Does Quartz Health Solutions Cover Ozempic?
The verdict
Conditional on most plans
Quartz Health Solutions covers Ozempic for type 2 diabetes with prior authorization — it does not cover Ozempic for off-label weight-loss use under any Quartz plan. As a smaller Wisconsin-headquartered regional insurer, Quartz's per-drug formulary detail is less publicly documented than major national carriers; readers should verify coverage specifics directly via the Quartz member portal or by calling member services. The standard T2D-covered-with-PA pattern applies across all lines of business.
Coverage is set by your specific plan and formulary. This is a research summary — always confirm with Quartz Health Solutions using your member ID.
Key facts
Ozempic is FDA-approved for type 2 diabetes glycemic control and cardiovascular risk reduction in T2D patients — not for weight loss.
FDA drug labeling (semaglutide injection)
All 50 state Medicaid programs cover GLP-1s including Ozempic for type 2 diabetes; Wisconsin ForwardHealth covers Ozempic for T2D with prior authorization.
KFF, Medicaid Coverage of and Spending on GLP-1s
The IRA Maximum Fair Price for semaglutide under Medicare is $274 per 30-day supply, effective January 1, 2027.
CMS, IRA Drug Price Negotiation Program, 2024
Medicare vs. commercial coverage
Whether Quartz Health Solutions covers Ozempic depends heavily on which kind of plan you hold. They follow completely different rules — here's each one, side by side.
Medicare
Part D & Advantage plans
Medicare Advantage (Quartz Medicare Advantage plans in WI): Ozempic is covered for type 2 diabetes with prior authorization. PA requires a documented T2D diagnosis and evidence of metformin step-therapy or a documented contraindication. The 2026 Part D out-of-pocket cap of $2,100 limits annual beneficiary spending on covered drugs. Medicare Advantage enrollees cannot use the NovoCare savings card — federal anti-kickback rules exclude Medicare beneficiaries. The IRA Maximum Fair Price for semaglutide is $274 per 30-day supply, effective January 1, 2027. Ozempic is not covered for weight loss under any Medicare Advantage plan.
Commercial / Employer
Group & marketplace plans
Commercial/Employer: Quartz covers Ozempic for type 2 diabetes with prior authorization and metformin step-therapy. Formulary tier is not publicly confirmed at the drug level — verify on the Quartz member portal or call Quartz PA line. Commercially insured T2D patients may be eligible for the NovoCare Ozempic Savings Card ($25 per fill, max $150 per 28-day supply) — verify at NovoCare.com. Not covered for off-label weight loss. ACA/Individual: covered for T2D with PA; not covered for weight loss. Medicaid (Quartz Wisconsin Medicaid managed care): covered for type 2 diabetes with PA and nominal Medicaid cost-share per the Wisconsin ForwardHealth PDL. Not covered for off-label weight loss. Medicaid enrollees cannot use the NovoCare savings card. Wisconsin ForwardHealth covers Ozempic for T2D separately under fee-for-service; Quartz's Medicaid managed-care book follows the same state PDL.
The 3 boxes you must tick to get approved
Commercial plans that will consider Ozempic require prior authorization. Check off what applies to you to see how close you are — this is a guide, not a guarantee of approval.
Meet all 3 and you have a documented case for approval. Missing any one is the most common reason requests are denied.
Your cost, three ways
What Ozempic actually costs you swings enormously depending on how it's covered. Here's the realistic range.
Paying cash
~$1,028/month (Novo Nordisk published pricing, ~$1,027.51 for the 0.25/0.5 mg pen). NovoCare self-pay: ~$199/month intro price (first two fills through December 31, 2026), then ~$349/month (0.25/0.5/1 mg) or ~$499/month (2 mg).
List price with no coverage — before any manufacturer savings card.
With coverage
Commercial: plan-specific cost-share — not publicly confirmed; verify on Quartz member portal or call member services. Medicare Advantage: cost-share depends on plan tier; $2,100 Part D OOP cap applies in 2026; IRA Maximum Fair Price of $274/30-day for semaglutide takes effect January 1, 2027. Medicaid: nominal Medicaid cost-share per Wisconsin ForwardHealth.
Typical monthly copay once prior authorization is approved.
Bridge program
NovoCare Ozempic Savings Card: commercially insured T2D patients may pay as little as $25 per fill (max $150 per 28-day supply). Not available to Medicare, Medicaid, VA, DoD, or TRICARE beneficiaries. Verify eligibility at NovoCare.com.
Reduced copay through the assistance program, where eligible.
All figures are estimates — verify exact cost-share with Quartz member services or on the Quartz member portal. As a smaller regional plan, per-drug cost-share details are best confirmed directly rather than from third-party sources.
Check YOUR exact coverage in 3 steps
General answers only get you so far. Here's how to confirm your own plan's decision in a few minutes.
- 1
Look up Ozempic on the Quartz member portal
Log in to your Quartz member account at quartzbenefits.com and use the formulary or drug-lookup tool to confirm Ozempic's tier and any prior-authorization or step-therapy requirements on your specific plan. Because Quartz is a smaller regional plan, the member portal or a direct call to member services is more reliable than third-party formulary databases for confirming exact PA criteria.
