Coverage at a glance
| Indication | Coverage |
|---|---|
| Type 2 diabetes | Covered with prior authorization |
If your plan denies coverage, two cash programs to check.
No insurance needed.
- Strut Health$149 a month, with auto-refillcompounded semaglutideCheck price →You pick Weight Loss, then a five-minute online visit
- Shed$199 a month30% off first month with code Shed10compounded semaglutideCheck price →A health form first, then you choose your plan
Cheapest GLP-1 without insurance compares the three cash routes. Cheapest GLP-1 ranks every cash price on the chart.
Prior authorization: the plan reviews the prescription before it pays.
Oscar covers Ozempic for type 2 diabetes, once the plan signs off. A quantity limit of one pen per fill period applies. It sits on tier 2 of Oscar's 2026 standard drug list. Ozempic is not covered for weight loss. Wegovy is the semaglutide the FDA approved for weight loss, and Oscar's standard individual plans usually leave weight-loss GLP-1 drugs out. This answer covers commercial plans that are not Medicare.
Source: Oscar policy PG152 v9. Checked August 27, 2026.
What your plan charges. Oscar's 2026 four-tier drug list for Tennessee standard plans puts Ozempic on tier 2, with prior authorization and a limit of one pen every 28 days. The summary of benefits for its Bronze Classic Standard plan charges $50 a prescription for a tier 2 drug at a retail pharmacy, after the deductible. Sources: Oscar 2026 Formulary, List of Covered Drugs, four-tier Tennessee standard plans. Summary of Benefits and Coverage, Oscar: Bronze Classic Standard Plan, coverage period January 1, 2026 to December 31, 2026. Checked September 6, 2026.
What it costs once they say yes. With commercial insurance the manufacturer savings card takes Ozempic to as little as $25 a month. Your plan sets the copay before the card applies. What Ozempic costs with your plan.
Coverage by indication
| Step therapy | Not required |
What the prior authorization needs:
- Prior authorization required before coverage
- Oscar's antidiabetic GLP-1 policy covers it for type 2 diabetes and nothing else
- Quantity limit: one pen per 28 days (2 mg/1.5 mL, 2 mg/3 mL, 4 mg/3 mL) or one pen per 30 days (8 mg/3 mL)
Source: Oscar policy PG152 v9. The plan's own covered-drug list.
Mounjaro and Rybelsus on Oscar plans
Mounjaro and Rybelsus are approved for type 2 diabetes, not weight loss.
Does Oscar cover Mounjaro?
Yes, with prior approval. Oscar pays for Mounjaro once your prescriber gets the plan to sign off.
Oscar does cover Mounjaro for type 2 diabetes, once the plan signs off. It sits on tier 2 of Oscar's 2026 drug list, with a quantity limit of four pens every 28 days. Approval needs a documented type 2 diabetes diagnosis, for example an A1C of 6.5% or higher. On top of that you need either a 90-day trial of metformin at 1,500 mg a day that failed, or a documented need for combination therapy with an A1C of 7.5% or higher. Oscar does not cover Mounjaro for weight loss, because the FDA approved it for type 2 diabetes only. Zepbound is the tirzepatide for weight loss. Oscar reviews that one under a separate weight-loss policy, and it is not on this 2026 drug list.
What Oscar requires for Mounjaro
| Step therapy | Required |
What the prior authorization needs:
- Documented type 2 diabetes diagnosis by at least one lab result: fasting glucose above 126 mg/dL, a 2-hour glucose tolerance test above 200 mg/dL, an A1C of 6.5% or higher, or a random plasma glucose of 200 mg/dL or higher with symptoms of hyperglycemia.
- Member is 18 years of age or older. Oscar approves ages 10 and up only for Bydureon BCise, Trulicity, and Victoza, not for Mounjaro.
- Step therapy. Three things qualify, and you need only one. You cannot use metformin. A trial of metformin at the minimum effective dose of 1,500 mg a day ran at least 90 days and failed. Or your record documents a need for combination therapy with an A1C of 7.5% or higher.
- The first approval lasts 12 months. To renew it you have to show a response. A drop in A1C since you started counts. So does holding a target A1C under 7%, or a better fasting plasma glucose.
Source: Oscar policy PG152 (Ver. 4). The plan's own clinical policy.
Does Oscar cover Rybelsus?
Yes, with prior approval. Oscar pays for Rybelsus once your prescriber gets the plan to sign off.
Oscar covers Rybelsus for type 2 diabetes, once the plan signs off. A quantity limit of 30 tablets every 30 days applies. It sits on tier 2 of Oscar's 2026 standard drug list. The FDA approved Rybelsus for type 2 diabetes only, not for weight loss. Wegovy is the semaglutide the FDA approved for weight loss, and Oscar's standard individual plans usually leave weight-loss GLP-1 drugs out.
Checked August 28, 2026.
What Oscar requires for Rybelsus
| Step therapy | Not required |
What the prior authorization needs:
- Prior authorization required before coverage
- Oscar's antidiabetic GLP-1 policy (PG152) covers it for type 2 diabetes and nothing else
- Quantity limit: 30 tablets every 30 days
Source: Oscar policy PG152 v9. The plan's own covered-drug list.
What to do next
If you qualify under one of the covered indications above, prior authorization is the path. Match the documentation in the requirements list then have your prescriber submit it. Plans that approve reassess at renewal, so know your long-term maintenance dose before you start.
- Browse the prior-authorization letter library for a template that matches your plan and indication.
- Read why plans say no and the four ways to appeal in the GLP-1 insurance guide.
- Your plan may treat another GLP-1 differently. The Oscar coverage check lists all 3, with the source for each.
- If the plan denies it, the appeal letter library has a template for each reason a plan gives. That covers the peer-to-peer call with a plan doctor, the Level 1 and Level 2 appeals inside the plan, and the outside review that follows them.
- If your plan does not cover the indication you need, compare cash prices in the cost guide or check whether a clinical trial near you fits. Neither one goes through your insurer. Clinical trials cost nothing and many pay you for your time.
What it costs without insurance
The programs below bill you directly. Prices checked every Monday.
Frequently asked questions
Does Oscar cover Ozempic?
Oscar covers Ozempic for type 2 diabetes, once the plan signs off. A quantity limit of one pen per fill period applies. It sits on tier 2 of Oscar's 2026 standard drug list. Ozempic is not covered for weight loss. Wegovy is the semaglutide the FDA approved for weight loss, and Oscar's standard individual plans usually leave weight-loss GLP-1 drugs out. Policy checked August 2026.
What does Oscar require to approve Ozempic?
For type 2 diabetes: your plan has to sign off first. The paperwork it asks for is in the requirements list on this page.
Coverage for other payers
See the full payer coverage index for every plan we have sourced.
How we built this page
Every page here comes from the payer's own policy, a federal law, or KFF's plan research. Each row links its source and gives the date we read it. Some plan files load at the address the payer gives but will not open. We check those against a second source and mark the row lower confidence. Job-based plans also choose whether to add the weight-drug benefit at all, so those rows say varies by plan rather than a flat yes.
This is reference information, not medical or legal advice, and not a guarantee of coverage. GLP-1 coverage policies change often. Always confirm the current policy with your insurer using the number on your card before you rely on this page. If your experience differs from what is shown here, email hello@glpchart.com with the details and we will re-verify.
