Humana coverage for Ozempic (Type 2 Diabetes)

No additional clinical requirements are listed beyond the diagnosis.

Qualification pathways

You can qualify through any one of these.

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

No additional clinical requirements are listed beyond the diagnosis.

Qualification pathways

You can qualify through any one of these.

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