Humana

Does Humana cover Ozempic?

Quick answer · Type 2 Diabetes

Humana covers Ozempic for type 2 diabetes with prior authorization on Medicare Part D and Medicare Advantage.

  • Medicare Part D: Covered with requirements. No additional clinical requirements listed.
  • Medicare Advantage: Covered with requirements. No additional clinical requirements listed.

Last verified July 13, 2026. Policy effective July 1, 2026. Source: 2026%20Super%20National%205%20MAPD-Prior%20Authorizationpdf. How we verify this data →

Check your card for your exact plan →

Ozempic for Type 2 Diabetes

What Humana requires, by plan type. Open this indication on its own page →

Medicare Part D

Covered with requirements

No additional clinical requirements are listed beyond the diagnosis.

Qualification pathways

You can qualify through any one of these.

Type 2 Diabetes Mellitus

All of:

  • Diagnosis of type 2 diabetes mellitus

Documentation to bring

  • Documentation of type 2 diabetes mellitus diagnosis

Approval and renewal

  • Initial approval: 12 months

Not covered when

  • Use for weight loss is excluded

Policy note: Document header states 'OZEMPIC - TABLET' which may be an error as Ozempic is an injectable; Rybelsus is the oral semaglutide tablet. The policy covers only type 2 diabetes mellitus. Approval duration is plan year duration. Prescriber restriction is licensed practitioner. Part B prerequisite is 0. The document is a single-page excerpt (page 269 of 446) likely from a Medicare Advantage formulary or PA criteria compendium, inferred from the Y0040 plan identifier prefix.

Policy effective June 1, 2026 · verified June 2, 2026 · source: 2026%20Super%20National%205%20MAPD-Prior%20Authorizationpdf

Medicare Advantage

Covered with requirements

No additional clinical requirements are listed beyond the diagnosis.

Qualification pathways

You can qualify through any one of these.

Type 2 Diabetes Mellitus

All of:

  • Diagnosis of type 2 diabetes mellitus

Documentation to bring

  • Documentation of type 2 diabetes mellitus diagnosis

Not covered when

  • Use for weight loss is explicitly excluded

Policy note: Policy states only 'The member has a diagnosis of type 2 diabetes mellitus.' No additional criteria specified. Explicit exclusion: 'The member is using for weight loss.' Coverage duration is Plan Year Duration. Prescriber restriction: Licensed Practitioner.

Policy effective July 1, 2026 · verified July 13, 2026 · source: 2026%20Super%20National%205%20MAPD-Prior%20Authorizationpdf

Ozempic for Weight Loss

What Humana requires, by plan type. Open this indication on its own page →

Medicare Advantage

Not covered

Exclusion Criteria states: 'The member is using for weight loss.'

Policy note: Ozempic is explicitly excluded when used for weight loss per the Exclusion Criteria of the OZEMPIC PA policy.

Policy effective July 1, 2026 · verified July 13, 2026 · source: 2026%20Super%20National%205%20MAPD-Prior%20Authorizationpdf

Why Ozempic requests get denied by Humana

Based on what this policy asks for. Fix these before the first submission.

  1. Wrong brand for the diagnosis. Ozempic and Wegovy are the same molecule with different approved uses; a request for Ozempic under a diagnosis that matches Wegovy is routinely denied.

Frequently asked questions

Does Humana cover Ozempic?
Humana covers Ozempic for type 2 diabetes with prior authorization on Medicare Part D and Medicare Advantage.
How long does a Ozempic approval last with Humana?
Initial approvals last 12 months.
How current is this information?
This page reflects Humana's written policy as of July 1, 2026, last verified against the source document on July 13, 2026.

Other medications under Humana

Ozempic coverage under other plans

All insurance plans · All medications

This page summarizes Humana's written prior-authorization policy. It is not a guarantee of coverage; plans vary by employer and benefit design. Verify with your plan before relying on it.