GLP-1 insurance plans & coverage
Search a directory of named insurers, pharmacy benefit managers and public programs to see their published GLP-1 formulary positions, dispensing pharmacies and effective dates.
Coverage varies by plan
Plan & formulary directory
Search named payers and pharmacy benefit managers to see which GLP-1 medications sit on their published formularies, which pharmacies fill them, and when the current rules took effect.
12 of 12 plans
Standard Control / template commercial formularies
- Effective dates
- Zepbound returns as a preferred option Oct 1, 2026
- Last verified September 2026
- Availability
- Nationwide (employer and marketplace plans)
Formulary position
- WegovyPreferred
Preferred weight-management GLP-1 since July 2025.
- ZepboundCovered with prior auth
Added back as an additional preferred option effective Oct 1, 2026.
- OzempicCovered with prior auth
Covered for type 2 diabetes with PA on most templates.
- MounjaroCovered with prior auth
Diabetes indication; step therapy common.
- TrulicitySet by plan sponsor
Position varies by template formulary.
- RybelsusCovered with prior auth
Oral semaglutide, diabetes indication.
- SaxendaNot on formulary
Excluded on standard weight-management templates.
Where prescriptions are filled
Common requirements
- Prior authorization for weight-management indications
- BMI and comorbidity documentation typical
- Plan sponsors may customize or exclude weight-loss coverage entirely
2026 National Preferred Formulary
- Effective dates
- January 1, 2026 – December 31, 2026
- Last verified September 2026
- Availability
- Nationwide
Formulary position
- OzempicCovered with prior auth
Diabetes indication on the National Preferred Formulary.
- WegovyCovered with prior auth
Weight management with PA; employer opt-in required on many plans.
- MounjaroCovered with prior auth
Diabetes indication with PA.
- ZepboundCovered with prior auth
Weight management with PA where the employer buys the benefit.
- TrulicityCovered with prior auth
Listed with step therapy on several plan designs.
- VictozaSet by plan sponsor
Generic liraglutide is often preferred instead.
Where prescriptions are filled
Common requirements
- Prior authorization for GLP-1 weight management
- EncircleRx / care-management enrollment on some employer plans
- Quantity limits per pen strength
2026 Premium Formulary
- Effective dates
- January 1, 2026, updated quarterly
- Last verified September 2026
- Availability
- Nationwide
Formulary position
- WegovyCovered with prior auth
Preferred weight-management option on the Premium formulary.
- ZepboundCovered with prior auth
Covered with PA on most 2026 Premium plan designs.
- OzempicPreferred
Preferred GLP-1 for type 2 diabetes.
- MounjaroCovered with prior auth
Diabetes indication with PA.
- RybelsusCovered with prior auth
Oral option for diabetes.
- SaxendaNot on formulary
Excluded in favor of newer agents.
Where prescriptions are filled
Common requirements
- Prior authorization and clinical criteria for anti-obesity medications
- Step therapy through preferred agents
- Weight-management rider required on many employer plans
FEP Basic / Standard Option formulary
- Effective dates
- Plan year 2026
- Last verified September 2026
- Availability
- Nationwide (federal employees and retirees)
Formulary position
- WegovyCovered with prior auth
Prior approval with BMI criteria.
- ZepboundCovered with prior auth
Prior approval with BMI criteria.
- OzempicCovered with prior auth
Diabetes indication.
- MounjaroCovered with prior auth
Diabetes indication.
Where prescriptions are filled
Common requirements
- Prior approval for weight-management GLP-1s
- Documented BMI plus a weight-related condition
- Participation in a lifestyle or wellness program on some options
Regional drug formularies (CA, CO, GA, HI, MD/VA/DC, NW, WA)
- Effective dates
- Updated monthly by region
- Last verified September 2026
- Availability
- 8 regions; rules differ by region
Formulary position
- OzempicCovered with prior auth
Diabetes indication in all regions.
- WegovySet by plan sponsor
Depends on whether your group bought weight-management coverage.
- ZepboundSet by plan sponsor
Region and rider dependent.
- MounjaroCovered with prior auth
Diabetes indication.
Where prescriptions are filled
Common requirements
- Kaiser physician prescription required
- Weight-management coverage is often an employer-purchased rider
- Regional formulary committee review
Standard Plan / Advanced Control Plan drug guides
- Effective dates
- January 1, 2026, with quarterly updates
- Last verified September 2026
- Availability
- Nationwide
Formulary position
- WegovyPreferred
Preferred weight-management agent, precertification required.
- ZepboundCovered with prior auth
Aligns with Caremark template change effective Oct 1, 2026.
- OzempicCovered with prior auth
Diabetes indication.
- TrulicityCovered with prior auth
Diabetes indication with step therapy.
Where prescriptions are filled
Common requirements
- Precertification for anti-obesity medications
- Six-month documented lifestyle-modification attempt on some plans
- Quantity limits
CMS-approved plan formularies
- Effective dates
- Contract year 2026; changes at January 1
- Last verified September 2026
- Availability
- Nationwide, plan availability by county
Formulary position
- OzempicCovered with prior auth
Type 2 diabetes; tier and PA vary by plan.
- MounjaroCovered with prior auth
Type 2 diabetes; tier varies by plan.
- WegovyCovered with prior auth
Covered only for the approved cardiovascular risk-reduction indication, not weight loss alone.
- ZepboundCovered with prior auth
Covered only for obstructive sleep apnea indication on plans that list it.
- RybelsusCovered with prior auth
Type 2 diabetes.
