Insurance Stopped Covering Your GLP-1 in 2027?

What changed in 2026, and what is coming in 2027?

Employer coverage of GLP-1 medications for weight loss is shrinking, and 2027 continues the trend. Business Group on Health's survey of large employers found that the share covering GLP-1 weight-loss drugs fell from 72% in 2025 to 60% in 2026, as Reuters reported on August 25, 2026. SHRM reported on September 1, 2026 that 14% of employers in the same survey, which covered 127 employers and 8.7 million lives, have already dropped or plan to drop GLP-1 coverage for weight management by 2027, up from 10% earlier in the year.

Several large employers have made their changes public. In each case below, the change applies to GLP-1s used for weight loss; PwC and PepsiCo said diabetes coverage continues. As reported:

Starbucks: starting in October 2026, no longer covers GLP-1 medications prescribed for weight loss for benefits-eligible employees, a change a company spokesperson confirmed (Business Insider, August 7, 2026).
PwC (US): ends weight-management coverage starting July 2026 and continues to cover diabetes (Financial Times, via The Irish Times, May 1, 2026).
Cigna, as an employer: stopped covering GLP-1s for weight loss through its own employee health plan on July 1, 2026 (ABC News, August 29, 2026).
PepsiCo: cut weight-loss coverage while keeping diabetes coverage, according to an employee letter ABC News reviewed (ABC News, August 29, 2026).
Massachusetts state employees (GIC): weight-loss GLP-1s are not covered starting July 1, 2026; some members still qualify through cardiovascular disease, sleep apnea or MASH (Mass.gov, June 8, 2026).

Does Zepbound’s return to CVS Caremark restore your coverage?

On May 28, 2026, CVS Health announced that CVS Caremark "will add Zepbound back to our commercial formularies as an additional preferred option October 1, 2026," for "plan sponsors who elect to provide coverage of those medications for their members." October 1, 2026 was the effective date CVS announced. The same release says plan sponsors that adopt CVS Caremark's template formularies "retain discretion to customize coverage for their members."

The same release said CVS Caremark would remove its new-to-market block on Foundayo (orforglipron), Lilly's once-daily GLP-1 pill, effective June 1, 2026, "where approved for coverage by plans." The FDA approved Foundayo on April 1, 2026, for chronic weight management in adults with obesity, or adults with overweight and at least one weight-related condition, alongside a reduced-calorie diet and increased physical activity.

In plain terms, a drug being on a formulary does not mean your plan covers it for weight loss. If your employer has excluded weight-loss GLP-1s, the October 1 change does not restore your coverage. If your employer does cover them, ask your plan which GLP-1s are preferred on your 2027 formulary, and talk to your prescriber before any switch.

What if Medicaid stopped covering GLP-1s for weight loss?

State Medicaid coverage is contracting too. KFF counted 13 state Medicaid programs covering GLP-1s for obesity under fee-for-service as of January 2026, down from 16 in October 2025 (KFF, January 16, 2026). California, New Hampshire, Pennsylvania and South Carolina stopped covering adult GLP-1 prescriptions for obesity on January 1, 2026 (KFF Health News, January 13, 2026). MassHealth in Massachusetts ended coverage for weight loss on July 3, 2026, after KFF's count.

Some programs still cover GLP-1s in narrower cases. MassHealth continues coverage, with prior authorization, for certain members with cardiovascular disease, MASH or obstructive sleep apnea (MassHealth Pharmacy Facts #271). Pennsylvania kept a pathway for members under 21 (Pennsylvania Bulletin, Vol. 55, No. 52).

If you have Medicaid, ask your plan directly what it will cover in 2027.

Which manufacturer self-pay offers have a December 31, 2026 deadline?

As of October 16, 2026, several manufacturer offers have a December 31, 2026 date. LillyDirect's vial prices do not.

Lilly's Zepbound Savings Card expires December 31, 2026. Its terms say: "Card expires and savings end on 12/31/2026." If your commercial insurance covers Zepbound, the card lets you pay as little as $25 for a one-, two- or three-month prescription of the single-dose pen, up to $1,300 in savings a year. If you have commercial insurance that does not cover Zepbound, it offers the single-dose pen from $499 a month. The card excludes people with government coverage, including Medicare, Medicaid, TRICARE and the VA (Lilly Zepbound Savings Card terms, checked September 24, 2026).

