Find a Medicare Part D prescription drug plan for 2027
Medicare Part D
Prescription Drug Coverage 2027
Does Medicare Part D Cover Ozempic in 2027? Coverage and the New $274 Price
Reviewed by Russell Noga, Licensed Medicare Insurance Broker (all 50 states) — Last updated October 31, 2026
Yes, Medicare Part D plans can cover Ozempic in 2027 when it is prescribed for type 2 diabetes, but Part D cannot cover it for weight loss alone. Starting January 1, 2027, Ozempic also carries a Medicare-negotiated price of $274 for a 30-day supply, down from a $959 list price in 2024, which lowers what you pay when you owe coinsurance.
2027 by the Numbers
$274
2027 Medicare negotiated price for a 30-day supply of semaglutide (CMS)
$959
2024 list price for the same 30-day supply (CMS)
$1,347
yearly Ozempic cost under the 2027 standard benefit in our example (our math from CMS 2027 parameters)
Ozempic is one of the most talked-about drugs in Medicare, and 2027 brings the biggest change to its cost so far. Semaglutide, the ingredient in Ozempic, Rybelsus and Wegovy, is one of 15 drugs whose Medicare-negotiated prices start January 1, 2027. Coverage rules, though, have not changed: the reason it is prescribed still decides whether Part D pays.
This page explains when Part D covers Ozempic, what the negotiated price means for your bill with our own worked math, how weight-loss coverage is being handled outside Part D, and what to check in a 2027 plan. It is part of our Medicare Part D plans 2027 series.
Key Takeaways
- Part D can cover Ozempic for type 2 diabetes; federal law bars Part D from covering drugs used only for weight loss.
- The 2027 negotiated price for semaglutide is $274 per 30-day supply, about 71% below the 2024 list price.
- In our standard-benefit example, Ozempic alone costs about $1,347 for 2027 and never reaches the $2,400 cap.
- A separate Medicare GLP-1 Bridge covers some weight-loss GLP-1s for a $50 copay through 2027, but Ozempic is not one of them.
- Plans may still require prior authorization and set their own tier and copay for Ozempic.
When Part D Pays for Ozempic and When It Cannot
| Semaglutide product | FDA-approved use | Part D in 2027 |
|---|---|---|
| Ozempic (weekly shot) | Type 2 diabetes; also lowers heart and kidney risks in some people with diabetes | Can be covered for diabetes-related uses |
| Rybelsus (daily pill) | Type 2 diabetes | Can be covered for diabetes |
| Wegovy (weekly shot) | Weight management; heart risk reduction; a liver condition called MASH | Can be covered for heart risk or MASH uses; not for weight loss alone |
Coverage depends on each plan’s 2027 formulary and approval rules. Plans differ on which drugs they cover.
The law, not the plan, sets the weight-loss rule: Medicare’s drug benefit statute excludes drugs used for weight loss, so no Part D plan can cover Ozempic when the only goal is losing weight, even with the new price.
What the 2027 Negotiated Price Means
$274
negotiated price per 30-day supply in 2027
$685
less than the 2024 list price per month
Jan 1, 2027
date the price takes effect
The negotiated price is what Part D plans pay for semaglutide, set through the Medicare Drug Price Negotiation Program. It does not set your copay. If your plan charges coinsurance, the percentage is figured from the lower price, so you pay less. If your plan charges a flat copay on Ozempic’s tier, the price change may matter less to you directly, though it still affects how fast you move through the deductible.
Our Math: What You Might Pay for Ozempic in 2027
These are our own calculations using the 2027 standard benefit: a $700 deductible, then 25% coinsurance until you hit the $2,400 cap. Real plans may use different deductibles or copays, and pharmacies may add small fees.
| Scenario | How the year plays out | 2027 yearly cost |
|---|---|---|
| Ozempic only, at the $274 price | $274 in January and February, $182.50 in March, then $68.50 a month | About $1,347 |
| Ozempic only, if priced at the old $959 list price | $764.75 in January, $239.75 a month after, cap reached in August | $2,400 |
| Ozempic plus a $500-a-month brand drug | $718.50 in January, $193.50 a month after, cap reached in October | $2,400 |
Illustrative math from CMS 2027 parameters; premiums are extra. Your plan’s tier, deductible and pharmacy pricing will change the result.
What the numbers show: At the new price, someone taking only Ozempic would likely pay about $1,000 less than the cap. People who also take other brand drugs may still hit $2,400, after which covered drugs cost $0 for the rest of 2027.
See plans in your area instantly!
Advertisement
Weight-Loss GLP-1s: The Medicare Bridge, Not Part D
Medicare is testing weight-loss coverage outside the normal Part D benefit. The Medicare GLP-1 Bridge began July 1, 2026, and CMS extended it through December 31, 2027, after delaying a larger plan-based model called BALANCE that will not launch on January 1, 2027.
