FillMapKP OR Family Dental - $100 Ded · 71287-71287OR0590003-0About this plan

Does KP OR Family Dental - $100 Ded cover semaglutide?

1 · Your plan

KP OR Family Dental - $100 Ded

71287-71287OR0590003-0 · ACA · ACA Marketplace

2 · Your medication

semaglutide

semaglutideunder KP OR Family Dental - $100 Ded

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 brand
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 (16)

0.25 MG, 0.5 MG Dose 3 ML semaglutide 0.68 MG/ML Pen Injector [Ozempic]Approval firstAmount limit
0.5 ML semaglutide 0.5 MG/ML Auto-Injector [Wegovy]Approval firstAmount limit
0.5 ML semaglutide 1 MG/ML Auto-Injector [Wegovy]Approval firstAmount limit
0.5 ML semaglutide 2 MG/ML Auto-Injector [Wegovy]Approval firstAmount limit
0.75 ML semaglutide 2.27 MG/ML Auto-Injector [Wegovy]Approval firstAmount limit
0.75 ML semaglutide 3.2 MG/ML Auto-Injector [Wegovy]Approval firstAmount limit
0.75 ML semaglutide 9.6 MG/ML Auto-Injector [Wegovy]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 1.5 MG Oral Tablet [Ozempic]Approval firstAmount limit
semaglutide 1.5 MG Oral Tablet [Wegovy]Approval firstAmount limit
semaglutide 25 MG Oral Tablet [Wegovy]Approval firstAmount limit
semaglutide 4 MG Oral Tablet [Ozempic]Approval firstAmount limit
semaglutide 4 MG Oral Tablet [Wegovy]Approval firstAmount limit
semaglutide 9 MG Oral Tablet [Ozempic]Approval firstAmount limit
semaglutide 9 MG Oral Tablet [Wegovy]Approval firstAmount limit

← All coverage for semaglutide