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Does Wellcare Cover Ozempic?

Written By: Irene Lefever
Reviewed By: William Rivers
Published: December 18, 2023
Last updated: January 11, 2024
KEY TAKEAWAYS

If you have a stand-alone Part D plan under Wellcare, your Ozempic medication is covered by your plan.[1]

If you are enrolled in a Wellcare Medicare Advantage plan, it may include prescription drug coverage that could potentially cover Ozempic.

Wellcare also covers a range of diabetes testing supplies under its various health plans, including blood glucose monitors, test strips, insulin pumps, and more.[2]

If you’re unsure whether your Wellcare plan covers Ozempic, check the most recent formulary for your plan to see if Ozempic is listed and under which tier.

Navigating the world of health insurance coverage for specific medications can be complex. One common query among those managing diabetes is: “Does Wellcare cover Ozempic?” In this blog, we’ll explore the intricacies of Wellcare's coverage policies, providing insights into eligibility criteria, cost implications, and how to access Ozempic under Wellcare plans. 

Does Wellcare Cover Ozempic?

Wellcare covers Ozempic, but only for members under specific plans. Wellcare's coverage for specific medications like Ozempic, which is used primarily for the treatment of type 2 diabetes, can depend on various factors, including the specific Wellcare plan you are enrolled in and the region you reside in. 

Here's a general overview of how coverage for Ozempic under Wellcare might work.

Plan Specifics

  • Medicare Advantage Plans: If you are enrolled in a Wellcare Medicare Advantage plan, it may include prescription drug coverage that could potentially cover Ozempic. The extent of coverage can vary by plan.
  • Prescription Drug Plans (Part D): For those with a stand-alone Part D plan, coverage for Ozempic will depend on the plan's formulary, which is the list of covered medications.[1]
  • Medicaid Plans: Coverage under Medicaid plans, which Wellcare also offers, varies significantly by state. Ozempic may be covered, but this is dependent on the state's formulary and prior authorization requirements.

Fast Facts

Wellcare typically includes a wide range of diabetes medications in its formulary, which can include insulin, oral diabetes medications, and newer classes of drugs.

Formulary Considerations

  • Tier Placement: Medications like Ozempic are placed in specific tiers within a formulary. The tier determines your out-of-pocket costs. Higher tiers generally mean higher costs.
  • Prior Authorization: Some plans may require prior authorization for Ozempic, meaning your doctor will need to provide justification for its necessity before the plan covers it.
  • Quantity Limits: There may be quantity limits on how much of the medication you can receive at one time.

Out-of-Pocket Costs

The cost of Ozempic under Wellcare plans can vary. It's essential to consider deductibles, copayments, or coinsurance that may apply.

Steps to Determine Coverage

  1. Review Your Plan's Formulary: Check the most recent formulary for your Wellcare plan to see if Ozempic is listed and under which tier.
  2. Contact Customer Service: Reach out to Wellcare's customer service for the most accurate and current information regarding Ozempic's coverage.
  3. Consult with Your Healthcare Provider: Discuss with your healthcare provider about the necessity of Ozempic and any coverage-related requirements, such as prior authorization.

Covered Diabetes Testing Supplies by Wellcare

As a leading healthcare insurance provider, Wellcare also covers a range of diabetes testing supplies under its various health plans.[2] These supplies are essential for individuals managing diabetes, allowing for regular monitoring of blood sugar levels.

The specific coverage details can vary based on the type of Wellcare plan you have, but generally, the following diabetes testing supplies are often included:

  1. Blood Glucose Monitors: Devices used to measure blood sugar levels. Wellcare may cover different types of monitors, including traditional and continuous glucose monitoring systems (CGMs).
  2. Test Strips: These are used with blood glucose monitors for testing blood sugar levels. The coverage typically includes a certain quantity of test strips over a specified period.
  3. Lancets and Lancing Devices: Lancets are small needles used to prick the skin to obtain a blood sample for testing. Lancing devices hold the lancet and are used to ensure a quick and minimal-pain blood sample collection.
  4. Control Solutions: Used to ensure that blood glucose meters and test strips are working properly and providing accurate readings.
  5. Insulin Pumps and Supplies: While not traditional testing supplies, insulin pumps (devices for insulin delivery) and related supplies may be covered, as they are essential for managing blood sugar levels in some individuals with diabetes.
  6. Glucose Control Tabs: Quick-dissolve tablets that are used to raise blood sugar levels rapidly in cases of hypoglycemia.

Fast Facts

Wellcare facilitates cost assistance programs to help reduce out-of-pocket expenses for expensive diabetes medications, making them more affordable for patients.

Unlock the Benefits of the Wellcare Flex Card

Are you a Wellcare member looking for more flexibility in managing your healthcare expenses? Use the Wellcare Flex Card to cover costs that are often not included in traditional health plans, such as certain over-the-counter medications, dental, vision, and hearing services. Discover the advantages of the Wellcare Flex Card – a powerful tool designed to enhance your healthcare experience!

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Irene Lefever is a senior advisor whose role is to make sure that senior citizens’ physical, mental, psychological, and emotional needs are catered to. Lefever got her degree in Multimedia Arts at the University of California, Riverside.
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