Considerations With Ozempic 0.25 Weekly

PAAS National® analysts receive many questions on Ozempic® relating to concerns about off label use; however, we also receive questions about what days’ supply to submit on claims – particularly for initiation dosing.

Section 2.1 of the manufacturer’s product label (available on DailyMed) lists the recommended dosage schedule based on clinical trials and includes the following titration schedule:

  • Start OZEMPIC with a 0.25 mg subcutaneous injection once weekly for 4 weeks. The 0.25 mg dosage is intended for treatment initiation and is not effective for glycemic control.
  • After 4 weeks on the 0.25 mg dosage, increase the dosage to 0.5 mg once weekly.
  • If additional glycemic control is needed after at least 4 weeks on the 0.5 mg dosage, the dosage may be increased to 1 mg once weekly.
  • If additional glycemic control is needed after at least 4 weeks on the 1 mg dosage, the dosage may be increased to 2 mg once weekly. The maximum recommended dosage is 2 mg once weekly.

What happens if the prescriber wants a patient to stay on the 0.25 mg dose for longer than 4 weeks? What if the prescription simply states “inject 0.25 mg weekly”? What days’ supply should the pharmacy transmit?

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Most pharmacists have heard the phrase, “start low and go slow” in their training (particularly for dosing elderly patients or when using medications with risk of unpleasant or risky side effects). While patients and prescribers can certainly take it slow with respect to dose titration to reduce gastrointestinal (GI) side effects, please be aware of two important points. First, as emphasized above, the 0.25 mg dosage is subtherapeutic and patients should not stay on this dose indefinitely. Second, while in-use Ozempic® pens have a 56-day beyond use date (which would allow eight weekly doses of 0.25 mg from the 2 mg/3 mL pen NDC 00169-418-13), there are only 6 pen needles included in the box.

If you receive a new Ozempic® prescription with instructions of 0.25 mg weekly, we suggest that pharmacies follow-up with prescribers to discuss the manufacturer recommended dosage titration and confirm if patients will be titrating the dose to 0.5 mg or 1 mg weekly, and when. If the prescriber’s office confirms that the patient should stay on the 0.25 mg weekly dose for eight weeks, then the pharmacy should submit the claim as a 56-day supply (if possible) and provide the patient with additional pen needles to accommodate all needed doses. As a reminder, pharmacies may be required to bill a claim as a 30-day supply due to plan limits – in these situations, make sure to follow the Can You Bill It As 30 Days? process to ensure that you do not refill early.

PAAS Tips:

  • Advise patients to NOT re-use pen needles
  • Do NOT advise patients to discard their first Ozempic pen at 42 days if they only use 0.25 mg per week
    • This would create unnecessary waste and could subject the claim to a future audit discrepancy for “early refills”
  • See August 2020 Newsline article, Ozempic® – Bill It Right! for examples on various titration schedules and suggested day supply for initial and maintenance dosing
  • See May 2023 Newsline article, Ozempic® Package Size Change for discussion of currently available NDCs, doses provided, and billing quantity

Eric Hartkopf, PharmD
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