Why Is Ozempic So Expensive? Understanding the Pricing Puzzle

Ozempic’s high cost can be a significant burden for many patients, but WHY.EDU.VN is here to break down the complex factors that contribute to its expense, from manufacturing costs to the role of pharmacy benefit managers. Understanding these factors can help you navigate the system and find potential solutions for affordable access. We’ll explore the price drivers, insurance coverage gaps, and potential solutions, touching on market competition and patient assistance programs.

1. What Factors Contribute to the High Cost of Ozempic?

Ozempic’s high price is influenced by several key factors, encompassing research and development expenses, manufacturing complexities, patent protection, and the dynamics of the pharmaceutical market. Let’s delve into each of these areas to understand why Ozempic carries such a hefty price tag.

1.1. Research and Development Costs

Developing a new drug like Ozempic requires substantial financial investment. Pharmaceutical companies must conduct extensive research, clinical trials, and regulatory approvals, all of which add up to billions of dollars.

Extensive Research: Developing a new drug isn’t just about creating a new compound. It starts with years of research to understand the disease, identify potential targets, and design molecules that can effectively address the condition.
Clinical Trials: Before a drug can hit the market, it needs to go through rigorous clinical trials. These trials, often divided into phases, involve testing the drug on animals and then on humans to ensure its safety and efficacy. Each phase requires careful monitoring, data collection, and analysis, which adds to the overall cost.
Regulatory Approvals: After clinical trials, the drug must pass regulatory scrutiny. In the United States, this means seeking approval from the Food and Drug Administration (FDA). The FDA reviews all the data from the clinical trials, manufacturing processes, and proposed labeling to ensure the drug is safe and effective. The process is thorough and time-consuming, contributing to the high cost of drug development.

1.2. Manufacturing Costs

Manufacturing Ozempic involves complex processes and specialized facilities. The cost of raw materials, equipment, and skilled labor contribute to the overall expense.

Complex Processes: Manufacturing Ozempic isn’t as simple as mixing ingredients in a lab. It involves advanced chemical processes, precise measurements, and stringent quality control measures to ensure each dose is safe and effective.
Specialized Facilities: The facilities used to manufacture Ozempic must meet strict regulatory standards. These facilities require specialized equipment, clean rooms, and highly trained personnel to prevent contamination and ensure product quality.
Raw Materials: The raw materials used to produce Ozempic can be expensive. Pharmaceutical-grade ingredients must meet rigorous purity standards, adding to the overall cost.

1.3. Patent Protection and Market Exclusivity

Pharmaceutical companies obtain patents to protect their inventions, granting them exclusive rights to market and sell the drug for a specified period. This exclusivity allows them to set prices without direct competition, which often leads to higher costs.

Patent Lifespan: Patents typically last for 20 years from the date of filing. However, the effective market exclusivity period is often shorter due to the time it takes to develop the drug and obtain regulatory approval.
Market Monopoly: During the patent period, the patent holder has a monopoly on the drug. This means they can set the price without worrying about competition from generic manufacturers.
Return on Investment: Patent protection allows pharmaceutical companies to recoup their investment in research and development. Without this protection, companies might be less willing to invest in developing new drugs.

1.4. Pharmaceutical Market Dynamics

The U.S. pharmaceutical market operates differently from other countries. Factors such as direct-to-consumer advertising, negotiations with insurance companies, and the role of pharmacy benefit managers (PBMs) influence drug prices.

Direct-to-Consumer Advertising: In the U.S., pharmaceutical companies are allowed to advertise their products directly to consumers. This can drive demand for certain drugs, which in turn can increase prices.
Negotiations with Insurance Companies: Pharmaceutical companies negotiate prices with insurance companies and PBMs. These negotiations can result in discounts and rebates, but the list price of the drug often remains high.
Role of Pharmacy Benefit Managers (PBMs): PBMs act as intermediaries between drug manufacturers, pharmacies, and insurance companies. They negotiate drug prices and create formularies, which are lists of covered drugs. PBMs can influence which drugs are prescribed and how much patients pay.

Understanding these factors provides a clearer picture of why Ozempic is so expensive. The high costs associated with research, manufacturing, patent protection, and market dynamics all play a role in determining the final price of the drug.

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2. How Does Ozempic Pricing Compare Internationally?

