Plan Name
\nAverage Annual Ozempic Cost
\nAverage Annual Mounjaro Cost<\/p>\n
AARP\/UnitedHealthcare
\n$327
\n$348<\/p>\n
Aetna\/CVS
\n$623
\n$1,144<\/p>\n
Alignment Health Plan
\n$38
\n$132<\/p>\n
Anthem
\n$592
\n$819<\/p>\n
Blue Cross Blue Shield
\n$31
\n$224<\/p>\n
Cigna
\n$93
\n$185<\/p>\n
Devoted Health
\n$658
\n$1,312<\/p>\n
Humana
\n$220
\n$198<\/p>\n
Kaiser Permanente
\n$47
\n$5,251<\/p>\n
Molina Healthcare
\n$47
\n$75<\/p>\n
$0 Doesn\u2019t Mean Hassle-Free <\/p>\n
Even when a plan lists Ozempic at $0, that price may come with strings attached. For example, Humana\u2019s Gold Plus plan offers Ozempic for $0, but requires prior authorization<\/a> from the insurer and may impose quantity limits.\u00a0\n<\/p>\n Prior authorization and step therapy are common in Medicare Advantage<\/a> plans for high-cost drugs like Ozempic. Under prior authorization<\/a>, you must receive approval from your insurer to get a prescription covered. With step therapy, you must try a lower-cost prescription for your medical issue first before the insurer will approve a more expensive one. In some cases, even that might not guarantee access to Ozempic. Plans may prefer policyholders to use rival drugs like Mounjaro.\n<\/p>\n Pharmacy benefit managers (PBMs), the intermediaries that negotiate drug prices on behalf of insurers, play a significant role in determining which drugs are favored. PBMs often encourage competition among pharmaceutical companies, such as GLP-1 medications (a class that includes Ozempic, Mounjaro, and Wegovy, used to manage type 2 diabetes and obesity).\n<\/p>\n \u201cThey can go to the maker of Ozempic, Novo Nordisk, and say, \u2018If you want to be our preferred GLP-1, we need a bigger discount or we\u2019ll go with a competitor,\u2019\u201d said Geoffrey Joyce, director of health policy at the USC Schaeffer Center.\n<\/p>\n If one company offers a bigger rebate, a PBM may be more likely to favor its drugs. That means your access to Wegovy or Mounjaro might depend on which manufacturer has a better deal with your insurer\u2019s PBM. And if a drug is not your PBM\u2019s preferred pick, it might get placed on a higher cost tier or come with more administrative hurdles to get it covered.\n<\/p>\n Comparing Medicare Advantage Drug Coverage <\/p>\n Despite these price differences, many Medicare enrollees<\/a> don\u2019t choose plans based on how they cover specific drugs, Joyce said.\n<\/p>\n \u201cWe have a lot of empirical evidence that says people choose plans based on the premium and whether their doctors are in-network,\u201d he said. \u201cIt\u2019s a little harder for people to be price shoppers on the drug side when they\u2019re choosing an MA plan.\u201d\n<\/p>\n Comparing costs can be especially challenging for drugs like Ozempic, which may fall into a gray area because it\u2019s often covered for diabetes but also sought off-label for weight loss, which Medicare typically won\u2019t pay for.\n<\/p>\n But to get a baseline, you can follow these steps to compare drug prices across different Medicare Advantage plans:\n<\/p>\n Go to Medicare.gov\/plan-compare<\/a> Tip<\/p>\n Look for whether the plan requires prior authorization or step therapy<\/a> before joining a Medicare Advantage or Part D plan. You\u2019ll see it noted next to the drug name on the formulary and in the comparison tool.<\/p>\n How We Got the Numbers <\/p>\n
\nEnter your ZIP code and select \u201cMedicare Advantage Plan (Part C)<\/a>\u201d
\nWhen prompted, add your drugs. For example, you can search for \u201cOzempic.\u201d\u00a0
\nChoose the dosage and frequency.
\nChoose up to five local pharmacies to compare pricing.
\nBrowse the list of available plans. Click \u201cPlan Details,\u201d then scroll to the \u201cDrug Coverage\u201d section.
\nCompare the monthly and annual costs for your drug at each pharmacy.<\/p>\n