Will Medicare Pay for the Pill Form of Semaglutide?
Semaglutide is a prescription medication. Injectable forms of the drug are available under the brand names Ozempic and Wegovy. The pill form of semaglutide is available as the brand-name drug Rybelsus.
Medicare drug plans usually cover Rybelsus when doctors prescribe it for type 2 diabetes.
Medicare coverage of the pill form of semaglutide
The Food and Drug Administration (FDA) has approved Rybelsus, the pill form of semaglutide, to lower blood sugar levels when taken along with exercise and diet in people with type 2 diabetes.
If you have a Part D prescription drug plan or a Medicare Advantage (Part C) plan with drug benefits, your plan may cover Rybelsus if your doctor prescribes it for this FDA-approved use.
Every Medicare drug plan has a list of covered drugs called a formulary. Not all Medicare plans may cover Rybelsus. If you're unsure whether your plan may cover Rybelsus, check its formulary or contact a plan representative.
Medicare coverage of semaglutide for weight loss
Some doctors prescribe the pill form of semaglutide off-label to assist with weight loss. 'Off-label' use describes taking a drug for a purpose the FDA hasn't approved.
Medicare doesn't cover drugs when people take them off-label. For this reason, it doesn't cover the pill form of semaglutide for weight loss.
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