Ozempic’s price varies significantly across different countries, reflecting diverse healthcare systems, regulatory environments, and negotiation strategies. Comparing international prices can shed light on why Americans often pay more for prescription drugs.

2.1. Price Discrepancies

Ozempic’s price can be substantially higher in the United States compared to other developed countries. This discrepancy is due to several factors, including the absence of government price controls, different negotiation practices, and varying levels of market competition.

Absence of Government Price Controls: Unlike many other countries, the U.S. does not have government price controls on prescription drugs. This means that pharmaceutical companies are free to set their own prices without direct government intervention.
Negotiation Practices: In countries with government-run healthcare systems, drug prices are often negotiated by a central authority. This gives the government greater leverage to negotiate lower prices.
Market Competition: In some countries, generic versions of Ozempic may be available, which can drive down prices. However, in the U.S., patent protection often prevents generic competition, allowing the manufacturer to maintain high prices.

2.2. Factors Contributing to Price Differences

Several factors contribute to the international price differences for Ozempic. These include government regulations, healthcare system structures, and economic conditions.

Government Regulations: Government regulations play a significant role in drug pricing. Countries with government price controls or single-payer healthcare systems often have lower drug prices.
Healthcare System Structures: The structure of a country’s healthcare system can also influence drug prices. In countries with universal healthcare coverage, the government can negotiate prices on behalf of all citizens.
Economic Conditions: Economic conditions, such as income levels and currency exchange rates, can affect drug prices. Countries with lower income levels may negotiate lower prices to ensure access to essential medicines.

2.3. Examples of International Prices

To illustrate the price differences, here are some examples of Ozempic prices in different countries:

Country	Price (per month)
United States	$850 – $1,000
Canada	$250 – $350
United Kingdom	$200 – $300
Australia	$150 – $250
European Union	$200 – $400

These examples highlight the significant price differences for Ozempic across different countries. The U.S. consistently has the highest prices, while other developed countries offer the drug at a fraction of the cost.

3. What Role Do Pharmacy Benefit Managers (PBMs) Play in Ozempic Pricing?

Pharmacy Benefit Managers (PBMs) are intermediaries between drug manufacturers, insurance companies, and pharmacies. They negotiate drug prices, create formularies (lists of covered drugs), and process prescription claims. PBMs play a significant role in determining the cost of Ozempic for patients and insurance companies.

3.1. How PBMs Influence Drug Prices

PBMs influence drug prices through several mechanisms, including negotiations with drug manufacturers, rebates, and formulary management.

Negotiations with Drug Manufacturers: PBMs negotiate drug prices with manufacturers on behalf of insurance companies. They use their collective bargaining power to secure discounts and rebates.
Rebates: Rebates are payments made by drug manufacturers to PBMs in exchange for including their drugs on the formulary. These rebates can lower the net cost of the drug for the PBM, but the list price often remains high.
Formulary Management: PBMs create formularies that determine which drugs are covered by insurance. They can exclude certain drugs from the formulary or place them on higher cost-sharing tiers, which can increase the cost for patients.

3.2. Rebates and Discounts

Rebates and discounts are a key part of the PBM business model. While they can lower the net cost of drugs, they also contribute to the complexity and lack of transparency in drug pricing.

Types of Rebates: Rebates can be based on market share, volume, or other factors. They are typically confidential and not disclosed to patients.
Impact on List Price: Rebates can lower the net cost of the drug for the PBM and insurance company, but the list price remains high. This means that uninsured patients or those with high-deductible plans may still pay the full list price.
Lack of Transparency: The lack of transparency in the rebate system makes it difficult to understand the true cost of drugs. Patients often don’t know how much their insurance company is paying for a drug, or how much of a rebate the PBM is receiving.

3.3. Formulary Decisions

PBMs make decisions about which drugs to include on their formularies. These decisions can have a significant impact on patient access to medications and their out-of-pocket costs.

Formulary Tiers: Formularies are typically divided into tiers, with each tier representing a different level of cost-sharing. Drugs on lower tiers have lower co-pays, while drugs on higher tiers have higher co-pays.
Exclusions: PBMs can exclude certain drugs from the formulary altogether. This means that patients who need these drugs may have to pay the full list price or switch to a different medication.
Impact on Patients: Formulary decisions can have a significant impact on patients, particularly those with chronic conditions who rely on medications to manage their health. Patients may have to switch medications, pay higher co-pays, or go without needed treatment.

