Kaiser Permanente Northwest

Does Kaiser Permanente Northwest cover Ozempic?

Quick answer · Type 2 Diabetes

Kaiser Permanente Northwest covers Ozempic for type 2 diabetes with prior authorization on Employer / Commercial Insurance.

  • Employer / Commercial Insurance: Covered with requirements. Diagnosis documented with a code (E08, E09, E11, E13)

Last verified June 5, 2026. Policy effective March 9, 2026. Source: mi-all-pa-guidelines-nw-en.pdf. How we verify this data →

Check your card for your exact plan →

Ozempic for Type 2 Diabetes

What Kaiser Permanente Northwest requires, by plan type. Open this indication on its own page →

Employer / Commercial Insurance

Covered with requirements

What you need to qualify

  • Diagnosis documented with a code (E08, E09, E11, E13)

Qualification pathways

You can qualify through any one of these.

Type 2 Diabetes Approval

All of:

  • Diagnosis of type 2 diabetes (ICD-10 Groups E08, E09, E13, or E11 except E11.A)
  • Diagnosis confirmed by medical records OR chart notes

Documentation to bring

  • Medical records or chart notes confirming type 2 diabetes diagnosis (ICD-10 Groups E08, E09, E13, or E11 except E11.A)

Approval and renewal

  • Initial approval: 12 months

Not covered when

  • ICD-10 code E11.A is explicitly excluded from qualifying T2DM diagnosis codes

Policy note: Approved for all strengths by GPID or GPI-14. ICD-10 code E11.A is explicitly excluded from the qualifying diagnosis codes despite being within the E11 group. Document does not address CV risk reduction, CKD, or weight loss indications for Ozempic.

Policy effective March 9, 2026 · verified June 5, 2026 · source: mi-all-pa-guidelines-nw-en.pdf

Why Ozempic requests get denied by Kaiser Permanente Northwest

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.
  2. Diagnosis code missing or wrong on the request.

Frequently asked questions

Does Kaiser Permanente Northwest cover Ozempic?
Kaiser Permanente Northwest covers Ozempic for type 2 diabetes with prior authorization on Employer / Commercial Insurance.
How long does a Ozempic approval last with Kaiser Permanente Northwest?
Initial approvals last 12 months.
How current is this information?
This page reflects Kaiser Permanente Northwest's written policy as of March 9, 2026, last verified against the source document on June 5, 2026.

Other medications under Kaiser Permanente Northwest

Ozempic coverage under other plans

All insurance plans · All medications

This page summarizes Kaiser Permanente Northwest'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.