Nurse Explains How to Get Free Ozempic From Medicare

Weight loss drugs Ozempic and Mounjaro remain in high demand, but many believe they’re out of their price range.

Without insurance, Ozempic can rack up a cost of $915 for just one injection. While many insurance policies cover the drug for diabetes treatment, those using the drug for weight loss have often struggled to gain coverage.

There are ways to get around this, however.

April Peter, the 37-year-old woman behind the TikTok account @ThatNurseApril, shared how her 69-year-old mother was able to get the drug completely free through Medicare.

Peter’s mother is diabetic and has chronic kidney disease, making her an ideal candidate for a drug like Ozempic or Mounjaro. She was prescribed Ozempic by her primary care doctor specifically for glucose control.

“It also has the added benefit of weight loss, which is also something her doctor wants for her due to her comorbid conditions,” Peter told Newsweek.

Unfortunately for many Medicare beneficiaries, obstacles can pop up when trying to get a drug like Ozempic.

“She wants to lose some weight,” Peter said in her recent video. “She’s also on Medicare, and she does not have a prescription insurance plan to get medications covered.”

Due to her specific situation, Mounjaro, another weight loss drug that has been linked to higher success than Ozempic, was deemed “off the table,” Peter said.

But there was hope for Ozempic. By applying for the Ozempic Patient Assistance Program, Peter’s mother was able to get the powerful drug completely free.

The Novo Nordisk assistance program asked for Peter’s mother’s doctor’s office to complete some paperwork, and after that, the medication was approved at no cost to Peter’s mom.

“The process to apply for the Patient Assistance Program was simple,” Peter said. “They have an online application as well, but her doctor’s office was kind enough to do it for her.”

While some income and insurance restrictions are used, Peter said most patients who meet the diagnostic criteria should be able to apply.

Difficulty Finding Drugs for Weight Loss

Still, for those looking to gain access to Ozempic or Mounjaro for weight loss, not diabetes, difficulties abound.

“If a person wanted to take Ozempic for weight loss, even with co-morbidities, Medicare will not pay,” Barb Herrera told Newsweek.

Herrera, who has lost almost 200 pounds in one year with the help of weight loss drugs, runs the HealthAtAnyCost website.

Herrera believes Medicare and other insurances will start covering the drug for weight loss only when there’s more research showing the benefits of avoiding heart disease and healing fatty liver disease in general.

“The powers that be need a lot of proof that they will, in one way or another, save tons of money by using the medications to lessen the massive illnesses that the cost of covering them will balance out,” Herrera said.

While the big pharma companies behind the two weight loss drugs, Novo Nordisk and Eli Lilly, are lobbying for Medicare coverage as weight loss drugs, so far patients have been unable to get the medications for obesity treatment.

“My hope is that in an ideal world they would,” Peter said. “However it has been a steady challenge for many GLP-1 users for the better part of over a year now. I feel there is still a lack of understanding when it comes to these medications.”

While the medications that contain the Glucagon-like peptide 1 hormone (GLP-1) are FDA approved for diabetes and chronic weight management, Peter said it still feels like those who have obesity face stark odds of getting the medications that would help them.

“It still feels as if those who have obesity are discriminated against or seen as using these meds for vanity reasons,” said Peter, who has been on Mounjaro for 18 months and lost 105 pounds while on the medication.

Today, patients looking to use the drugs solely for weight management have just a few options.

Forking over the money is one, of course, but others are choosing to buy compounded medications, which carries higher risks.

Plus, patients need to be aware that the drugs are not a one-stop fix, doctors say.

When a patient’s ability to pay or prescription runs out, they tend to gain all the weight lost during their time on the drugs.

“Many people who start the drugs stop taking them within the first year, and too often, they gain the weight back that they lost,” Julia Hu, the founder of Lark Health, told Newsweek.

“People are most successful on these medications when they have clinical support to manage side effects and help them achieve successful outcomes.”