OT: oh oh oh Ozempic !

[bac2therac]

its called Ozempiac now

 

[DHajekRC84]

I don’t know if you’re wrong . I know a lot of people that get prescribed it that don’t have type 2 diabetes. I have also heard instances that insurance didn’t cover the medication , so they had to go out of pocket.

This. That was my initial experience with just looking into it with my doctor and insurance . Of all these drugs only one (ozem) was possibly covered and I say possibly because you actually had to have an A1C high enough to be diabetic to get it covered (at crazy high price because it was Medicare and not private).
That was a shake my head moment when I thought..so wait. The preventative to keep you from becoming one is there but in this case you need to get the disease before you can get the preventative?

 

[rutgersdave]

This. That was my initial experience with just looking into it with my doctor and insurance . Of all these drugs only one (ozem) was possibly covered and I say possibly because you actually had to have an A1C high enough to be diabetic to get it covered (at crazy high price because it was Medicare and not private).
That was a shake my head moment when I thought..so wait. The preventative to keep you from becoming one is there but in this case you need to get the disease before you can get the preventative?

https://www.npr.org/sections/shots-health-news/2025/01/17/nx-s1-5262886/drugs-medicare-price-negotiation-biden-ozempic

The Biden administration, in its last full weekday in office, announced the next 15 drugs up for Medicare price negotiation. Blockbuster diabetes drug Ozempic is on the list.

That means the federal government and the pharmaceuticals industry are about to go head-to-head once again. The Centers for Medicare and Medicaid Services negotiated prices for a first batch of drugs last year — something it could only do because of the Inflation Reduction Act, which passed in 2022. Those new prices go into effect in January 2026.

 

[DHajekRC84]

https://www.npr.org/sections/shots-health-news/2025/01/17/nx-s1-5262886/drugs-medicare-price-negotiation-biden-ozempic

The Biden administration, in its last full weekday in office, announced the next 15 drugs up for Medicare price negotiation. Blockbuster diabetes drug Ozempic is on the list.

That means the federal government and the pharmaceuticals industry are about to go head-to-head once again. The Centers for Medicare and Medicaid Services negotiated prices for a first batch of drugs last year — something it could only do because of the Inflation Reduction Act, which passed in 2022. Those new prices go into effect in January 2026.

yes, I was going to mention that too. Unfortunately those prices for the new 15 wouldn't go into effect until 2027. But here's yet another thing. Starting a few weeks ago the Cap on Medicare Part D (including Advantage plans) drug expenses for covered drug is now $2,000!

• Your yearly Part D
  Out-of-pocket costs
  Health or prescription drug costs that you must pay on your own because they aren’t covered by Medicare or other insurance.
  will be capped at $2,000 in 2025. You’ll also have the option to pay out-of-pocket costs in monthly amounts over the plan year, instead of when they happen.

Saving money with the prescription drug law

A new prescription drug law that went into effect January 1, 2023, will help save money for people with Medicare.

www.medicare.gov

I need to hear this from my Insurance prover first but if true than that takes the annual cost of something like Ozempic down from $7,872 to $2,000. (and the few other items I get would be free then). Game changer.