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Is My Diabetes Drug Covered in Virginia Insurance Marketplace?

Check your specific medication coverage in Virginia Insurance Marketplace before you enroll.

Virginia Insurance Marketplace is Virginia's state health insurance marketplace. If you're shopping for a plan and managing diabetes with medications like Ozempic, Mounjaro, Trulicity, or others, you need to verify coverage before enrolling.

Drugs Commonly Searched in Virginia Insurance Marketplace

Here are the diabetes medications people most often ask about when shopping Virginia Insurance Marketplace plans:

  • Ozempic (semaglutide) — GLP-1 agonist for Type 2 diabetes
  • Mounjaro (tirzepatide) — GIP/GLP-1 receptor agonist for Type 2 diabetes
  • Trulicity (dulaglutide) — GLP-1 agonist for Type 2 diabetes
  • Rybelsus (semaglutide oral) — Oral GLP-1 agonist for Type 2 diabetes
  • Jardiance (empagliflozin) — SGLT2 inhibitor for Type 2 diabetes
  • Synjardy (empagliflozin/metformin) — Combination SGLT2 inhibitor + metformin for Type 2 diabetes

How to Check Coverage in Virginia Insurance Marketplace

Each plan available in Virginia Insurance Marketplace includes a drug formulary — the list of medications covered and at what cost tier.

  1. Go to virginia-insurance-marketplace.org
  2. Navigate to the plan comparison tool
  3. Search for each medication by name (e.g., "Ozempic", "Mounjaro")
  4. Note the tier (Tier 1, 2, 3, or not covered)
  5. Check if prior authorization is required
  6. Compare copay amounts across plans

What Each Tier Means

  • Tier 1: Generic drugs, lowest copay
  • Tier 2: Preferred brand-name drugs, mid-range copay
  • Tier 3: Non-preferred drugs, higher copay
  • Specialty/Tier 4+: High-cost specialty drugs, highest copay or coinsurance
  • Not Covered: The plan does not cover this drug

Prior Authorization Matters

Many diabetes medications require prior authorization — meaning your doctor needs to get approval from the plan before the drug is covered. The Virginia Insurance Marketplace formulary search will show if prior authorization is required for each drug.

Get Help Comparing Coverage

If you're overwhelmed by the formulary search, a licensed broker can do this homework for you. We specialize in matching people managing diabetes with Virginia Insurance Marketplace plans that cover their specific medications.

BenZen is licensed in Virginia. Call us at 888-488-3321 (Mon-Fri, 10am-4pm) to discuss your medication coverage and find the right plan.