Lilly's KwikPen self-pay prices also end December 31, 2026. LillyDirect's Zepbound KwikPen prices ($299 for 2.5 mg, $399 for 5 mg, and $449 for 7.5 mg to 15 mg, with the same 45-day refill rule) run through Lilly's Zepbound KwikPen Self-Pay Savings Program, which allows up to 11 fills a year and whose terms say "Card expires and savings end on 12/31/2026" (Lilly, checked October 16, 2026).

NovoCare's introductory Wegovy price ends December 31, 2026. New patients pay $199 a month for the first two monthly fills of the 0.25 mg or 0.5 mg pen, then $349 a month, and NovoCare says its pricing is "to be updated after December 31, 2026" (NovoCare, checked October 16, 2026). Wegovy self-pay prices for 2027 have not been published. Novo Nordisk’s February 24, 2026 announcement sets the list price (wholesale acquisition cost) of Wegovy® 2.4 mg injection and 25 mg tablets at $675 effective January 1, 2027. As verified October 16, 2026, Novo says self-pay prices are not affected. List price is not a patient self-pay quote; 2027 self-pay prices have not been published.

Among Lilly's Zepbound offers, the vial self-pay prices have no published end date. The Zepbound vial prices ($299 for 2.5 mg, $399 for 5 mg, and $449 for 7.5 mg to 15 mg on the first fill and on refills within 45 days) show no expiration on the LillyDirect page as of October 16, 2026. Lilly can still change them, so confirm the price before each refill.

As of October 16, 2026, LillyDirect lists a 30-day Foundayo™ supply at regular prices of $149 (0.8 mg), $199 (2.5 mg), $299 (5.5 mg or 9 mg), and $349 (14.5 mg or 17.2 mg). Through December 31, 2026, the 2.5 mg price is temporarily $149 and the 5.5 mg price is $199. The 14.5 mg and 17.2 mg doses are $299 per month when refilled within 45 days; otherwise $349. The self-pay card expires and savings end December 31, 2026. A valid prescription and program terms apply (LillyDirect terms modified September 15, 2026).

As of October 16, 2026, TrumpRx.gov lists manufacturer offers and routes patients to LillyDirect or Novo pharmacy coupons. You cannot buy drugs directly from TrumpRx. It is not insurance, does not cover compounded drugs, and cash/TrumpRx purchases do not count toward a Medicare deductible or out-of-pocket maximum. Confirm the product, dose, refill deadline and eligibility with the manufacturer; no separate TrumpRx price is quoted here.

Does Medicare’s GLP-1 Bridge run through December 31, 2027?

As of October 16, 2026, CMS describes the Medicare GLP-1 Bridge as a short-term demonstration running July 1, 2026 through December 31, 2027, outside the regular Part D benefit and payment flow. Humana processes claims for CMS. For weight management with lifestyle modification, it covers all formulations of Foundayo™, Wegovy® injection (including Wegovy HD) and tablets, and Zepbound® KwikPen® only. Zepbound single-dose vials and single-dose pens are not covered. The Bridge does not cover compounded drugs.

As of October 16, 2026, Medicare.gov lists a $50 copayment for a one-month supply (28 or 30 days, depending on the drug), at any income. No Part D deductible applies, and the payment does not count toward the Part D out-of-pocket cap. Extra Help/low-income subsidies and the Medicare Prescription Payment Plan do not apply. Coupons and discount programs cannot be applied to Bridge claims. Pen needles are not covered.

As of October 16, 2026, CMS requires enrollment in an eligible Part D plan: a standalone prescription drug plan (PDP), or a Medicare Advantage drug plan that is an HMO, HMOPOS, or local or regional PPO; Special Needs Plans (SNPs), employer group waiver plans (EGWPs) and LI NET are eligible. Private fee-for-service plans, section 1876 cost-contract plans, section 1833 health care prepayment plans, PACE, fallback plans and religious fraternal benefit plans are excluded unless the person also has a standalone PDP.

