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Information for Vermont Prescribers of Prescription Drugs (Long Form)

Ozempic® (semaglutide) tablets 4 mg or 9 mg

  • This list does not imply that the products on this chart are interchangeable or have the same efficacy or safety. Please refer to each product's FDA-approved label and indication for further information.
  • The prices listed below are Average Wholesale Prices ("AWP") as established and made available to the public by a third-party publisher or as calculated from data made available to the public by a third-party publisher. The price paid by consumers may be higher or lower than the prices listed below. Information about AWP of these drugs is being provided to Vermont prescribers pursuant to Vermont law, to give you information about the relative prices of marketed drugs and other drugs in the same therapeutic class.
  • The prices listed here do not necessarily reflect price per dosage, price per course of treatment, or the cost effectiveness of all the products listed. For simplicity, only the smallest package sizes available for each product are included.
Product Name Manu­fact­urer NDC or UPC Package Size AWP Per Package AWP Per Pill
Marketed Product
OZEMPIC® TABLETS 1.5 MG NOVO NOR­DISK 0169-1715-30 30 EA $1,233.01 $41.10
OZEMPIC® TABLETS 4 MG NOVO NOR­DISK 0169-1704-30 30 EA $1,233.01 $41.10
OZEMPIC® TABLETS 9 MG NOVO NOR­DISK 0169-1709-30 30 EA $1,233.01 $41.10
Other Products
EXENATIDE (5MCG/0.02ML)AMNEAL70121-1685-01Non-pill product
EXENATIDE (10MCG/0.04ML)AMNEAL70121-1686-01Non-pill product
FOUNDAYO® TAB 0.8MGELI LILLY00002-4178-3130 EA$778.80$25.96
FOUNDAYO® TAB 2.5MGELI LILLY00002-4503-3130 EA$778.80$25.96
FOUNDAYO® TAB 5.5MGELI LILLY00002-4794-3130 EA$778.80$25.96
FOUNDAYO® TAB 9MGELI LILLY00002-4803-3130 EA$778.80$25.96
FOUNDAYO® TAB 14.5MGELI LILLY00002-4839-3130 EA$778.80$25.96
FOUNDAYO® TAB 17.2MGELI LILLY00002-4953-3130 EA$778.80$25.96
LIRAGLUTIDE (18MG/3ML)CIPLA69097-0910-55Non-pill product
LIRAGLUTIDE (18MG/3ML)CIPLA69097-0920-67Non-pill product
LIRAGLUTIDE (18MG/3ML)CIPLA69097-0920-68Non-pill product
LIRAGLUTIDE (18MG/3ML)HIKMA00143-9144-02Non-pill product
LIRAGLUTIDE (18MG/3ML)HIKMA00143-9144-03Non-pill product
LIRAGLUTIDE (18MG/3ML)TEVA00480-3667-20Non-pill product
LIRAGLUTIDE (18MG/3ML)TEVA00480-3667-22Non-pill product
LIRAGLUTIDE (18MG/3ML)TEVA00480-7250-46Non-pill product
LIRAGLUTIDE (18MG/3ML)LUPIN70748-0346-02Non-pill product
LIRAGLUTIDE (18MG/3ML)LUPIN70748-0346-03Non-pill product
LIRAGLUTIDE (18MG/3ML)MEITHEAL71288-0563-84Non-pill product
LIRAGLUTIDE (18MG/3ML)MEITHEAL71288-0563-85Non-pill product
MOUNJARO® (2.5MG/0.5ML)ELI LILLY00002-1506-80Non-pill product
MOUNJARO® (5MG/0.5ML)ELI LILLY00002-1495-80Non-pill product
MOUNJARO® (7.5MG/0.5ML)ELI LILLY00002-1484-80Non-pill product
MOUNJARO® (10MG/0.5ML)ELI LILLY00002-1471-80Non-pill product
