{"id":8730,"date":"2025-12-07T23:57:54","date_gmt":"2025-12-07T23:57:54","guid":{"rendered":"https:\/\/healthmedicinet.com\/review\/hmn-does-the-va-cover-ozempic-in-2025\/"},"modified":"2025-12-07T23:57:54","modified_gmt":"2025-12-07T23:57:54","slug":"hmn-does-the-va-cover-ozempic-in-2025","status":"publish","type":"post","link":"https:\/\/healthmedicinet.com\/review\/hmn-does-the-va-cover-ozempic-in-2025\/","title":{"rendered":"HMN: Does the VA cover Ozempic? in 2025"},"content":{"rendered":"<p>\n<br \/>Do you know:  Does the VA cover Ozempic? in 2025<\/p>\n<div id=\"main-content\">\n<div id=\"post-intro\">\n<div id=\"takeaways\">\n<h2>Key takeaways<\/h2>\n<ul>\n<li>\n<p><span style=\"font-weight: 400;\">The VA will often cover Ozempic, but patients must meet specific criteria and may require prior authorization to receive coverage.<\/span><\/p>\n<\/li>\n<li>\n<p><span style=\"font-weight: 400;\">This VA coverage only applies to people diagnosed with Type 2 diabetes. It will not cover Ozempic prescribed solely for weight loss, although it may cover Wegovy for weight management in patients who meet the inclusion criteria.<\/span><\/p>\n<\/li>\n<li>\n<p><span style=\"font-weight: 400;\">The national formulary\u2019s copays can range from $0 to $33 per prescription, depending on your priority group, the specific drug, and the quantity you\u2019re receiving.<\/span><\/p>\n<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<section class=\"table-of-contents\">\n<div class=\"anchorLinks\">\n<div class=\"mobile-only\">\n<div class=\"dropdownLists\">\n<div tabindex=\"0\" class=\"dropdownBtn\"><span class=\"listsIcon\"><br \/>\n\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.singlecare.com\/blog\/wp-content\/themes\/singlecare\/images\/union.svg\" width=\"14\" height=\"20\"\/><\/span><br \/>\n\t\t\t\t\t\t\t<label><\/label><br \/>\n\t\t\t\t\t\t\t<span class=\"downArrow\"><br \/>\n\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.singlecare.com\/blog\/wp-content\/themes\/singlecare\/images\/dropDownArrow.svg\" width=\"24\" height=\"24\"\/><br \/>\n\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/section>\n<p><span style=\"font-weight: 400;\">Ozempic<\/span><span style=\"font-weight: 400;\"> (semaglutide) is one of the most prominent diabetes medications on the market\u2014one that millions of Americans take for Type 2 diabetes and <\/span><span style=\"font-weight: 400;\">off-label<\/span><span style=\"font-weight: 400;\"> for obesity. As a <\/span><span style=\"font-weight: 400;\">GLP-1 drug<\/span><span style=\"font-weight: 400;\">, it mimics natural hormones to stimulate insulin production, regulate blood sugar levels, and manage appetite. While insurance often covers it for people with diabetes, veterans might wonder if it\u2019s included in their VA health care benefits\u2014it usually is, but that depends on several factors. We\u2019ll cover them all here.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<div id=\"coupon-cta\" class=\"coupon-cta master-template\">\n<p id=\"headline\">Save up to 80% on Ozempic with <\/p>\n<p id=\"subheadline\">Different pharmacies offer different prices for the same medication.  helps find the best price for you.<\/p>\n<div class=\"details-wrap\">\n<p>\n\t\t\t\t\tOzempic 2 mg\/3 mL (1 Pen)\t\t\t\t<\/p>\n<p>\n\t\t\t\t\t23666 &#8211; Hampton, VA\t\t\t\t<\/p>\n<\/p><\/div>\n<div class=\"api-response\">\n<div class=\"coupon\">\n<div class=\"logo\">\n\t\t\t<img decoding=\"async\" src=\"https:\/\/images.singlecare.com\/content\/images\/pharmacy\/logo-color-cvs.svg\" alt=\"CVS Pharmacy\"\/>\t\t\t<\/div>\n<\/p><\/div>\n<div class=\"coupon\">\n<div class=\"logo\">\n\t\t\t<img decoding=\"async\" src=\"https:\/\/images.singlecare.com\/content\/images\/pharmacy\/logo-color-kroger.svg\" alt=\"Kroger Pharmacy\"\/>\t\t\t<\/div>\n<\/p><\/div>\n<\/p><\/div>\n<p>\t\t\tSee Ozempic prices at all pharmacies\n\t\t<\/p><\/div>\n<h2 id=\"does-the-va-cover-ozempic\"><span style=\"font-weight: 400;\">Does the VA cover Ozempic?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">In some cases, yes. However, patients must meet certain criteria before coverage is issued. The VA will not cover Ozempic when prescribed solely for weight loss, as this is not an FDA-approved use.