The role of PBMs in Ozempic pricing is complex and controversial. While they negotiate discounts and rebates, they also contribute to the lack of transparency in drug pricing and can limit patient access to medications.

4. What Is the Impact of Insurance Coverage on Ozempic Costs?

Insurance coverage plays a crucial role in determining the out-of-pocket costs for Ozempic. The extent of coverage, formulary placement, and cost-sharing arrangements can significantly affect how much patients pay for the medication.

4.1. Coverage Variations

Insurance coverage for Ozempic varies widely depending on the plan. Some plans may cover Ozempic with a low co-pay, while others may not cover it at all.

Formulary Placement: The placement of Ozempic on the formulary can affect coverage. If Ozempic is on a preferred tier, patients may pay a lower co-pay. If it is on a non-preferred tier, patients may pay a higher co-pay or coinsurance.
Prior Authorization: Many insurance plans require prior authorization for Ozempic. This means that patients must get approval from their insurance company before they can fill the prescription. Prior authorization may require documentation of medical necessity or a trial of other medications.
Exclusions: Some insurance plans may exclude Ozempic from coverage altogether. This is more common for plans that do not cover weight-loss drugs.

4.2. Co-pays, Coinsurance, and Deductibles

Co-pays, coinsurance, and deductibles are cost-sharing arrangements that can affect the out-of-pocket costs for Ozempic.

Co-pays: A co-pay is a fixed amount that patients pay for each prescription. Co-pays for Ozempic can range from $20 to $100 or more, depending on the insurance plan.
Coinsurance: Coinsurance is a percentage of the drug cost that patients pay. For example, if a plan has 20% coinsurance, patients would pay 20% of the cost of Ozempic.
Deductibles: A deductible is the amount that patients must pay out-of-pocket before their insurance coverage kicks in. If a plan has a high deductible, patients may have to pay the full cost of Ozempic until they meet their deductible.

4.3. Uninsured and Underinsured

Uninsured and underinsured individuals face the greatest challenges in affording Ozempic. They may have to pay the full list price of the drug, which can be prohibitively expensive.

Full List Price: Uninsured individuals typically pay the full list price of Ozempic, which can be $850 to $1,000 per month.
Limited Access: Underinsured individuals may have high deductibles or co-insurance, which can make Ozempic unaffordable.
Patient Assistance Programs: Some pharmaceutical companies offer patient assistance programs to help uninsured and underinsured individuals afford their medications. These programs may provide free or discounted drugs to eligible patients.

Insurance coverage is a critical factor in determining the cost of Ozempic. Patients with comprehensive insurance coverage may pay a low co-pay, while those who are uninsured or underinsured may face significant financial barriers to accessing the drug.

5. Are There Patient Assistance Programs Available for Ozempic?

Patient Assistance Programs (PAPs) are designed to help eligible individuals afford their medications. These programs, typically offered by pharmaceutical companies, provide free or discounted drugs to those who meet certain income and insurance criteria.

5.1. Novo Nordisk Patient Assistance Program

Novo Nordisk, the manufacturer of Ozempic, offers a patient assistance program to help eligible individuals afford the medication. The program provides free Ozempic to those who meet certain income and insurance requirements.

Eligibility Criteria: To be eligible for the Novo Nordisk Patient Assistance Program, individuals must have a household income at or below 400% of the federal poverty level, have no insurance coverage for Ozempic, and meet other program requirements.
Application Process: The application process for the Novo Nordisk Patient Assistance Program involves completing an application form, providing documentation of income and insurance status, and obtaining a prescription from a healthcare provider.
Benefits: Eligible individuals receive free Ozempic for up to one year. They may be able to reapply for the program after one year.

5.2. Other Assistance Programs

In addition to the Novo Nordisk Patient Assistance Program, other organizations and programs may provide assistance with the cost of Ozempic.

Non-profit Organizations: Some non-profit organizations offer assistance to individuals who need help paying for their medications. These organizations may provide grants, co-pay assistance, or other forms of financial support.
State Pharmaceutical Assistance Programs: Some states have pharmaceutical assistance programs that help residents afford their medications. These programs may offer discounts, rebates, or other forms of assistance.
Discount Cards: Discount cards can help individuals save money on prescription drugs. These cards are typically free and can be used at participating pharmacies.

