Can You Get Ozempic on Medical Aid in South Africa?

It is one of the most common questions we hear. The honest answer is that it depends on your scheme and your reason for treatment. Here is how medical aid coverage works for GLP-1 medication in South Africa.

The short answer

For weight loss specifically, most South African medical aids do not currently fund GLP-1 medication like Ozempic from the main risk benefit. The situation is more favourable when the medication is used for type 2 diabetes, and coverage is slowly evolving as these treatments become more established.

Coverage for diabetes

When semaglutide is used to manage type 2 diabetes, some schemes do provide cover under their chronic medication benefit, often subject to specific clinical criteria and authorisation. If you have type 2 diabetes, it is worth asking your scheme what their requirements are.

Coverage for weight loss

When the same medication is used purely for weight management, funding is much less common today. Schemes have historically treated weight loss treatment as a lifestyle rather than chronic benefit. This is an area that may change over time as the health value of treating obesity becomes better recognised.

Cover often hinges on the reason for treatment. Diabetes management is more likely to be funded than weight loss alone.

Using medical savings

Even where the medication is not funded from risk, you may be able to pay for it from your medical savings account, depending on your plan. Your blood tests are usually claimable from savings too. This will not cover everything, but it can soften the cost.

Practical steps

Call your scheme and ask directly whether GLP-1 medication is covered for your situation, and under what conditions. Ask whether savings can be used. Request an itemised invoice from your provider that you can submit. And factor the likely out-of-pocket cost into your decision before you start, so there are no surprises. Our pricing page sets out exactly what each part costs.