\u00a0<\/span><\/p>\n<h2 id=\"the-va-s-national-formulary\"><span style=\"font-weight: 400;\">The VA\u2019s national formulary<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">A <\/span><span style=\"font-weight: 400;\">formulary<\/span><span style=\"font-weight: 400;\"> is a list that shows how a particular insurance plan covers different drugs, and the VA formulary differs from those that commercial insurance companies use. \u201cCommercial entities will often use their own P&amp;T committees, but regional differences, benefit design strategy, and varying population needs may influence formulary decisions greatly,\u201d says<\/span><a href=\"https:\/\/www.drugwatch.com\/contributors\/shannon-fitzgerald-pharmd\/\"> <span style=\"font-weight: 400;\">Shannon Fitzgerald, Pharm.D<\/span><\/a><span style=\"font-weight: 400;\">, pharmacist, toxicologist, and contributor at Drugwatch.com. \u201cThe VA formulary, in contrast, is managed by the U.S. Department of Veterans Affairs (VA) and is structured on a single, national formulary that is the same across all VA facilities.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The VA updates this formulary frequently and posts new versions<\/span><a href=\"https:\/\/www.pbm.va.gov\/nationalformulary.asp\"> <span style=\"font-weight: 400;\">on its website<\/span><\/a><span style=\"font-weight: 400;\">, along with monthly notices about additions and changes. Ozempic is listed on the national formulary, which includes a link to the coverage criteria (see below).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Yet not every drug is on the national formulary. For example, Ozempic\u2019s weight-loss counterpart, Wegovy,<\/span><a href=\"https:\/\/www.va.gov\/formularyadvisor\/drugs\/4040576-SEMAGLUTIDE-INJ-SOLN\"> <span style=\"font-weight: 400;\">isn\u2019t listed<\/span><\/a><span style=\"font-weight: 400;\">. But that doesn\u2019t mean it\u2019s impossible to get coverage. If you need a medication that\u2019s not listed on the formulary, your healthcare provider can<\/span><a href=\"https:\/\/www.pbm.va.gov\/PBM\/AcademicDetailingService\/Documents\/508\/IB10-1761_CommunityCareNetworkProviderQR_P97205.pdf\"> <span style=\"font-weight: 400;\">submit a non-formulary request<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">According to Fitzgerald, this request should include reasons why<\/span> <span style=\"font-weight: 400;\">Wegovy<\/span><span style=\"font-weight: 400;\"> is medically necessary and why other weight loss drugs are not effective. She says the VA pharmacy will review this request within 96 hours, and if it\u2019s denied, the prescriber can make an appeal to the VA care team.<\/span><\/p>\n<h2 id=\"va-requirements-for-ozempic-coverage\"><span style=\"font-weight: 400;\">VA requirements for Ozempic coverage<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The VA won\u2019t cover Ozempic indiscriminately for everyone. Only for people who meet certain requirements. Typically, patients need <\/span><span style=\"font-weight: 400;\">prior authorization<\/span><span style=\"font-weight: 400;\">, which is the process by which they confirm that Ozempic is truly medically necessary. Here are<\/span><a href=\"https:\/\/www.va.gov\/formularyadvisor\/drugs\/4040140-SEMAGLUTIDE-INJ-SOLN\"> <span style=\"font-weight: 400;\">the requirements<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h3 id=\"diagnosis\"><span style=\"font-weight: 400;\">Diagnosis<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">First and foremost, they need to have a diagnosis of Type 2 diabetes mellitus. According to the Ozempic label, the<\/span><a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=adec4fd2-6858-4c99-91d4-531f5f2a2d79\"> <span style=\"font-weight: 400;\">FDA has only approved it<\/span><\/a><span style=\"font-weight: 400;\"> for managing blood glucose and reducing the risk of sustained eGFR decline, end-stage kidney disease, and major cardiovascular events in people with Type 2 diabetes. So the VA needs proof that you have Type 2 diabetes before they\u2019ll cover it.