Where prescriptions are filled
Common requirements
- Statute bars Part D coverage of drugs used only for weight loss
- Coverage allowed for diabetes and for approved cardiovascular indications
- Prior authorization and step therapy permitted
- $2,000 annual out-of-pocket cap applies in 2026
State preferred drug lists (PDLs)
- Effective dates
- Varies by state; PDLs typically reviewed quarterly
- Last verified September 2026
- Availability
- All 50 states plus DC; roughly a dozen cover obesity indications
Formulary position
- OzempicCovered with prior auth
Covered for type 2 diabetes in every state PDL.
- MounjaroCovered with prior auth
Diabetes indication, PA required.
- WegovySet by plan sponsor
Obesity coverage exists in a minority of states.
- ZepboundSet by plan sponsor
Obesity coverage exists in a minority of states.
Where prescriptions are filled
Common requirements
- Prior authorization nearly universal
- Diagnosis and BMI documentation for weight-management coverage
- Trial of lower-cost alternatives in many states
TRICARE Uniform Formulary
- Effective dates
- Reviewed by the DoD Pharmacy & Therapeutics Committee each quarter
- Last verified September 2026
- Availability
- Worldwide for eligible service members and families
Formulary position
- WegovyCovered with prior auth
On the uniform formulary with prior authorization.
- ZepboundCovered with prior auth
Prior authorization required.
- OzempicCovered with prior auth
Diabetes indication.
- MounjaroCovered with prior auth
Diabetes indication.
Where prescriptions are filled
Common requirements
- Prior authorization for weight-management GLP-1s
- Documented BMI and prior weight-loss attempts
VA National Formulary
- Effective dates
- Updated monthly
- Last verified September 2026
- Availability
- Nationwide VA medical centers
Formulary position
- OzempicCovered with prior auth
Criteria-for-use review for type 2 diabetes.
- WegovyCovered with prior auth
Restricted to veterans meeting criteria for use.
- ZepboundSet by plan sponsor
Availability varies by facility and criteria for use.
Where prescriptions are filled
Common requirements
- VA prescriber and criteria-for-use review
- Enrollment in MOVE! weight-management program often expected
Cash-pay program (no insurance)
- Effective dates
- Current self-pay pricing program
- Last verified September 2026
- Availability
- Nationwide shipping
Formulary position
- ZepboundPreferred
Self-pay vials and pens sold directly, no formulary review.
- MounjaroPreferred
Self-pay pricing available.
Where prescriptions are filled
Common requirements
- Valid prescription required
- Cannot be combined with insurance or federal program benefits
Cash-pay program (no insurance)
- Effective dates
- Current self-pay pricing program
- Last verified September 2026
- Availability
- Nationwide shipping
Formulary position
- WegovyPreferred
Direct self-pay pricing for all dose strengths.
- OzempicPreferred
Self-pay pricing offered for eligible cash payers.
Where prescriptions are filled
Common requirements
- Valid prescription required
- Not for use with Medicare, Medicaid or other federal programs
Directory entries summarize each payer's publicly posted formulary or policy pages as of the verification date shown. Employers and plan sponsors can customize coverage, and formularies change mid-year — always confirm with your own plan before filling a prescription.
Plan types
Employer-sponsored and individual marketplace plans vary widely. GLP-1 coverage depends on the plan's drug formulary, medical policy, and whether the medication is prescribed for diabetes, obesity, or another indication.
- Check your plan's formulary tier for each GLP-1 brand.
- Prior authorization (PA) is commonly required.
- Step therapy may require trying metformin or other drugs first.
- Coverage for weight-loss indications is often more restrictive than for type 2 diabetes.
Medicare Part D plans may cover GLP-1 medications, but formularies differ by plan. Weight-loss-only medications often face restrictions, while diabetes indications are more commonly covered.
- Review your Annual Notice of Change and Evidence of Coverage each year.
- Formularies place GLP-1 drugs in different cost tiers.
- Coverage gap and catastrophic coverage affect out-of-pocket costs.
- Medicare Advantage plans may have different rules than standalone Part D.
Medicaid GLP-1 coverage varies by state. Many state programs cover GLP-1 medications for type 2 diabetes, but coverage for weight management is less consistent and often requires documentation.
- Contact your state Medicaid office or managed care plan for the current formulary.
- Prior authorization and diagnosis requirements are common.
- Some states require documented BMI or comorbidities for weight-loss coverage.
- Formularies are updated regularly.
Affordable Care Act marketplace plans vary by state and insurer. Essential health benefits do not uniformly include obesity medications, so GLP-1 coverage is plan-specific.
- Compare plan formularies during open enrollment.
- Look for plans that list anti-obesity medications if weight loss is the indication.
- Verify whether your prescriber is in-network.
- Request a plan's drug list before enrolling.
Cost assistance options
Manufacturer savings cards
Drug makers often offer copay or savings cards for eligible commercially insured patients. These can reduce out-of-pocket costs but usually cannot be combined with government insurance.
Patient assistance programs
Uninsured or underinsured patients may qualify for free medication through manufacturer patient assistance programs based on income and other criteria.
Pharmacy discount programs
Third-party discount cards and some pharmacies offer lower cash prices, though these are not insurance and may not beat an insured copay.
Coverage verification checklist
Use this list when you call your insurer or pharmacy benefits manager.
- 1Call the member-services number on your insurance card.
- 2Ask whether the specific GLP-1 brand is on the formulary.
- 3Confirm whether prior authorization is required and what documents are needed.
- 4Ask about step-therapy or quantity limits.
- 5Request your estimated copay or coinsurance.
- 6Ask whether coverage differs by diagnosis (e.g., type 2 diabetes vs. obesity).
Frequently asked questions
Ready to track your dose?
Use our dosing calculator to see your current week and dose for common GLP-1 medications.