Does Kaiser Permanente cover Ozempic?
From published formulary and policy documents for the plan type below. Not a decision for your member ID.
Sources last checked October 24, 2026
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Covered with restrictions. Kaiser Northwest lists injectable semaglutide (Ozempic) with criteria-based coverage with nine initiation pathways. Type 2 diabetes pathways generally require HbA1c above 6.9% and below 10% after dual-therapy trials (metformin and others), or ASCVD or proteinuria variants, with no MTC or MEN 2 history. Weight, OSA and MASH pathways require failed trials of two weight-loss drugs and are only covered for members whose plan includes weight-loss drug coverage.
Applies to: Kaiser Permanente Northwest region, commercial. Type 2 diabetes pathways plus weight, OSA, CV and MASH pathways; other regions differ
Source: Kaiser Permanente Northwest: Criteria for Drug Coverage, Injectable semaglutide (Ozempic), Revised 2026-04-09; effective 2026-06-04
Policy details
Sources last checked October 18, 2026
Approval criteria
- Adults 20 and older with type 2 diabetes (no insulin, or less than 0.5 units/kg/day): HbA1c or GMI remains greater than 6.9% but less than 10% after an adequate trial (defined as 3 months).
- Separate pathways cover chronic weight management, obstructive sleep apnea and MASH.
Source: Kaiser Permanente Northwest Region Criteria for Drug Coverage: injectable semaglutide (Ozempic)
Step therapy
Type 2 diabetes (adults 20 and older): currently taking at least two of maximally tolerated metformin, a maximally tolerated sulfonylurea, pioglitazone or an SGLT2 inhibitor for at least 3 months, and on maximum tolerated liraglutide (1.8 mg/day) or has a contraindication or intolerance to liraglutide. Weight management and sleep apnea pathways: failed an adequate trial (defined as 3 months) of at least two of phentermine, diethylpropion, topiramate, phentermine/topiramate (Qsymia) or naltrexone/bupropion (Contrave), or an allergy, intolerance or contraindication to all of them.
Source: Kaiser Permanente Northwest Region Criteria for Drug Coverage: injectable semaglutide (Ozempic)
Approval length
12 months for the weight management, sleep apnea and MASH pathways; the criteria state no approval length for the type 2 diabetes pathways
Source: Kaiser Permanente Northwest Region Criteria for Drug Coverage: injectable semaglutide (Ozempic)
Renewal criteria
- Updated weight and BMI are recently documented (weight management and sleep apnea).
- Achieved and maintained 5% or greater weight loss after starting semaglutide.
Source: Kaiser Permanente Northwest Region Criteria for Drug Coverage: injectable semaglutide (Ozempic)
Exclusions and limits
- Covered for weight loss only for Kaiser Northwest members whose plan includes coverage for weight-loss medications. Others pay the member cash price.
Source: Kaiser Permanente Northwest Region Criteria for Drug Coverage: injectable semaglutide (Ozempic)
Policy
Revised 4/9/26, effective 06/04/26
Source: Kaiser Permanente Northwest Region Criteria for Drug Coverage: injectable semaglutide (Ozempic)
Effective June 4, 2026
Source: Kaiser Permanente Northwest Region Criteria for Drug Coverage: injectable semaglutide (Ozempic)
Region and plan differences
These criteria are for the Kaiser Permanente Northwest region (Kaiser Foundation Health Plan of the Northwest). Kaiser publishes criteria by region, and the document tells members to contact Pharmacy Services in their home region, so coverage in other regions can differ.
Source: Kaiser Permanente Northwest Region Criteria for Drug Coverage: injectable semaglutide (Ozempic)
What this means
The published policy lists approval criteria, step therapy, an initial approval of 12 months for the weight management, sleep apnea and MASH pathways; the criteria state no approval length for the type 2 diabetes pathways, continuation criteria, and uses that are not covered.
This reflects the insurer's published formulary and policy for the plan type above. Your employer or plan may exclude weight-loss drugs or differ. Confirm with the number on your ID card.