Check your plan’s formulary to see whether Ozempic is covered and what the prior authorization requirements are
Confirm whether your plan covers Ozempic for type 2 diabetes only or also for other uses
Ask your doctor to document your diagnosis, lab results, and prior treatments
Request a prior authorization from your prescriber
Make sure your prescription uses the exact diagnosis and dosing required by your insurer
Provide proof of medical necessity if your insurer asks for it
Ask your doctor to submit a letter of medical necessity
Show that you have tried and failed other covered medications if required
Ask your insurer whether step therapy is required and complete it if needed
File an appeal if coverage is denied
Submit any supporting records, including A1C results, medication history, and chart notes
Ask your doctor to help with the appeal and provide additional documentation
Request a formulary exception if Ozempic is not on the preferred drug list
Check whether a different GLP-1 medication is covered if Ozempic is not
Use the insurer’s patient assistance or savings program if eligible
Contact the manufacturer’s savings card program if you qualify
Verify whether your pharmacy is in-network
Recheck coverage whenever your plan renews or changes
Keep copies of all denials, approvals, and submitted documents
Call your insurer and ask for the exact reason for denial and the next required step