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Diet, Nutrition & Weight Loss
Reply to "Why won’t insurance cover ozempic for pre-diabetics? "
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[quote=Anonymous]I’m also on Carefirst and I was able to get covered for Ozempic. The caveat is that I had to have completed step therapy by using metformin first. I had labs and have no kidney issues so Dr was good with prescribing metformin. Once I filled the metformin I had no additional requirements for Ozempic. I chose to instead use Mounjaro to treat my obesity and metabolic syndrome. It took several attempts to get it approved and insurance wanted me on Ozempic instead. Please check your policy and ask your insurance for a copy of your prescription formulary or look it up on the portal. My formulary clearly stated that for Ozempic, a prior authorization (PA) was required if step therapy was not done. New policies are coming out though regarding Ozempic and similar medicines where access will be restricted to type 2 diabetics primarily. You can still file a request for a PA but it will be harder to get approved[/quote]
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