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.
Become an audit assistance member today to continue reading this article. As a member, you’ll have access to hundreds of articles and receive our monthly proactive newsletter!
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
I have a Bachelor of Science degree from the University of Wisconsin-River Falls and have been a Certified Pharmacy Technician since 2001. Prior to joining the PAAS team, I was a floating technician, 3rd party district chargeback specialist, and district pharmacy training coordinator. Formerly, I was also an instructor for pharmacy technician certification classes.
PAAS’ personal, one-on-one connection will help your pharmacy become more successful in dealing with tiresome PBM audits. It is a pleasure knowing that my colleagues and I can help member pharmacies.
- FDA Proposed Guidance for Biosimilar Updates - October 23, 2024
- Avoid OptumRx® Double Chargeback Pitfalls – Review Your Days’ Supply - October 1, 2024
- Unveiling a Health Care Fraud and Illegal Black-Market Conspiracy - September 17, 2024