5.3. How to Find and Apply

Finding and applying for patient assistance programs can be challenging. However, several resources can help individuals navigate the process.

NeedyMeds: NeedyMeds is a website that provides information on patient assistance programs and other resources for affording medications.
RxAssist: RxAssist is another website that offers information on patient assistance programs and discount cards.
Healthcare Provider: Your healthcare provider may be able to provide information on patient assistance programs and help you apply.

Patient assistance programs can be a valuable resource for individuals who need help affording Ozempic. These programs can provide free or discounted drugs to eligible individuals, making the medication more accessible.

6. What Are Some Strategies for Lowering Ozempic Costs?

Lowering the cost of Ozempic can involve a combination of strategies, including exploring insurance options, using discount cards, and discussing alternatives with your healthcare provider.

6.1. Reviewing Insurance Options

Reviewing your insurance options can help you find a plan that covers Ozempic at a lower cost.

Compare Plans: Compare different insurance plans to see which ones cover Ozempic and what the co-pays, coinsurance, and deductibles are.
Formulary Coverage: Check the formulary to see where Ozempic is placed. If it’s on a non-preferred tier, you may want to consider switching to a plan that covers it on a preferred tier.
Open Enrollment: Take advantage of open enrollment periods to switch to a plan that better meets your needs.

6.2. Using Discount Cards and Coupons

Discount cards and coupons can help you save money on Ozempic, even if you have insurance.

SingleCare: SingleCare offers discounts on prescription drugs, including Ozempic. You can search for discounts on their website or app and present the card to your pharmacist.
GoodRx: GoodRx is another website and app that offers discounts on prescription drugs. You can compare prices at different pharmacies and find coupons to use at checkout.
Manufacturer Coupons: Check the manufacturer’s website for coupons or discount offers. Novo Nordisk may offer coupons to help lower the cost of Ozempic.

6.3. Discussing Alternatives with Your Doctor

Discussing alternatives with your doctor can help you find a more affordable option for managing your condition.

Generic Medications: Ask your doctor if there are any generic alternatives to Ozempic. Generic medications are typically less expensive than brand-name drugs.
Other Medications: Discuss other medications that may be effective for managing your condition. Some medications may be more affordable than Ozempic.
Lifestyle Changes: Lifestyle changes, such as diet and exercise, can also help manage your condition and may reduce your need for medication.

By exploring these strategies, you may be able to lower the cost of Ozempic and make it more affordable.

7. What Are the Potential Policy Changes That Could Affect Ozempic Pricing?

Policy changes at the state and federal levels could significantly affect Ozempic pricing. These changes may include government price negotiations, importation of drugs from other countries, and greater transparency in drug pricing.

7.1. Government Price Negotiations

Government price negotiations could lower the cost of Ozempic by allowing the government to negotiate directly with pharmaceutical companies.

Medicare Price Negotiations: The Inflation Reduction Act allows Medicare to negotiate prices for certain drugs, starting in 2026. Ozempic may be included in future rounds of negotiations, which could lower its cost for Medicare beneficiaries.
State-Level Negotiations: Some states are exploring their own drug price negotiation strategies. These strategies may involve negotiating prices for all state residents or for specific populations, such as Medicaid beneficiaries.
Impact on Prices: Government price negotiations could significantly lower the cost of Ozempic, making it more affordable for patients and reducing healthcare costs for the government.

7.2. Drug Importation

Drug importation could lower the cost of Ozempic by allowing individuals to import drugs from other countries where they are less expensive.

Personal Importation: Some individuals may be able to import drugs for personal use, as long as they meet certain requirements. The FDA has guidelines for personal importation of drugs.
Wholesale Importation: Some states are exploring wholesale importation programs, which would allow them to import drugs from other countries for sale to residents.
Safety Concerns: Drug importation raises safety concerns, as imported drugs may not be subject to the same quality control standards as drugs manufactured in the U.S.

7.3. Transparency Measures

Transparency measures could help lower the cost of Ozempic by increasing accountability and reducing the power of PBMs.

Price Disclosure: Requiring pharmaceutical companies to disclose the prices they charge for drugs could increase transparency and help consumers make informed decisions.
PBM Oversight: Increasing oversight of PBMs could help ensure that they are acting in the best interests of patients and not just maximizing their profits.
Impact on Prices: Transparency measures could help lower the cost of Ozempic by reducing the ability of pharmaceutical companies and PBMs to charge excessive prices.

