Beware: Same Ingredients, Different FDA Indications

Ozempic® is an injectable diabetic medicine used to improve glycemic control in adults for type 2 diabetes management. Please see our May 2021 Newsline New Package Size Available for Ozempic® for reference on how to bill for Ozempic®. On June 4, 2021, the FDA approved a new drug treatment for chronic weight management called Wegovy™ which has the exact same ingredient – semaglutide.

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Similarly, Victoza® is also used to improve glycemic control in patients 10 years and older for type 2 diabetes and is composed of an ingredient called liraglutide. Saxenda® also contains liraglutide but is used for chronic weight management. Pharmacies need to be aware that there is an audit risk if the prescriber is ordering for off-label use.

GLP-1 Receptor Agonist Analog Name FDA Indication Goal Dose
Ozempic® semaglutide Type 2 diabetes management 0.5 mg or 1 mg weekly
Wegovy™ semaglutide Chronic weight management 2.4 mg weekly
Victoza® liraglutide Type 2 diabetes management 1.2 mg or 1.8 mg daily
Saxenda® liraglutide Chronic weight management 3 mg daily

PAAS Tips:

  • Prescribers may try to help patients get around plan exclusions for weight loss medications by prescribing Ozempic® or Victoza® at higher doses
    • FDA approved medications being used off-label like this would likely not be covered under federal programs and are subject to audit recoupment
    • Claims paid at point-of-sale do not guarantee payment
  • If a prescription is written for the Analog name, pharmacies need to confirm the diagnosis to bill the correct medication
  • These products come in multiple strengths and package sizes which would also need to be confirmed
  • Medicare Part D and Medicaid may restrict coverage of medications if the prescribed use is not for a medically accepted indication
Jennifer Ottman, CPhT