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Brand name (Generic drug name)

OZEMPIC

Active Ingredient: semaglutide

Drug Class: GLP-1 Agonists

WAIT.  This drug requires Special Authorization.

You and your doctor need to fill out and submit a Special Authorization form in order to be considered for coverage.  You can download the form from your insurer/plan administrator website.

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OZEMPIC is used to treat  
Diabetes