Policy changes at the state and federal levels could have a significant impact on Ozempic pricing. These changes may include government price negotiations, drug importation, and transparency measures.

8. Are There Any Promising New Treatments on the Horizon That Could Affect Ozempic’s Market and Price?

The pharmaceutical landscape is constantly evolving, with new treatments emerging that could potentially disrupt the market and influence the pricing of existing drugs like Ozempic. Several promising new treatments are on the horizon that could impact Ozempic’s market share and price.

8.1. Competing GLP-1 Receptor Agonists

Several pharmaceutical companies are developing new GLP-1 receptor agonists that could compete with Ozempic. These new drugs may offer improved efficacy, fewer side effects, or more convenient dosing schedules.

Eli Lilly’s Tirzepatide: Tirzepatide is a dual GIP and GLP-1 receptor agonist that has shown promising results in clinical trials. It may offer better blood sugar control and weight loss than Ozempic.
Other GLP-1 Agonists: Several other pharmaceutical companies are developing new GLP-1 receptor agonists that could compete with Ozempic. These drugs may offer different benefits or target different patient populations.
Impact on Market: The entry of new GLP-1 receptor agonists into the market could increase competition and drive down prices.

8.2. Novel Weight Loss Drugs

In addition to GLP-1 receptor agonists, several other types of weight loss drugs are in development. These drugs may work through different mechanisms of action and offer new options for managing obesity.

Amycretin: Amycretin is an experimental oral drug developed by Novo Nordisk. Early trial results show ‘remarkable’ weight loss, suggesting it could be a strong competitor.
Combination Therapies: Some companies are developing combination therapies that combine multiple drugs to achieve better weight loss results.
Impact on Market: The introduction of novel weight loss drugs could increase competition and drive down prices in the weight loss market.

8.3. Gene Therapies and Personalized Medicine

Gene therapies and personalized medicine approaches could revolutionize the treatment of diabetes and obesity. These approaches may offer more targeted and effective treatments with fewer side effects.

Gene Editing: Gene editing technologies, such as CRISPR, could be used to correct genetic defects that contribute to diabetes and obesity.
Personalized Medicine: Personalized medicine approaches tailor treatment to the individual based on their genetic profile, lifestyle, and other factors.
Impact on Market: Gene therapies and personalized medicine approaches could disrupt the traditional drug market and offer new options for managing diabetes and obesity.

The emergence of new treatments on the horizon could have a significant impact on Ozempic’s market and price. Increased competition, novel mechanisms of action, and personalized approaches could all contribute to lower prices and better outcomes for patients.

9. How Does the High Cost of Ozempic Affect Patient Access and Health Outcomes?

The high cost of Ozempic can have a significant impact on patient access and health outcomes. When medications are unaffordable, patients may skip doses, delay treatment, or forgo medication altogether, leading to poorer health outcomes and increased healthcare costs.

9.1. Reduced Adherence

The high cost of Ozempic can lead to reduced adherence, as patients may skip doses or delay refills to save money.

Skipping Doses: Patients may skip doses of Ozempic to stretch their supply and save money. This can lead to poorer blood sugar control and increased risk of complications.
Delaying Refills: Patients may delay refilling their prescriptions to save money. This can lead to a lapse in treatment and increased risk of complications.
Impact on Health: Reduced adherence can lead to poorer blood sugar control, increased risk of complications, and poorer overall health outcomes.

9.2. Disparities in Access

The high cost of Ozempic can exacerbate disparities in access to healthcare, particularly for low-income and minority populations.

Low-Income Individuals: Low-income individuals may be unable to afford Ozempic, even with insurance coverage. This can lead to poorer health outcomes and increased risk of complications.
Minority Populations: Minority populations may face additional barriers to accessing Ozempic, such as lack of insurance coverage, language barriers, and cultural differences.
Impact on Health Equity: Disparities in access to Ozempic can contribute to health inequities and poorer health outcomes for vulnerable populations.

9.3. Increased Healthcare Costs

The high cost of Ozempic can lead to increased healthcare costs in the long run. When patients cannot afford medications, they may require more frequent doctor visits, hospitalizations, and other costly interventions.