Key Bridge facts (subject to change)
✔
Covers Wegovy, Zepbound KwikPen and Foundayo for weight reduction, not Ozempic
✔
$50 copay per month in every benefit phase
✔
Requires a prior authorization showing you meet BMI and health criteria
✔
Copays do not count toward the $700 deductible or the $2,400 cap
✔
Extra Help does not reduce the $50 copay
Rules for this program may change, so check Medicare.gov or your plan before counting on it.
A Note on Wegovy
Wegovy uses Part D plans may cover
✔
Reducing the risk of heart attack and stroke in adults with heart disease and excess weight
✔
Treating MASH, a liver disease, where the plan covers that use
Wegovy use Part D cannot cover
✔
Weight loss alone, though the separate Bridge may apply
Wegovy shares Ozempic’s $274 negotiated price. We cover it in more detail on does Medicare Part D cover Wegovy.
Begin Choosing your plan
Advertisement
CALL TO SPEAK WITH A LICENSED INSURANCE AGENT
Advertisement
Getting Ozempic Approved Under a 2027 Plan
1
Check the 2027 formulary. Find Ozempic’s tier and whether it has a PA (prior authorization) or QL (quantity limit) flag.
2
Have your diagnosis on file. Plans commonly ask your prescriber to confirm type 2 diabetes before they approve a GLP-1.
3
Expect a review if you switch plans. A new plan may make you go through prior authorization again, even if your old plan approved it.
4
Use the transition fill. New members can usually get a temporary supply in the first months while an approval or exception is worked out.
5
Appeal a denial. Your doctor can request an exception and explain why Ozempic is medically needed.
Our Medicare Part D formulary 2027 guide explains tiers and exceptions.
Choosing a 2027 Plan if You Take Ozempic
Compare these for each plan
✔
Whether Ozempic is on the 2027 list and at which tier
✔
Whether the plan charges coinsurance or a flat copay for that tier
✔
How much of the $700 deductible applies to brand drugs
✔
Prior authorization and quantity limits on GLP-1s
✔
Total yearly cost with all your drugs plus premiums
If January and February bills look steep, the Medicare Prescription Payment Plan 2027 can spread costs into monthly payments. Our Part D out-of-pocket maximum 2027 page explains the cap.
The Bottom Line
The Bottom Line
Part D plans can cover Ozempic in 2027 for type 2 diabetes, and the new $274 negotiated price should lower costs for members who pay coinsurance. It still cannot be covered for weight loss alone. Compare plans with your full drug list, since tier, prior authorization and deductible rules vary from plan to plan.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048) to get information on all of your options.
Frequently Asked Questions
➤ Will Ozempic be cheaper with Medicare in 2027?
For many people, yes. The Medicare-negotiated price of $274 per 30-day supply starts January 1, 2027, so members who pay coinsurance pay a share of a much lower price. Copay-based plans may see a smaller change.
➤ Is the $274 Ozempic price what I pay at the pharmacy?
No. $274 is what plans pay for a 30-day supply. You pay your plan’s deductible, copay or coinsurance, which is figured from that price.
➤ Can my doctor prescribe Ozempic for weight loss and have Part D pay?
No. Federal law excludes weight-loss-only drugs from Part D. Ozempic is covered only when used for a medically accepted use like type 2 diabetes.
➤ Is Ozempic part of the Medicare GLP-1 Bridge for weight loss?
No. The Bridge covers Wegovy, Zepbound KwikPen and Foundayo for weight reduction. Ozempic stays under regular Part D rules.
➤ Will Ozempic alone get me to the $2,400 Part D cap in 2027?
Probably not. In our standard-benefit example, Ozempic alone costs about $1,347 for the year. Adding other brand drugs could push you to the cap.
➤ Does Rybelsus get the same 2027 negotiated price as Ozempic?
Yes. CMS negotiated one price for semaglutide that applies to Ozempic, Rybelsus and Wegovy, starting January 1, 2027.
➤ Do I need prior authorization for Ozempic on a Medicare plan?
Often, yes. Many plans require proof of type 2 diabetes before approving Ozempic. Check the 2027 formulary for a PA flag.
➤ Does Extra Help lower my Ozempic copay in 2027?
Yes, when Ozempic is covered by your Part D plan. Extra Help sets low fixed copays for covered drugs, though it does not apply to the separate weight-loss Bridge.
ZRN Health & Financial Services, LLC, a Texas limited liability company.
Begin Choosing your plan
Advertisement
CALL TO SPEAK WITH A LICENSED INSURANCE AGENT
Advertisement