MOUNJARO® (12.5MG/0.5ML)ELI LILLY00002-1460-80Non-pill product
MOUNJARO® (15MG/0.5ML)ELI LILLY00002-1457-80Non-pill product
OZEMPIC® (0.25MG OR 0.5MG DOSE)NOVO NOR­DISK00169-4181-13Non-pill product
OZEMPIC® (1MG DOSE)NOVO NOR­DISK00169-4130-13Non-pill product
OZEMPIC® (2MG DOSE)NOVO NOR­DISK00169-4772-12Non-pill product
RYBELSUS® TAB 3MGNOVO NOR­DISK00169-4303-3030 EA$1,233.01$41.10
RYBELSUS® TAB 7MGNOVO NOR­DISK00169-4307-3030 EA$1,233.01$41.10
RYBELSUS® TAB 14MGNOVO NOR­DISK00169-4314-3030 EA$1,233.01$41.10
SAXENDA® (18MG/3ML)NOVO NOR­DISK00169-2800-15Non-pill product
SOLIQUA® 100/33 (100-33 UNIT-MCG/ML)SANOFI-AVENTIS00024-5761-05Non-pill product
TRULICITY® (.75MG/5ML)ELI LILLY00002-1433-80Non-pill product
TRULICITY® (1.5MG/5ML)ELI LILLY00002-1434-80Non-pill product
TRULICITY® (3MG/5ML)ELI LILLY00002-2236-80Non-pill product
TRULICITY® (4.5MG/5ML)ELI LILLY00002-3182-80Non-pill product
VICTOZA® (18MG/3ML)NOVO NOR­DISK00169-4060-12Non-pill product
VICTOZA® (18MG/3ML)NOVO NOR­DISK00169-4060-13Non-pill product
WEGOVY® TAB 1.5MGNOVO NOR­DISK00169-4415-3130 EA$1,618.82$53.96
WEGOVY® TAB 4MGNOVO NOR­DISK00169-4404-3130 EA$1,618.82$53.96
WEGOVY® TAB 9MGNOVO NOR­DISK00169-4409-3130 EA$1,618.82$53.96
WEGOVY® TAB 25MGNOVO NOR­DISK00169-4425-3130 EA$1,618.82$53.96
WEGOVY® (0.25MG/0.5ML)NOVO NOR­DISK00169-4525-14Non-pill product
WEGOVY® (0.5MG/0.5ML)NOVO NOR­DISK00169-4505-14Non-pill product
WEGOVY® (1MG/0.5ML)NOVO NOR­DISK00169-4501-14Non-pill product
WEGOVY® (1.7MG/0.75ML)NOVO NOR­DISK00169-4517-14Non-pill product
WEGOVY® (2.4MG/0.75ML)NOVO NOR­DISK00169-4524-14Non-pill product
WEGOVY® HD (7.2MG/0.75ML)NOVO NOR­DISK00169-4572-14Non-pill product
XULTOPHY® 100/3.6 (100-3.6 UNIT-MG/ML)NOVO NOR­DISK00169-2911-15Non-pill product
ZEPBOUND® (2.5MG/0.5ML)ELI LILLY00002-0152-04Non-pill product
ZEPBOUND® (2.5MG/0.5ML)ELI LILLY00002-2506-80Non-pill product
ZEPBOUND® (2.5MG/0.6ML)ELI LILLY00002-3566-11Non-pill product
ZEPBOUND® (5MG/0.5ML)ELI LILLY00002-0243-04Non-pill product
ZEPBOUND® (5MG/0.5ML)ELI LILLY00002-2495-80Non-pill product
ZEPBOUND® (5MG/0.6ML)ELI LILLY00002-3555-11Non-pill product
ZEPBOUND® (7.5MG/0.5ML)ELI LILLY00002-1214-04Non-pill product
ZEPBOUND® (7.5MG/0.5ML)ELI LILLY00002-2484-80Non-pill product
ZEPBOUND® (7.5MG/0.6ML)ELI LILLY00002-3544-11Non-pill product
ZEPBOUND® (10MG/0.5ML)ELI LILLY00002-1340-04Non-pill product
ZEPBOUND® (10MG/0.5ML)ELI LILLY00002-2471-80Non-pill product
ZEPBOUND® (10MG/0.6ML)ELI LILLY00002-3533-11Non-pill product
ZEPBOUND® (12.5MG/0.5ML)ELI LILLY00002-1423-04Non-pill product
ZEPBOUND® (12.5MG/0.5ML)ELI LILLY00002-2460-80Non-pill product
ZEPBOUND® (12.5MG/0.6ML)ELI LILLY00002-3522-11Non-pill product
ZEPBOUND® (15MG/0.5ML)ELI LILLY00002-2002-04Non-pill product
ZEPBOUND® (15MG/0.5ML)ELI LILLY00002-2457-80Non-pill product
ZEPBOUND® (15MG/0.6ML)ELI LILLY00002-3511-11Non-pill product

Medi-Span® Price Rx® Pro Plus is the source of this information.

Obtained on 4/17/2026