How to pay for promising medications like Ozempic

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This article was published 27/12/2023 (996 days ago), so information in it may no longer be current.

Steve Haines always loved to go for walks, but exercise had become a nightmare when he was 380 pounds and diabetic. The 49-year-old from Champaign, Illinois, says he would get ulcers on his feet after long walks.

About six years ago, Haines’ doctor prescribed Ozempic, a medication approved by the Food and Drug Administration to treat diabetes that also helps with weight loss. Haines lost weight and began to feel more active. Now, at 220 pounds and with his diabetes under control, he gets out of the house a lot.

“I sometimes walk 10 to 15 miles in a day,” says Haines.

Haines is one of many Americans who live with diabetes. According to the Centers for Disease Control and Prevention, around 1 in 10 Americans have diabetes, and the vast majority have Type 2, a condition in which the body can’t control the amount of sugar in the blood.

Ozempic, generically known as semaglutide, can be a lifeline for many. Semaglutide stimulates insulin secretion and controls blood sugar, which helps manage Type 2 diabetes. The medication also slows digestion and sends signals to the brain that the stomach is full, which can lead to weight loss.

Prescriptions in the U.S. for semaglutide medications like Ozempic increased 300% from 2020 to 2022, despite a high price tag. Depending on factors like the dosage and your pharmacy, Ozempic can cost over $11,000 annually. Insurance provides coverage for some patients, but others must find alternative ways to pay, through savings or assistance programs or borrowing.

UNDERSTANDING INSURANCE COVERAGE

Most health insurance plans, including Medicare and Medicaid, cover at least some of the cost of semaglutide medication when it’s prescribed to treat Type 2 diabetes. However, coverage can vary depending on an individual’s plan and state requirements.

Alvin Carlos, a certified financial planner based in Washington, D.C., suggests calling your insurance provider to ask if your plan covers drugs like Ozempic and what the out-of-pocket costs may be.

When choosing insurance, a low-deductible plan can be better for expected costs such as ongoing prescriptions, says Carlos. A health savings account or flexible savings account, which use pre-tax income to pay for health expenses, can also mitigate out-of-pocket costs.

Those who don’t have insurance that covers Ozempic for diabetes, or are seeking the drug for weight management and other non-diabetic reasons, will likely have to find alternative ways to pay for the medication.

EXPLORING PAYMENT OPTIONS

Hillary Filstrup, 37, a customer success manager in Tulsa, tried to get Ozempic to manage her weight after being diagnosed with polycystic ovary syndrome and developing insulin resistance. However, her insurance wouldn’t cover the medication since her condition wasn’t diabetes-related. Filstrup opted to pay out of pocket for a semaglutide medication from a compounding pharmacy.

For those like Filstrup with high out-of-pocket costs or no insurance coverage for Ozempic, there are ways to help pay for the medication.

— MANUFACTURERS’ SAVINGS PROGRAMS

Pharmaceutical companies often offer savings cards to reduce out-of-pocket costs for eligible patients. Novo Nordisk, the manufacturer of Ozempic, provides a savings card that can significantly lower the cost for up to three months for qualifying patients with private or commercial insurance.

— PATIENT ASSISTANCE PROGRAMS

Patient assistance programs are designed to help uninsured patients who cannot afford their medications. Qualification criteria may include income limits and lack of insurance coverage.

— BORROWING MONEY FOR MEDICAL BILLS

A medical credit card like CareCredit or a personal loan are two ways to finance medical bills, but both come with interest that can increase the total cost. According to Carlos, using a loan or credit card is best for one-time urgent medical expenses rather than recurring costs like semaglutide medications. But they can be fast-funding options that help bridge a gap while patients sort out insurance coverage and their longer-term finances.

BE PROACTIVE

Once you decide to start Ozempic, create a plan that factors in the additional costs to your monthly budget and ways to manage the financial impact. Filstrup acknowledges that the medication, despite its benefits, is an expense that many people may not be able to afford.

Both Haines and Filstrup agree that semaglutide medication like Ozempic is a tool, alongside exercise and nutrition, for a more significant shift in health.

“The medication is just very helpful. It provides you with the opportunity to become healthier,” says Haines.

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This article was provided to The Associated Press by the personal finance website NerdWallet. Ronita Choudhuri-Wade is a writer at NerdWallet. Email: rcwade@nerdwallet.com.

RELATED LINK:

NerdWallet: Does Medicare Cover Ozempic? https://bit.ly/nerdwallet-medicare-ozempic