How Much Does Ozempic Cost at Kaiser Permanente?

Kaiser Permanente is a large health system with over 12 million members that covers prescriptions through its pharmacy plans.

If you’re wondering how much Ozempic costs at Kaiser, it depends on your insurance plan, whether you’re using it for diabetes or weight loss, and if you have prior authorization. As of the recent update, the cost can range from a $25 copay (with coverage) to $700-$900 out-of-pocket (without coverage). Ozempic is usually covered for type 2 diabetes but weight loss coverage is only available in certain areas, like the Northwest region.

In today’s article, we will discuss Kaiser’s policies, 2025 updates, requirements, user reports, alternatives, and checking steps, based on official documents and experiences.

How Much Does Ozempic Cost at Kaiser Permanente

Overview of Ozempic and Kaiser’s Pharmacy Benefits

Ozempic is a GLP-1 receptor agonist from Novo Nordisk, primarily FDA-approved for type 2 diabetes to control blood sugar. It also often helps with weight loss. Kaiser Permanente acts as both your insurance and your doctor.

Their coverage for medications can differ based on where you live (like the Northwest or Georgia) and what type of plan you have (like from your job or Medicare). Without insurance, Ozempic costs about $800 to $900 a month. However, because Kaiser has its own pharmacies, they can often offer it at a lower price.

In 2025 formularies, Ozempic is listed for diabetes under tiers requiring copays after deductibles, with mail-order options for 90-day supplies. Coverage for weight loss is limited to specific regions, like the Northwest, as most plans don’t cover off-label use.

Kaiser’s General Coverage Policy for Ozempic

Kaiser covers Ozempic for type 2 diabetes in commercial and Medicare plans. You’ll usually need to get prior approval to show it’s needed.

Your share of the cost (copay) can be anywhere from $25 to $100 for a month’s supply. If you get a 90-day supply, it could cost between $50 and $200. Even with Medicare, there might be a limit on how much you can get at one time.

For weight loss, the policy is restrictive only Northwest members with specific coverage get it under prescription benefits for obesity. In other areas, it’s not covered because it’s not FDA-approved for weight loss. If you pay for it yourself at a Kaiser pharmacy, it will cost about $700 for a one-month supply.

Recent Updates and Changes in Kaiser’s Coverage

In 2025, Kaiser will keep Ozempic on its formularies (like Northwest Commercial and Medicare Comprehensive) for diabetes. PA forms will be updated to speed up processing. Northwest will also expand coverage for weight loss, specifically including obesity under prescription benefits.

Medicare plans updated October 2025 include it in Dual Eligible Special Needs lists, with cost-sharing based on income. Due to shortages, Kaiser is focusing on people with diabetes and limiting use for weight loss in other cases. GoodRx is helping uninsured people by offering their first prescriptions at an introductory price of $199 per month.

Prior Authorization and Requirements

You need permission (PA) from most Kaiser plans to get Ozempic.

For diabetes: You must have a diagnosis, an A1C over 7%, and have tried other drugs like metformin first.

For weight loss (in the Northwest only): You need a BMI of 30 or more (or 27 with other health issues) and be in a lifestyle program.

User Experiences and Reports

People on Reddit say they pay around $700 for Ozempic at Kaiser if it’s not covered. If it is covered for diabetes, the cost can be as low as $25. Some pay $50 for a 3-month supply. Others say they were denied for weight loss and had to pay the full $900. People like that Kaiser has its own pharmacies, which makes things easy.

Alternatives If Kaiser Doesn’t Cover Ozempic

If you have diabetes, options like Trulicity or Victoza might cost less. For weight loss, some Northwest plans may cover Wegovy. GoodRx offers a $199 starter price, or you can use a Novo card for $25/month. Compounded versions are more affordable but usually aren’t covered by insurance.

How to Check Your Specific Kaiser Plan

Here’s how to check your specific Kaiser plan for Ozempic coverage and costs:

Log In: Go to your member account on the Kaiser Permanente website (kp.org) or open the KP app.
Check Your Benefits: Look for the “Pharmacy” or “Benefits” section. Use the search tool to find “Ozempic.” This will show you if it’s covered, what your copay is, and if you need prior authorization (PA).
Review the Formulary: Download the latest formulary (drug list) PDF for your specific region (e.g., Southern California). This document will list any rules or limits for the medication.
Contact Member Services: For the most direct answer, call the number on your Kaiser card (usually 1-800-464-4000) and ask about Ozempic coverage for your plan.
Talk to Your Doctor: Send a message to your provider through the app. They can confirm your eligibility and start the prior authorization process if needed.

Challenges and Appeals Process

Getting Ozempic approved at Kaiser can be tough. Common problems include missing info, weight loss requests, or local rules. About 70% of diabetes requests get approved, but fewer for weight loss. High demand may cause 1-2 week delays.

If your request is denied, you can appeal. Collect your medical records, like lab results and your doctor’s notes. Send your appeal online or by mail within 30-60 days. Your doctor can help explain why you need the drug. If the appeal is also denied, you can ask your state’s insurance department for help.

Conclusion

At Kaiser Permanente, Ozempic costs $25-$100 if covered for diabetes, but $700-$900 if you’re paying out of pocket for weight loss (except in Northwest plans). Check your insurance plan and get prior authorization (PA) for better access. If it’s not approved, look into alternatives or savings programs.

FAQs

Does Kaiser Permanente cover Ozempic for type 2 diabetes?

Yes, Kaiser usually covers Ozempic for type 2 diabetes if you have a Commercial or Medicare plan. You will need to get approval from them first. The cost can be between $25 and $100.

Why might Kaiser Permanente deny Ozempic for weight loss?

Kaiser Permanente limits Ozempic for weight loss since it’s not FDA-approved for that. Most plans don’t cover it, except in the Northwest for obesity. They focus on diabetes use to control costs, following industry trends.

What are the 2025 changes to Kaiser Permanente’s Ozempic coverage?

In 2025, Kaiser changed its lists to include Ozempic for diabetes. It’s now easier to get approval in some areas. In the Northwest, it’s also covered for weight loss. There have been some shortages, so people with diabetes get it first.

How do I get prior authorization for Ozempic with Kaiser Permanente?

Submit a PA through your provider with diagnosis, labs (like A1C >7%), and tried alternatives. Forms are on healthy.kaiserpermanente.org. Approval takes 1-3 days. If denied, appeal within 30-60 days with more info.

What alternatives does Kaiser Permanente cover if Ozempic is denied?

Kaiser might cover GLP-1 drugs like Trulicity or Victoza for diabetes at lower costs. For weight loss, Wegovy may be covered in Northwest plans with approval.