As of October 16, 2026, CMS requires age 18 or older and one of these criteria when GLP-1 therapy was initiated, including therapy started before Part D enrollment or July 1, 2026: BMI at least 35; BMI at least 30 with heart failure with preserved ejection fraction, uncontrolled hypertension, or chronic kidney disease stage 3a or above; or BMI at least 27 with prediabetes, a previous heart attack, a previous stroke, or symptomatic peripheral artery disease. The prescription must be for weight management with lifestyle modification.

As of October 16, 2026, CMS excludes people with type 2 diabetes, moderate-to-severe obstructive sleep apnea, or noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH); ask your Part D plan about coverage for those conditions. Anyone who received a GLP-1 through Part D in calendar 2026 is ineligible for the Bridge in 2026. CMS has not yet set the relevant lookback period for 2027.

As of October 16, 2026, the process starts with the prescriber sending a prescription to the pharmacy. The pharmacy claim establishes program eligibility; the pharmacy then requests prior authorization from the prescriber (allow 24–72 hours). The prescriber should wait for that request before submitting the authorization. A decision follows within 72 hours and a letter is mailed. Approval covers refills and dose changes through December 31, 2027 unless the GLP-1 drug changes. There is no Bridge appeals process; resubmission is allowed.

As of October 16, 2026, CMS identifies $245 per monthly supply as the manufacturer net price to the Bridge, not the patient copayment. The separate IRA Medicare Drug Price Negotiation fact sheet lists a $274 negotiated 30-day price for semaglutide products (Ozempic®/Rybelsus®/Wegovy®), effective January 1, 2027. That is a different program and is not a patient quote or a promise of Part D coverage for weight loss.

See the coverage-changed guide for the same criteria and primary sources.

When is open enrollment for 2027 coverage?

Open enrollment is your chance to pick a plan that covers your medication, if one is available to you. Check the formulary of every plan you are considering, including a spouse's plan, before you enroll. Dates checked September 24, 2026:

Medicare Open Enrollment: October 15 to December 7, 2026, with coverage starting January 1 (Medicare.gov).
HealthCare.gov Marketplace: November 1, 2026 to January 15, 2027. Enroll by December 15 for coverage that starts January 1. State-run marketplaces can set different dates (HealthCare.gov).
Employer plans: your employer sets its own open enrollment window. Ask HR for the dates and the 2027 prescription formulary.

What does paying out of pocket cost?

As of October 16, 2026, if your coverage ends, these are the published monthly prices to compare. Brand-name prices are per LillyDirect and NovoCare, checked October 16, 2026, and require a valid prescription from your prescriber. Cora's prices are from its published plans. The Cora rows are compounded medications, which are not FDA-approved and are not therapeutically equivalent to FDA-approved products; this table compares prices, not products. Brand names are trademarks of their respective owners.

