary, but generally is in the range of: 

• Wegovy® (for weight loss): Pricing varies and estimated costs can be $1,200 to $1,500* per month 

• Ozempic® (for type 2 diabetes): Pricing varies and estimated costs can be $900 to $1,300* monthly 

While the price of brand-name semaglutide may be out of reach for some, there are more affordable alternatives, such as compounded semaglutide. 

Compound semaglutide is made by specialized compounding pharmacists. It may be prescribed by your health care provider if you meet certain criteria that would make you eligible for this treatment option. Ivím Health offers online compound semaglutide membership plans starting at $125 per month**. These compound options can offer the same weight loss effects while being more cost-effective for certain patients.  

* Dependent on individual insurance coverage and pricing / contact your insurance provider to confirm medication pricing 

**Medication pricing and plans pricing may vary, inquire for details, does not include monthly membership fee 

Semaglutide Cost With Insurance 

If you have insurance, your out-of-pocket cost for brand-name semaglutide could be much lower. However, coverage varies widely between insurance plans. Here’s what you need to know: 

For Ozempic® (Type 2 diabetes treatment): 

• Many insurance plans cover it as it’s FDA-approved for type 2 diabetes 

• You may be required to pay a copay for medication based on insurance plan coverage  

• Some plans may require you to try other diabetes medications first 

For Wegovy® (weight loss): 

• May not be eligible for insurance coverage due it be a newer weight management medication  

• Some plans may cover it if you meet specific criteria (like having a BMI over 30 or over 27 with weight-related health issues) 

• Without insurance coverage patients typically bear the full retail cost of the medication 

Individual insurance companies offer different coverage options and can provide details about coverage, copays, and any requirements, as well as discuss specifics on how much Wegovy® and Ozempic® costs with insurance. Ivím Health offers benefits verifications to help patients determine their brand-name semaglutide coverage and pricing. 

Comparing Costs: Wegovy® and Ozempic® 

Despite sharing semaglutide as their active ingredient, Wegovy® and Ozempic® are distinct in their prescribed uses and potential price points: 

Wegovy® Cost: 

• Prescribed for weight loss 

• Often less likely to be covered by insurance 

• Without insurance, expect to pay $1,200 to $1,500* monthly 

• With insurance, costs vary widely – from affordable copays to full retail price 

 *Dependent on individual insurance coverage and pricing / contact your insurance provider to confirm medication pricing 

Ozempic® Online With Insurance: 

• Prescribed for type 2 diabetes 

• More commonly covered by insurance plans 

• Costs can be dependent on insurance coverage  

• Some plans may cover it fully after you meet your deductible 

Remember, your actual costs can vary based on your specific plan, pharmacy, and location. 

When is Compounded Semaglutide Prescribed? 

Compounded semaglutide offers a more affordable alternative to brand-name versions. Your doctor might recommend it if, during your visit, they determine that you meet certain clinical criteria or that brand name medications are not accessible to you. 

Compounded GLP-1 medications are made in specialized compounding pharmacies. This allows for more flexibility in dosing and ingredients, often at a lower cost.  Compounded medications may be prescribed based on personal weight loss needs. While federal law allows the prescription of compounded drugs, they are not FDA-approved and do not undergo safety, effectiveness, or manufacturing review. 

Is Compounded Semaglutide Covered by Insurance? 

Most insurance plans don’t cover compounded medications, including compounded semaglutide and other compound GLP-1 medications. Ivím Health providers will discuss with individual patients whether compounded semaglutide might be a good option for them. The lower cost of compounded medications often makes them more affordable than brand-name versions, making compounded semaglutide without insurance a more cost-effective choice for some patients. 

Many patients ask if semaglutide is HSA approved or FSA eligible. The good news is you can use your Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs) for your compounded semaglutide prescription. The funds from these accounts can be used to pay for compounded semaglutide, helping to offset the cost. 

