VA Ozempic prior authorization request tracker

Records to have ready for the VA prescriber

• Recent A1C results, each with its date
• Every diabetes medicine tried (metformin, empagliflozin, insulin, others): dose, dates and why it stopped
• Any heart attack, stroke, peripheral artery disease or kidney disease, with the records that show it
• A diabetic eye exam from the past 12 months, and the eye doctor's name
• Any current GLP-1 or DPP-4 medicine (such as sitagliptin)
• Any earlier VA approval for Ozempic at another VA facility

What VA's own documents say

• VA's national formulary file lists Ozempic injection as a formulary drug with facility-level prior authorization (PA-F), in copay tier 2.[1]
• VA's national formulary is the only formulary allowed in VHA; separate local or regional formularies are prohibited.[2]
• A routine request is reviewed and the prescriber told the decision as soon as possible, ideally within 96 hours of receipt.[2]
• If information needed to evaluate the request is missing, the reviewer discontinues it.[2]
• Prescriber appeals of a disapproved request go to the chair of the facility P&T Committee.[2]
• An existing approval carries over when care is transferred to another VA medical facility.[2]
• VA asks for a diabetic eye exam result from the past 12 months before a GLP-1 is considered.[3]
• Oral semaglutide is non-formulary, and VA says it should be reserved for veterans physically unable to use an injection.[3]
• Ozempic doses up to 1 mg are on VA's national contract; the 2 mg dose is not.[4]

2026 medication copays

• From January 1, 2026, a tier 2 medication costs $8 for a 1 to 30 day supply, $16 for 31 to 60 days and $24 for 61 to 90 days.[5]
• Veterans in priority group 1 pay no medication copays.[5]
• Medication copays stop for the calendar year once $700 has been charged.[5]

Request tracker

If the request is disapproved

Questions for your VA prescriber or clinic pharmacist

1. Has a prior authorization drug request for Ozempic been entered, and on what date?
2. Was it sent as routine or urgent?
3. Is anything missing that could get the request discontinued?
4. Which of the Criteria for Use inclusion criteria does my record meet?
5. If it was disapproved, has an appeal gone to the P&T Committee chair?
6. Which dose is planned, and would a 2 mg dose need separate review here?
7. Will it be filled at the VA pharmacy or mailed, and for how many days' supply?