Insurance Coverage & Savings Guide

Last updated: March 1, 2026 — Coverage information subject to change; verify with your insurer

1. Cost Overview

GLP-1 receptor agonists are among the most expensive prescription medications. Without insurance coverage, patients face significant out-of-pocket costs.

Medication	Indication	List Price (Monthly)	With Insurance (Typical)	Compounded Alternative
Wegovy (semaglutide 2.4 mg)	Weight management	$1,349	$0–$500	$150–$400
Ozempic (semaglutide 0.5/1/2 mg)	Type 2 diabetes	$935	$0–$150	$150–$400
Zepbound (tirzepatide)	Weight management	$1,059	$0–$550	$200–$500
Mounjaro (tirzepatide)	Type 2 diabetes	$1,023	$0–$150	$200–$500
Saxenda (liraglutide 3.0 mg)	Weight management	$1,430	$0–$400	N/A

Prices are approximate retail (AWP) and subject to change. Compounded pricing varies by pharmacy, dose, and formulation. Insurance copay ranges depend on plan tier and deductible status.

2. Insurance Coverage by Type

Commercial / Employer Insurance

Coverage for GLP-1 medications through employer-sponsored plans varies widely:

• Diabetes indication (Ozempic, Mounjaro): Most commercial plans cover these when prescribed for type 2 diabetes, though they may be on a higher formulary tier (Tier 3 or specialty) requiring higher copays.
• Weight management indication (Wegovy, Zepbound): Coverage has expanded significantly since 2024, with many large employers adding anti-obesity medication (AOM) benefits. However, approximately 40% of employer plans still exclude weight loss medications. Check your plan's formulary or call the number on your insurance card [1].
• Prior authorization (PA): Required by most plans. Typical requirements include documented BMI ≥30 (or ≥27 with comorbidities), failed lifestyle modification attempts, and sometimes failed prior medications.

Medicare Part D

As of 2026, Medicare Part D covers GLP-1 RAs for diabetes (Ozempic, Mounjaro) but does not cover medications prescribed solely for weight loss. The Treat and Reduce Obesity Act (TROA), which would expand Medicare coverage to include FDA-approved AOMs, has been introduced in Congress multiple times but has not yet passed [2]. Some Medicare Advantage plans offer supplemental obesity treatment coverage — check your specific plan.

Medicaid

Medicaid coverage varies by state. Most state Medicaid programs cover GLP-1 RAs for diabetes. Coverage for weight management indications is expanding but remains inconsistent. States with Medicaid AOM coverage as of early 2026 include California, New York, Massachusetts, and several others. Check your state Medicaid formulary.

Tricare (Military)

Tricare covers GLP-1 RAs for diabetes. Coverage for weight management was added in 2024 for Wegovy and Zepbound, subject to prior authorization and step therapy requirements.

3. The Prior Authorization Process

Prior authorization (PA) is a requirement by your insurer that your prescriber obtain approval before the medication is covered. Here is the typical step-by-step process:

4. Appeal Strategies for Denied Claims

If your prior authorization is denied, do not give up. Approximately 40–60% of first-level appeals for GLP-1 medications are successful [3]. Follow these strategies:

1. Understand the denial reason. Request the denial letter in writing. Common reasons include: not medically necessary, formulary exclusion, step therapy requirement not met, or insufficient documentation.
2. Gather additional documentation. Ask your prescriber to write a detailed letter of medical necessity (LMN) that includes your complete weight history, comorbidities (hypertension, dyslipidemia, sleep apnea, PCOS, pre-diabetes, etc.), failed prior interventions, and clinical trial evidence supporting the medication.
3. Cite clinical guidelines. Reference the American Association of Clinical Endocrinology (AACE), Endocrine Society, and AGA guidelines that recommend pharmacotherapy for patients with BMI ≥30 or ≥27 with comorbidities [4].
4. Cite the SELECT trial for cardiovascular risk reduction if you have established cardiovascular disease or significant risk factors.
5. File the first-level internal appeal within the timeframe specified in your denial letter (usually 30–180 days).
6. If denied again, file an external appeal. Most states allow an independent external review by a physician not affiliated with your insurer.
7. Contact your state insurance commissioner if you believe the denial violates state parity laws or coverage mandates.
8. Consider peer-to-peer review. Your prescriber can request a direct conversation with the insurer's medical director to make the clinical case.

