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PacificSource Health

Does PacificSource Health cover Ozempic for Heart Disease Risk Reduction?

Yes. PacificSource Health covers Ozempic for heart disease risk reduction with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy document

  • Employer and ACA Marketplace: Covered with requirements. See the qualification pathways below.

Earliest policy review June 10, 2026. How we verify · Check your exact plan

Full requirements: Ozempic for Heart Disease Risk Reduction (2 plan types)

Applies to Employer and ACA Marketplace plans.

Covered with requirements

Qualification pathways

You can qualify through any one of these.

T2DM with Cardiovascular Disease (FDA-approved indication)

All of:

  • Diagnosis of Type 2 diabetes confirmed with lab testing
  • Diagnosis of cardiovascular disease
  • No concurrent use of other GLP-1 receptor agonists
  • Not using for weight loss or other excluded diagnosis

Documentation to bring

  • Lab confirmation of Type 2 diabetes diagnosis
  • Documentation of cardiovascular disease diagnosis
  • Claims history and ICD-10 codes reviewed

Approval and renewal

  • Initial approval: 24 months
  • Renewal: every 24 months
  • Renewal: Documentation of disease responsiveness to therapy required at reauthorization.

Not covered when

  • Use for weight loss or other excluded diagnosis
  • Concurrent use of other GLP-1 receptor agonists
  • History of ketoacidosis

Policy note: Covered as FDA-approved indication 'T2DM and cardiovascular disease'. Policy does not exclude T2DM patients for this indication — this is distinct from Wegovy's CV indication which does not require T2DM.

Policy effective June 22, 2026 · verified June 10, 2026 · source: Cw577pv8jf · View policy document (PDF)

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Questions people ask
Does PacificSource Health cover Ozempic?
Yes. PacificSource Health covers Ozempic for heart disease risk reduction with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Ozempic approval last with PacificSource Health?
Heart Disease Risk Reduction — Applies to Employer and ACA Marketplace plans. Initial approval: 24 months. Renewal: every 24 months.
What does PacificSource Health require to renew Ozempic?
Heart Disease Risk Reduction — Applies to Employer and ACA Marketplace plans. Documentation of disease responsiveness to therapy required at reauthorization.
How current is this information?
The oldest review date among the policies on this page is June 10, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under PacificSource Health: Mounjaro, Wegovy

Ozempic under other plans: Kaiser Permanente Northwest, Oregon Medicaid, Regence, Alabama Medicaid, Arkansas Medicaid, California Medicaid, Clover Health, Colorado Medicaid

All insurance plans · All medications

Summary of PacificSource Health's written policy, not a guarantee of coverage. Plans vary by employer and benefit design.