- 2
Have your prescriber initiate the prior-authorization request
Ask your provider to submit a PA request to Quartz documenting: a T2D diagnosis (ICD-10 E11.x), evidence of metformin use or a documented contraindication. The clinical indication must be type 2 diabetes — not weight management. Your prescriber can reach Quartz's PA line directly for submission details.
- 3
Check savings-card eligibility and 2027 IRA pricing
If you are on a Quartz commercial plan with a T2D diagnosis, ask your pharmacist about the NovoCare $25 savings card. If you are on Medicare Advantage, note the IRA Maximum Fair Price of $274/30-day for semaglutide takes effect January 1, 2027 — a meaningful reduction from current list price. Call Quartz member services for a personalized cost estimate for the current plan year.
Options if Quartz Health Solutions won't cover Ozempic
A denial isn't the end of the road. These are the paths people commonly explore next — discuss any of them with your prescriber.
Rybelsus (oral semaglutide)
Oral semaglutide tablet for type 2 diabetes. Also covered for T2D with PA on most formularies. Subject to the IRA Maximum Fair Price of $274/30-day effective January 1, 2027 for Medicare patients. Verify tier on Quartz member portal.
Jardiance (empagliflozin)
SGLT-2 inhibitor commonly used as step-therapy before GLP-1 approval. Often at a lower cost-share tier than Ozempic. Verify on Quartz formulary.
Metformin (generic)
First-line oral diabetes medication universally covered at low or no cost. Required as step therapy before Ozempic PA in most Quartz plans.
Compounded semaglutide (weight-loss seekers only)
For Wisconsin and upper Midwest patients seeking semaglutide for weight management who are denied by Quartz, compounded semaglutide from $49/mo is available at getcurex.com/cl/glp without insurance. See the Curex offer section below for full disclaimers.
These options are listed for information only — your own clinician decides what is appropriate for you.
❓Frequently Asked Questions
No. Quartz does not cover Ozempic for weight loss under any plan. Ozempic holds FDA approval for type 2 diabetes and cardiovascular risk reduction in T2D patients — not for chronic weight management. This is a universal rule across all insurers: off-label weight-loss use of Ozempic is not covered. For weight-loss seekers who are Quartz members, there is no insurance-covered path for Ozempic weight-loss use; semaglutide for weight management requires a separate product (like Wegovy) on an employer plan that covers it, or a non-insurance option.
Yes, Quartz Health Solutions covers Ozempic for type 2 diabetes with prior authorization across its commercial, ACA, Medicare Advantage, and Medicaid lines. Your prescriber must document a T2D diagnosis and metformin step-therapy or a contraindication. Quartz's per-drug formulary details are not publicly confirmed — verify on the Quartz member portal or by calling Quartz member services, as direct contact is the most reliable path for this regional plan.
Log in to the Quartz member portal at quartzbenefits.com and search for Ozempic in the formulary or drug-lookup tool. If the portal does not show drug-level PA criteria clearly, call Quartz member services directly — as a smaller regional plan, Quartz's PA team is accessible and knowledgeable about its own formulary. Have your T2D diagnosis documentation ready; your prescriber will need this for the PA submission.
Commercially insured T2D patients on a Quartz commercial plan may be eligible for the NovoCare Ozempic Savings Card ($25 per fill, max $150 per 28-day supply) — verify eligibility at NovoCare.com. Medicare Advantage and Medicaid enrollees cannot use the savings card; federal anti-kickback rules exclude government program beneficiaries. If you are on a Quartz commercial plan with a confirmed T2D diagnosis, this card can significantly reduce out-of-pocket cost.
Quartz follows the same standard T2D-covered-with-PA pattern as BCBS of Minnesota and Medica for Ozempic. The key difference is transparency: larger carriers have more publicly documented formulary detail, while Quartz's per-drug tier and PA criteria are less available through third-party sources. For Quartz specifically, verifying directly via the member portal or member services call is more important than for larger national carriers.
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Quartz Health Solutions does not cover Ozempic for weight loss. For Wisconsin and upper Midwest patients seeking semaglutide for weight management without an insurance-covered T2D diagnosis, Curex offers compounded semaglutide starting at $49/mo with no prior authorization needed. Compounded tirzepatide is also available from $149/mo. Compounded semaglutide is not the same medication as Ozempic or Wegovy. Prescription required, subject to provider review.
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Compounded semaglutide and tirzepatide are not the same medications as Ozempic and are not branded or FDA-approved products. Compounded medications have not been approved by the FDA and the FDA has not evaluated their safety or efficacy.
This content is for informational purposes only and does not constitute medical, financial, or insurance advice. Coverage rules, prior-authorization criteria, and copay amounts change frequently and vary by plan, formulary tier, and effective date — always verify current benefits directly with Quartz Health Solutions before making any decision. Consult a licensed healthcare provider and your plan administrator for guidance specific to your situation. Curex offers compounded semaglutide and tirzepatide, which are not the same medications as Ozempic and are not branded or FDA-approved products; prescription required, subject to provider review. Compounded medications have not been approved by the FDA and the FDA has not evaluated their safety or efficacy.