Ivím Health: Comprehensive Wegovy® (semaglutide), Ozempic® (semaglutide), or Compounded Semaglutide Treatment and Weight Management Memberships 

Ivím Health offers a streamlined, all-inclusive approach to brand-name and compounded semaglutide treatment and weight management: 

• Fill out a quick online medical questionnaire 

• Schedule a virtual consultation with an Ivím healthcare provider 

• If you are eligible, receive a personalized semaglutide prescription 

• Embark on your tailored weight management journey 

Our monthly membership program provides a world of support: 

• Unlimited one-on-one consultations with healthcare providers 

• A team of dedicated obesity healthcare specialists that includes doctors, nurses, and nutritionists 

• Mobile app access for user-friendly progress tracking  

• An online virtual community of individuals on similar health journeys 

• Expedited prescription refills to keep your treatment on track 

• Personalized nutrition plans and health coaching 

With Ivím Health, you’re not merely getting a prescription – you’re joining a comprehensive, personalized weight management program for $74.99 per month. This holistic approach ensures you have all the tools and support needed to achieve your health goals, making your investment in semaglutide treatment even more valuable.  

Ivím has partnered with Klarna to offer flexible payment options for online weight loss memberships, including a 3-Month Jumpstart program at $125/month, which gradually increases your dosage. Longer-term plans are available at $175/month for 3 months, $165/month for 6 months, or $125/month for 12 months, all requiring the base Ivím membership.  

These options allow you to choose the plan that best fits your health journey and budget, making it easier to commit to your weight management goals. 

Choosing the Right GLP-1 Medication 

Wegovy®, Ozempic®, compounded semaglutide, and other GLP-1 medications are known as GLP-1 receptor agonists. This group includes other notable drugs such as liraglutide (marketed as Victoza® and Saxenda®) and the newer tirzepatide (marketed as Zepbound® and Mounjaro®). Tirzepatide stands out for its dual action, targeting both GLP-1 receptors and glucose-dependent insulinotropic polypeptide (GIP) receptors. This unique mechanism potentially offers enhanced benefits for weight management and glycemic control.  

Ozempic®, Wegovy®, Saxenda®, and Victoza® are registered trademarks of Novo Nordisk.  Zepbound® and Mounjaro® are registered trademarks of Eli Lilly. Ivím Health has no affiliation with Novo Nordisk or Eli Lilly.   The compounded products available as part of Ivím Health’s Weight Loss Program are not made by Novo Nordisk or Eli Lilly or any company affiliated with Novo Nordisk or Eli Lilly. 

Select compounding pharmacies make customized formulations of both semaglutide and tirzepatide, providing alternative options to brand-name versions of these GLP-1 medications. Compounding can provide a more cost-effective alternative for patients who lack insurance coverage or face substantial out-of-pocket expenses for brand-name versions.  

FDA notice on Zepbound®/ Mounjaro® shortage: On October 2, 2024, the U.S. Food and Drug Administration determined that the shortage of tirzepatide injection, a glucagon-like peptide 1 (GLP-1) medication, has ended. (Read more).  

Schedule a visit with an Ivim provider to discuss what this means for you and your treatment options. 

Your healthcare provider will help you choose the best option based on factors like: 

• Your medical history and current health status 

• Your weight loss goals 

• Your risk of potential side effects 

• Your insurance coverage and ability to access the medication 

• The availability of compounded versions, which may offer cost savings 

However, it’s always important to discuss the pros and cons of compounded medications with your healthcare provider. Compounded medications may be prescribed based on personal weight loss needs. While federal law allows the prescription of compounded drugs, they are not FDA-approved and do not undergo safety, effectiveness, or manufacturing review. 

Remember, the “best” medication is the one that works for you – both medically and financially. Your provider can help you weigh the benefits, risks, and costs of each option to find the most suitable treatment for your individual needs. 

Ivím Health offers free consultations with our obesity specialist healthcare professionals. We’ll help you understand your options, discuss potential costs, and create a personalized, cost-effective treatment plan tailored to your individual needs. Start your weight loss journey today towards better health with semaglutide.