5. Manufacturer Savings Programs

Both Novo Nordisk and Eli Lilly offer savings programs that can significantly reduce out-of-pocket costs:

Program	Medication	Eligible Patients	Savings	How to Access
Wegovy Savings Card	Wegovy	Commercial insurance; not for government programs	Pay as low as $0–$25/month for up to 13 fills	wegovy.com/savings
Mounjaro Savings Card	Mounjaro	Commercial insurance	Pay as low as $25/month	mounjaro.com/savings
Zepbound Savings Card	Zepbound	Commercial insurance or cash-pay	Pay as low as $25/month (insured) or $550/month (cash)	zepbound.lilly.com/savings
Novo Nordisk PAP	Ozempic, Wegovy	Uninsured or underinsured, income-qualified	Free medication for qualifying patients	novocare.com
Lilly Cares	Mounjaro, Zepbound	Uninsured, income-qualified (≤400% FPL)	Free medication for qualifying patients	lillycares.com

PAP = Patient Assistance Program. FPL = Federal Poverty Level. Savings card terms and availability change; verify on manufacturer websites. Government-insured patients (Medicare, Medicaid, Tricare) are typically not eligible for commercial savings cards.

6. Compounded Alternatives

When brand-name GLP-1 medications are unaffordable or unavailable, compounded versions may be an option. Compounding pharmacies produce semaglutide and tirzepatide under FDA enforcement discretion when these drugs appear on the FDA Drug Shortage List [5].

Cost Comparison: Brand vs. Compounded

Factor	Brand-Name	Compounded (503B)	Compounded (503A)
Monthly Cost	$935–$1,430	$200–$500	$150–$400
FDA Approved	Yes	No	No
Delivery Device	Pre-filled pen	Multi-dose vial	Multi-dose vial
Insurance Coverage	Possible (with PA)	Rarely covered	Rarely covered
Quality Assurance	cGMP, FDA-inspected	cGMP-like, FDA-registered	State-regulated
Requires Prescription	Yes	Yes	Yes
Reconstitution Required	No	Sometimes	Often

7. Telehealth Options

Several telehealth platforms specialize in GLP-1 prescriptions and can streamline the process of obtaining medication:

• Ro / Found / Calibrate / Sequence: Telehealth platforms offering physician consultations, prescriptions, and sometimes integrated pharmacy services for GLP-1 medications. Monthly subscription fees typically range from $99–$199 plus medication cost.
• PlushCare / MDLIVE / Teladoc: General telehealth platforms where you can consult with physicians who may prescribe GLP-1 medications.
• Endocrinologist telehealth: Many academic medical centers now offer telehealth endocrinology or obesity medicine consultations.

Regardless of the platform, ensure you are seeing a licensed physician (MD/DO) or qualified advanced practice provider (NP/PA) in your state. Be cautious of platforms that prescribe without adequate medical evaluation.

8. Tax Deductions

GLP-1 medications prescribed for a diagnosed medical condition (obesity, type 2 diabetes) may be deductible as a medical expense on your federal tax return if your total unreimbursed medical expenses exceed 7.5% of your adjusted gross income (AGI). Eligible expenses include:

• Prescription medication costs (copays and full cash prices)
• Doctor visit copays and telehealth fees
• Lab work costs
• HSA/FSA accounts can be used for prescription GLP-1 medications with a valid prescription

Consult a tax professional for guidance specific to your situation.