NC Medicare Drug Spending: Ozempic
The Diabetes Shot Behind $407 Million in North Carolina Medicare Spending
Ranked 43rd in prescriptions. But Ozempic is North Carolina's second most expensive Medicare drug, and it's still climbing.
$407.4M
Total NC Medicare spend on Ozempic (semaglutide), 2023
$1,311
Average cost per prescription
#43 / #2
Rank by prescriptions / rank by total cost
What is Ozempic and why is it such a big deal?
Ozempic (semaglutide) is a once-weekly injectable GLP-1 receptor agonist for Type 2 diabetes. It lowers blood sugar and has demonstrated cardiovascular benefits. Medicare Part D covers it for diabetes, not for weight loss alone. North Carolina has one of the higher Type 2 diabetes prevalence rates in the country, roughly 14% of North Carolinians have diagnosed diabetes compared to about 11% nationally. That disease burden drives significant GLP-1 volume.
Why does it cost $1,311 per prescription?
Novo Nordisk manufactures Ozempic under patent. No generic exists. The company faces minimal pricing pressure in the U.S. market compared to other countries. NC Medicare filled 310,812 Ozempic prescriptions in 2023 at $1,311 each. Metformin, used for the same condition by more than twice as many patients, costs about $10 per prescription.
What this means for Part D enrollees
Most Part D plans place Ozempic on Tier 4 or Tier 5. At $1,311 per prescription, patients can reach the 2025 out-of-pocket cap of $2,000 in fewer than two months. If you're comparing plans during open enrollment, check Ozempic specifically in Medicare Plan Finder. Tier placement varies and the annual cost difference between plans can exceed $1,000 for this one drug.
What to watch going forward
Oral semaglutide (Rybelsus) is available under Part D for diabetes. New GLP-1 combinations are entering the market. None currently have generics. North Carolina already has one of the largest GLP-1 drug bills in the Southeast, and that figure will keep growing.
NC Medicare filled 310,812 Ozempic prescriptions in 2023 at $1,311 each. Metformin, used for the same condition by more than twice as many NC Medicare patients, costs about $10 per prescription. Ozempic costs 131 times more per fill.
Top 10 North Carolina Drugs by Total Medicare Part D Spending, 2023
Source: CMS Medicare Part D Prescribers by Geography and Drug, 2023. North Carolina state-level data.
A note on this data: All figures come from the Centers for Medicare & Medicaid Services
(CMS) Medicare Part D Prescribers by Geography & Drug dataset, 2023. This data covers Medicare Part D
(prescription drug coverage) only and does not represent commercial insurance, Medicaid, or cash-pay prescriptions.
Suppressed values (fewer than 11 beneficiaries) are excluded from totals.
This article is for educational purposes only. Nothing here is medical advice. Talk to your doctor before
making any decisions about your medications or treatment. This content is not connected with or endorsed
by the U.S. Government or the federal Medicare program.
