A couple of resources for Medicare beneficiaries struggling with GLP-1 costs:
- Novo Nordisk Patient Assistance Program (PAP) — for Medicare patients who meet income requirements (generally under 400% FPL), they may provide Ozempic at no cost. Call 1-866-310-7549.
- Extra Help / Low-Income Subsidy (LIS) — if your income is below certain thresholds, Medicare's Extra Help program can significantly reduce Part D costs. Apply through SSA.
- State Pharmaceutical Assistance Programs (SPAPs) — many states have programs that supplement Part D coverage. Check your state.
Also, to everyone advocating for change: the Treat and Reduce Obesity Act (S.1906) needs constituent pressure. Call your senators. The CBO scored it and the long-term savings from reduced obesity-related complications actually offset the drug costs.
I know this is a thread about Medicare coverage, but I want to mention that compounded semaglutide is an option for Medicare beneficiaries too. Since you're paying cash for compounded (it's not going through insurance), there's no Medicare restriction.
My mother is 71, on Medicare, and gets compounded semaglutide through a telehealth provider for $135/month. Her Medicare covers Ozempic for her diabetes, but during the coverage gap she was paying over $400/month. She switched to compounded for the weight loss benefit and kept her Ozempic for official diabetes management.
Talk to your doctor about whether this makes sense for your situation.
This thread has been incredibly helpful. I applied for the Novo PAP yesterday — fingers crossed. My income is right around 350% FPL so I think I might qualify.
Also going to shop Part D plans aggressively during the next enrollment period. The difference between $380/month and $47/month copay on the SAME drug is insane. The system makes no sense but at least there are paths to navigate it.
Thank you all. This forum is the only reason I haven't given up on getting affordable access.
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