<\/span><\/p>\n<h3 id=\"medical-necessity\"><span style=\"font-weight: 400;\">Medical Necessity<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">A simple diagnosis, however, isn\u2019t the end of the road. As a prior authorization requirement, patients must have pre-existing atherosclerotic cardiovascular disease and\/or chronic kidney disease, and a medical determination that they\u2019re not a good candidate for empagliflozin (brand name: <\/span><span style=\"font-weight: 400;\">Jardiance<\/span><span style=\"font-weight: 400;\">). This would be enough evidence that the patient needs Ozempic over cheaper alternatives.<\/span><\/p>\n<h3 id=\"step-therapy\"><span style=\"font-weight: 400;\">Step Therapy<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">If the patient doesn\u2019t have cardiovascular or chronic kidney disease, they can go through a process called<\/span><a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC9067323\/\"> <span style=\"font-weight: 400;\">step therapy<\/span><\/a><span style=\"font-weight: 400;\">\u2014trying certain alternatives first, and moving on to Ozempic if they don\u2019t work. Specifically, patients must try empagliflozin and the maximally tolerated dose of <\/span><span style=\"font-weight: 400;\">metformin<\/span><span style=\"font-weight: 400;\"> (if they can take it). If neither of these medications achieves the desired results or causes significant side effects, the patient may be eligible for coverage for Ozempic.<\/span><\/p>\n<h3 id=\"what-about-for-weight-loss\"><span style=\"font-weight: 400;\">What about for weight loss?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">The VA won\u2019t cover Ozempic for weight loss, but there\u2019s a chance they might cover Wegovy. A semaglutide drug from the same manufacturer, Novo Nordisk, Wegovy is FDA-approved for weight management, while Ozempic isn\u2019t. Since Wegovy isn\u2019t listed on the national formulary, it will require a non-formulary request, and if the VA approves health benefits, the patient needs to <\/span><a href=\"https:\/\/www.va.gov\/formularyadvisor\/DOC_PDF\/CFU_Semaglutide_WEGOVY_for_weight_management_CFU_Rev_Aug_2025.pdf\"><span style=\"font-weight: 400;\">meet the following criteria<\/span><\/a><span style=\"font-weight: 400;\">:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Participate in a comprehensive lifestyle intervention (CLI) that includes diet, exercise, and behavioral changes.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Have a body mass index (BMI) of 30 kg\/m2 or higher with at least one weight-related health condition, like cardiovascular disease or a metabolic disorder.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Before Wegovy is approved for coverage in a female who can become pregnant, the healthcare provider will confirm a negative pregnancy test and counsel the patient on using effective birth control and potential risks of becoming pregnant during treatment.\u00a0<\/span><\/p>\n<h2 id=\"costs-of-ozempic-under-the-va\"><span style=\"font-weight: 400;\">Costs of Ozempic under the VA<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The VA\u2019s copays can vary based on<\/span><a href=\"https:\/\/www.va.gov\/health-care\/eligibility\/priority-groups\/\"> <span style=\"font-weight: 400;\">the priority group to which you <\/span><\/a><span style=\"font-weight: 400;\">are assigned. People in priority group 1 don\u2019t have copays, while people in groups 2\u20138 do. Here are the factors that determine your priority group:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Military service history<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Service-connected disability rating<\/span><\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Income level<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Medicaid eligibility<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Other benefits<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">For anyone in groups 2\u20138,<\/span><a href=\"https:\/\/www.va.gov\/health-care\/copay-rates\/\"> <span style=\"font-weight: 400;\">the national formulary\u2019s copays<\/span><\/a><span style=\"font-weight: 400;\"> can range from $0 to $33 per prescription, depending on the drug and the amount you\u2019re getting. It divides medications into four different tiers, each with its own rates and coverage.