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Premera

Does Premera cover Ozempic for Type 2 Diabetes?

Yes. Premera covers Ozempic for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.

Policy document

  • Employer and ACA Marketplace: Covered (preferred drug). See the qualification pathways below.

Earliest policy review June 3, 2026. How we verify · Check your exact plan

Full requirements: Ozempic for Type 2 Diabetes (2 plan types)

Applies to Employer and ACA Marketplace plans.

Covered (preferred drug)

Qualification pathways

You can qualify through any one of these.

Initial approval for Type 2 Diabetes (First-Line)

All of:

  • Individual is aged 18 years or older
  • Diagnosed with type 2 diabetes
  • Has had an adequate trial of or a contraindication to metformin
  • Drug will not be used in combination with another GLP-1 or GIP/GLP-1 receptor agonist
  • Does not exceed FDA labeled maximum daily dose

Documentation to bring

  • Office visit notes containing the diagnosis of type 2 diabetes
  • Relevant history and physical evaluation
  • Medication history documenting adequate trial of or contraindication to metformin
  • Documentation that drug will not be used in combination with another GLP-1 or GIP/GLP-1 receptor agonist

Quantity limits

  • 0.25 mg/dose, 0.5 mg/dose — 1 pen (3 mL)
  • 1 mg/0.75 mL — 1 pen (3 mL)
  • 2 mg/0.75 mL — 1 pen (3 mL)

Approval and renewal

  • Initial approval: 12 months
  • Renewal: every 12 months
  • Renewal: Re-authorization approved up to 12 months as long as drug-specific coverage criteria are met and chart notes demonstrate the individual continues to show a positive clinical response to therapy.

Not covered when

  • Use in combination with another GLP-1 or GIP/GLP-1 receptor agonist is excluded
  • Exceeding FDA labeled maximum daily dose is excluded

Policy note: Ozempic is listed as a first-line preferred GLP-1 receptor agonist for type 2 diabetes. The policy states that 'adequate trial of or a contraindication to metformin' is required but does not specify a duration for the metformin trial. Diagnosis of type 2 diabetes must meet criteria defined in the Related Information section (A1C ≥6.5%, FPG ≥126 mg/dL, 2-h PG ≥200 mg/dL during OGTT, or random plasma glucose ≥200 mg/dL with classic symptoms).

Policy effective May 1, 2026 · verified June 3, 2026 · source: 5.01.569 · View policy document (PDF)

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Questions people ask
Does Premera cover Ozempic?
Yes. Premera covers Ozempic for type 2 diabetes with prior authorization. Other policy requirements and your plan's benefits also apply.
How long does a Ozempic approval last with Premera?
Type 2 Diabetes — Applies to Employer and ACA Marketplace plans. Initial approval: 12 months. Renewal: every 12 months.
What does Premera require to renew Ozempic?
Type 2 Diabetes — Applies to Employer and ACA Marketplace plans. Re-authorization approved up to 12 months as long as drug-specific coverage criteria are met and chart notes demonstrate the individual continues to show a positive clinical response to therapy.
How current is this information?
The oldest review date among the policies on this page is June 3, 2026. Each policy's effective and verification dates appear with its requirements. Confirm current benefits with your plan.

Also under Premera: Mounjaro, Wegovy, Zepbound

Ozempic under other plans: Kaiser Permanente Northwest, Molina Healthcare, Regence, Washington Medicaid, Elevance Health, HCSC, Wellmark, Aetna

All insurance plans · All medications

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