What Your Prescriptions Cost
How much does Ozempic cost with Medicare in 2026?
Last reviewed: · Big Sioux Benefits Data Desk
Ozempic is not among the ten drugs with Medicare-negotiated prices in 2026. CMS claims data shows Part D spent an average of $1,302.82 per Ozempic claim in 2025, across 2.0 million beneficiaries and $16.2 billion in total spending, an average of $7,899.58 per beneficiary for the year. Under the standard 2026 benefit, a member taking it monthly reaches the $2,100 out-of-pocket cap around the sixth month and pays nothing for covered drugs after that.
The qualifier, and it is the one that decides whether you get it covered at all: Medicare Part D covers Ozempic when it is prescribed for type 2 diabetes, which is its approved indication in this formulation. Drugs prescribed for weight loss are excluded from Part D by federal law. Same molecule, different branded product, different indication, entirely different coverage answer, which is why this question generates so much confusion.
What the CMS data shows
| Measure | 2025 value |
|---|---|
| Average Part D spending per claim | $1,302.82 |
| Average Part D spending per beneficiary, per year | $7,899.58 |
| Medicare beneficiaries using it | 2,044,798 |
| Total Part D spending | $16.15 billion |
| Your approximate out-of-pocket for the year | $2,100, the cap, reached around month six |
How this illustration is built: the 2026 standard Part D benefit, meaning a full $615 deductible, then 25% coinsurance, then $0 once your out-of-pocket total reaches $2,100. Your plan may use copays instead of coinsurance, may charge a smaller deductible or none, and may place the drug on a different tier, so treat this as the shape of the year rather than a quote. We are not showing plan-specific copays because we will not publish a number we cannot source.
Two forward-looking notes. Ozempic was not selected for the first negotiation cycle, but the program expands each year, and CMS announced fifteen more drugs in January 2026 for prices effective in 2028. The selection list is public, and the current status is in which drugs are next for negotiation. On coverage, the weight-loss exclusion and how it interacts with GLP-1 drugs is worked through in does Medicare cover weight-loss drugs.
Sources
- CMS — Medicare Part D Spending by Drug — CY2025 full year and CY2026 Q1 files; accessed 2026-08-21
- CMS — Announcement of Calendar Year 2026 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies (Part D benefit parameters) — CY2026 parameters; accessed 2026-08-21
- Medicare.gov — What Medicare Part D drug plans cover — accessed 2026-08-21
- CMS — Medicare Drug Price Negotiation Program: Selected Drugs for Initial Price Applicability Year 2028 — announced January 27, 2026; accessed 2026-08-21
Related questions
Will Medicare cover Ozempic if I take it for weight loss?
No. Federal law excludes drugs used for weight loss from Part D coverage entirely, and no plan can cover them under the basic benefit. Coverage of semaglutide depends on the specific product and the indication it was prescribed for, which is a question for your prescriber and your plan, not a plan-shopping decision.
Why is Ozempic not on the negotiated price list?
The first cycle selected ten drugs based on Part D spending and statutory criteria, using an earlier data period. The program adds drugs each cycle: fifteen more take negotiated prices in 2027, and CMS announced another fifteen in January 2026 for 2028. Selection lists are published by CMS as each cycle is announced.
Drug costs turn on your specific prescriptions, so the arithmetic is worth doing once, properly: book a free, no-pressure conversation, see your county's South Dakota plan lineup, or browse all answers. SHIINE, the state's free counseling program, is at 1-800-536-8197 and sells nothing.
Big Sioux Benefits is a licensed insurance agency, not affiliated with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area. Contact Medicare.gov, 1-800-MEDICARE, or SHIINE (South Dakota's SHIP) for all of your options.