Qualify for Ozempic: Who Can Use It and What Insurance Covers It

When you hear Ozempic, a prescription medication originally for type 2 diabetes that also helps with weight loss. Also known as semaglutide, it works by slowing digestion and helping your brain feel full faster. But not everyone can get it—and even if you can, insurance might say no. If you’re trying to qualify for Ozempic, you’re not alone. Thousands in India and the U.S. are asking the same question: Do I meet the criteria? And more importantly, can I afford it?

To qualify for Ozempic, you typically need a diagnosis of type 2 diabetes or obesity (BMI over 30, or over 27 with weight-related health issues). It’s not a quick fix for anyone who wants to lose a few pounds. Doctors look at your medical history—especially if you have pancreatitis, thyroid cancer, or a family history of medullary thyroid cancer. If you’re on other diabetes meds or have kidney problems, that matters too. Insurance companies like Express Scripts, a major pharmacy benefit manager that handles prescriptions for millions of Americans don’t just approve it on request. They require prior authorization, proof of failed diet and exercise attempts, and sometimes lab results showing your HbA1c levels. Even then, coverage for weight loss alone is still limited in many plans.

Some people think switching to Wegovy—the same drug, just approved specifically for weight loss—will make approval easier. But the truth? Insurance often treats them the same. If your plan won’t cover Ozempic for weight loss, they likely won’t cover Wegovy either. That’s why so many turn to savings programs, patient assistance apps, or even explore alternatives like metformin or berberine. But if you’ve tried those and still need help, Ozempic might be your next step—if you meet the medical and insurance rules.

What you’ll find in the posts below are real-world stories and facts: how people got Express Scripts to approve Ozempic, what Kelly Clarkson actually said about using it, why some insurance plans deny claims, and what you can do when your doctor says yes but your insurer says no. There’s no magic trick. But there are clear steps—and you’ll see them laid out plainly, without fluff.