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Tier 0 (prescription and over-the-counter medicines with no copay): <\/b><span style=\"font-weight: 400;\">$0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Tier 1 (<\/b><a href=\"https:\/\/www.va.gov\/resources\/va-tier-1-copay-medication-list\/\"><b>preferred generic prescription medications<\/b><\/a><b>): <\/b><span style=\"font-weight: 400;\">$5 for 1\u201330 day supply, $10 for 31\u201360 day supply, $15 for 61\u201390 day supply.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Tier 2 (non-preferred generic prescription medications\/some OTC medications): <\/b><span style=\"font-weight: 400;\">$8 for 1\u201330 day supply, $16 for 31\u201360 day supply, $24 for 61\u201390 day supply.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Tier 3 (brand-name prescription medications): <\/b><span style=\"font-weight: 400;\">$11 for 1\u201330 day supply, $22 for 31\u201360 day supply, $33 for 61\u201390 day supply.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">The VA puts an annual $700 cap on copays, and once you hit it, you won\u2019t need to pay any other copays for the year, even if you continue getting medications.<\/span><\/p>\n<p><b>Ozempic is a brand-name drug, so you will have a $0 copay if you are in group 1. If you are in groups 2 through 8, your copay will be $11 for a one-month supply, $22 for two months, or $33 for three months. But if you are in groups 2 through 8 and have already paid $700 in copays for the calendar year, you will have a $0 copay.\u00a0<\/b><\/p>\n<h2 id=\"ways-to-save-on-ozempic\"><span style=\"font-weight: 400;\">Ways to save on Ozempic<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Ozempic prices can look intimidating on the surface, especially for people who are<\/span> <span style=\"font-weight: 400;\">paying entirely out of pocket<\/span><span style=\"font-weight: 400;\">. Ozempic\u2019s manufacturer (Novo Nordisk) also offers patient assistance programs and savings cards that can reduce the drug\u2019s out-of-pocket cost. However, people who have VA benefits aren\u2019t eligible, so you\u2019ll need to look elsewhere for savings. But rest assured that there are effective<\/span> <span style=\"font-weight: 400;\">ways to save on Ozempic<\/span><span style=\"font-weight: 400;\">, even if you don\u2019t get any coverage from the VA.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">For example,  offers free Ozempic coupons, which can lower the cost by hundreds of dollars. Instead of paying the average $1,400 for a one-month supply, you could pay $825 at CVS with an <\/span><span style=\"font-weight: 400;\">Ozempic  discount<\/span><span style=\"font-weight: 400;\">. It\u2019s<\/span> <span style=\"font-weight: 400;\">free to sign up<\/span><span style=\"font-weight: 400;\">, and all you have to do is present your  card at a participating pharmacy.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Beyond that, some people are eligible for Medicaid benefits\u2014even if they\u2019re already receiving VA benefits. 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This VA coverage only applies to people diagnosed with Type 2 diabetes. It will not cover Ozempic prescribed solely for weight loss, although [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-8730","post","type-post","status-publish","format-standard","hentry","category-health-news"],"blocksy_meta":[],"_links":{"self":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts\/8730","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/comments?post=8730"}],"version-history":[{"count":0,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts\/8730\/revisions"}],"wp:attachment":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/media?parent=8730"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/categories?post=8730"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/tags?post=8730"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}