FillMapSmart Silver 22 Health · 13887-13887FL0010004-0About this plan

Does Smart Silver 22 Health cover semaglutide?

1 · Your plan

Smart Silver 22 Health

13887-13887FL0010004-0 · ACA · ACA Marketplace

2 · Your medication

semaglutide

semaglutideunder Smart Silver 22 Health

Covered — requires prior authorization

Your plan has to approve it first — your doctor’s office handles it.

What you'd pay

This plan doesn't publish a price for this tier. Your pharmacy can quote it before you fill.

Amount limit applies — you can still fill it, but your plan caps how much you get at a time. This plan's drug list records the cap without stating the amount — your pharmacy can tell you when they fill it.

Tier: Preferred brands
Approval first: Required
Try another first: No
Amount limit: Yes

Talk to your pharmacist or doctor before acting on anything here. They can see your full history and this page cannot. Never start, stop, or switch a medication based on it. Coverage rules change and plans make exceptions — your pharmacy can check your exact benefit in seconds.As of Sep 14, 2026 · CMS QHP machine-readable. Reference information, not medical advice and not a price.

Your cost-sharing levelMarketplace plans publish a different amount for each level. Your eligibility notice says which applies. Nothing here is saved.

Covered forms and strengths (6)

0.25 MG, 0.5 MG Dose 3 ML semaglutide 0.68 MG/ML Pen Injector [Ozempic]Approval firstAmount limit
3 ML semaglutide 1.34 MG/ML Pen Injector [Ozempic]Approval firstAmount limit
3 ML semaglutide 2.68 MG/ML Pen Injector [Ozempic]Approval firstAmount limit
semaglutide 14 MG Oral Tablet [Rybelsus]Approval firstAmount limit
semaglutide 3 MG Oral Tablet [Rybelsus]Approval firstAmount limit
semaglutide 7 MG Oral Tablet [Rybelsus]Approval firstAmount limit

← All coverage for semaglutide