Complications: Poor blood sugar control can lead to complications such as heart disease, kidney disease, and nerve damage. These complications can require costly medical treatment.
Hospitalizations: Patients who cannot afford Ozempic may be more likely to be hospitalized for diabetes-related complications.
Long-Term Costs: In the long run, the high cost of Ozempic can lead to increased healthcare costs for patients, insurers, and the healthcare system as a whole.

The high cost of Ozempic can have a significant impact on patient access and health outcomes. Reduced adherence, disparities in access, and increased healthcare costs are all potential consequences of unaffordable medications.

10. What Are the Ethical Considerations Surrounding Ozempic Pricing?

The pricing of Ozempic raises several ethical considerations, including fairness, access, and the balance between innovation and affordability.

10.1. Fairness and Equity

The high cost of Ozempic raises questions about fairness and equity in healthcare. Is it fair for some patients to be unable to afford a medication that could significantly improve their health?

Equal Access: Everyone should have equal access to essential medications, regardless of their income or insurance status.
Social Justice: The high cost of Ozempic can perpetuate social injustices and widen the gap between the rich and the poor.
Ethical Obligation: Pharmaceutical companies have an ethical obligation to ensure that their medications are affordable and accessible to all who need them.

10.2. Innovation vs. Affordability

Balancing the need to incentivize innovation with the need to make medications affordable is a complex ethical challenge.

Research and Development: Pharmaceutical companies need to recoup their investment in research and development to continue innovating and developing new drugs.
Profit Margins: However, profit margins should not come at the expense of patient access. Pharmaceutical companies should find ways to balance innovation with affordability.
Social Responsibility: Pharmaceutical companies have a social responsibility to ensure that their medications are affordable and accessible to all who need them.

10.3. Transparency and Accountability

Transparency and accountability are essential for ensuring ethical pricing of medications.

Price Disclosure: Pharmaceutical companies should be required to disclose the prices they charge for drugs and the rationale behind those prices.
PBM Oversight: PBMs should be subject to greater oversight to ensure that they are acting in the best interests of patients and not just maximizing their profits.
Ethical Standards: Pharmaceutical companies and PBMs should adhere to high ethical standards and be held accountable for their pricing practices.

The pricing of Ozempic raises several ethical considerations. Fairness, access, the balance between innovation and affordability, and transparency and accountability are all important factors to consider.

Navigating the complexities surrounding Ozempic’s cost can be overwhelming, but WHY.EDU.VN is here to help you find the answers you need. Our platform offers expert insights and comprehensive information to empower you to make informed decisions about your health. Have more questions or need personalized guidance? Visit why.edu.vn today at 101 Curiosity Lane, Answer Town, CA 90210, United States, or reach out via WhatsApp at +1 (213) 555-0101. Let us help you explore solutions for affordable access and understand the ever-evolving landscape of healthcare costs, including prescription savings and value-based pricing.

FAQ: Understanding Ozempic Costs

Here are some frequently asked questions about Ozempic costs, providing you with quick and informative answers.

Why Is Ozempic So Expensive in the US compared to other countries?
- The U.S. lacks government price controls and has different negotiation practices, leading to higher prices.
How do Pharmacy Benefit Managers (PBMs) affect the cost of Ozempic?
- PBMs negotiate drug prices, create formularies, and can influence which drugs are prescribed and how much patients pay.
What if my insurance doesn’t cover Ozempic?
- Review alternative insurance options, use discount cards, or discuss other treatment options with your doctor.
Can I import Ozempic from another country to save money?
- Personal drug importation is possible but has restrictions and safety concerns.
What are my options if I cannot afford Ozempic?
- Patient assistance programs, discount cards, and generic medications may help lower costs.
What are the potential long-term consequences of not taking Ozempic due to its high cost?
- Skipping doses can lead to complications such as heart and kidney issues.
What are some strategies to get more affordable medications?
- Explore government price negotiation measures, and increase transparency in drug pricing.
Are there alternative drugs that are cheaper than Ozempic?
- Discuss alternative medications or weight loss drugs with your doctor.
How do patient assistance programs work for Ozempic?
- Programs can provide free or discounted medications to eligible individuals, making the medication more accessible.
What is the role of insurance companies in determining Ozempic’s cost for patients?
- Insurance plans can cover Ozempic, depending on its formulary tier and plan coverage.