Option	Monthly price	FDA-approved?	Conditions
Medicare GLP-1 Bridge (Wegovy, Foundayo, Zepbound KwikPen)	$50 copayment for a one-month supply	Yes	Medicare Part D enrollees who meet the criteria; provider prior authorization required; runs through December 31, 2027
LillyDirect: Zepbound vial, 2.5 mg	$299	Yes	A month is 28 days (four vials); no published end date; needles and syringes sold separately
LillyDirect: Zepbound vial, 5 mg	$399	Yes	A month is 28 days (four vials); no published end date; needles and syringes sold separately
LillyDirect: Zepbound vial, 7.5 mg to 15 mg	$449	Yes	First fill and refills within 45 days of the previous delivery; otherwise $499 (7.5 mg) or $699 (10 mg to 15 mg); no published end date; needles and syringes sold separately
LillyDirect: Zepbound KwikPen, 2.5 mg / 5 mg / 7.5 mg to 15 mg	$299 / $399 / $449	Yes	Same 45-day rule; KwikPen self-pay program ends December 31, 2026 and allows up to 11 fills a year; pen needles sold separately
NovoCare: Wegovy pen 0.25 mg or 0.5 mg, new patients	$199	Yes	First two monthly fills only; offer runs through December 31, 2026
NovoCare: Wegovy pen 0.25 mg to 2.4 mg	$349	Yes	Pricing to be updated after December 31, 2026
NovoCare: Wegovy HD 7.2 mg	$399	Yes	Pricing to be updated after December 31, 2026
LillyDirect: Foundayo™ tablets (October 16, 2026)	$149 (0.8 mg); $149 (2.5 mg) / $199 (5.5 mg) temporarily; $299 (9 mg); $299 (14.5 or 17.2 mg) with 45-day refill	Yes	30-day supply; 2.5/5.5 mg offers and self-pay card end December 31, 2026; regular $199 (2.5 mg), $299 (5.5 mg), $349 (14.5/17.2 mg without qualifying refill); valid prescription and LillyDirect terms apply
NovoCare: Wegovy pill	$149 (1.5 mg), $199 (4 mg), $299 (9 mg or 25 mg)	Yes	Pricing to be updated after December 31, 2026
Cora Health: Essential Plan for compounded semaglutide injections (October 16, 2026)	The Essential Plan for compounded semaglutide injections prescribed through Cora Health is $99/month ($1,188 billed upfront every 12 months); $120/month ($720 billed upfront every 6 months); $145/month ($435 billed upfront every 3 months); $175/month ($175 billed monthly). Plans renew automatically until you cancel. Prices may change. Includes licensed-provider consultation, medication, pharmacy fulfillment, expedited shipping and ongoing monitoring. A licensed provider decides eligibility. Cancellation and refund policy. Compounded medications are not FDA-approved. They are prepared by state-licensed pharmacies based on a valid prescription from a licensed provider. Compounded medications are not therapeutically equivalent to FDA-approved products.	No. Compounded medications are not FDA-approved and are not therapeutically equivalent to FDA-approved products	As of October 16, 2026; a licensed provider determines eligibility
Cora Health: Premium Plan for compounded tirzepatide injections (October 16, 2026)	The Premium Plan for compounded tirzepatide injections prescribed through Cora Health is $135/month ($1,620 billed upfront every 12 months); $175/month ($1,050 billed upfront every 6 months); $199/month ($597 billed upfront every 3 months); $225/month ($225 billed monthly). Plans renew automatically until you cancel. Prices may change. Includes licensed-provider consultation, medication, pharmacy fulfillment, expedited shipping and ongoing monitoring. A licensed provider decides eligibility. Cancellation and refund policy. Compounded medications are not FDA-approved. They are prepared by state-licensed pharmacies based on a valid prescription from a licensed provider. Compounded medications are not therapeutically equivalent to FDA-approved products.	No. Compounded medications are not FDA-approved and are not therapeutically equivalent to FDA-approved products	As of October 16, 2026; a licensed provider determines eligibility

What should you do before your coverage ends?

As of October 16, 2026, work through these in order, ideally as soon as you get the notice:

Ask HR or your plan for the 2027 prescription formulary, the exact date weight-loss coverage ends, and whether GLP-1s stay covered for other conditions.
Ask your prescriber whether your medical history meets any criteria the plan will still cover, and whether a prior authorization or appeal is worth filing. If a renewal was already denied, see what to do after a prior authorization denial.
Compare plans during open enrollment, including a spouse's plan, and check each plan's formulary.
Compare self-pay prices, including LillyDirect's 45-day refill rule and the offers that end December 31, 2026.
As of October 16, 2026, if you have eligible Part D coverage, ask your provider about the GLP-1 Bridge criteria. The pharmacy first requests the prior authorization from the prescriber.
Don't stop, switch or change your dose on your own; any change to your medication is a decision for your prescriber.
For a situation-by-situation guide (lost job, turning 65, restarting after a break, switching providers), see Your GLP-1 coverage changed: what to do next.

Where does Cora Health fit?

As of October 16, 2026, Cora Health is one cash-pay option. Check a coverage appeal, manufacturer self-pay and Medicare Bridge eligibility first. Cora connects patients with licensed providers at Wasef Health, PC, who may prescribe compounded semaglutide or compounded tirzepatide injections when appropriate. Medication is prepared by US-licensed 503A compounding pharmacies, including Hallandale Pharmacy (PCAB-accredited) and VialsRx. Cora does not prescribe or compound medication. Compounded medications are not FDA-approved. They are prepared by state-licensed pharmacies based on a valid prescription from a licensed provider. Compounded medications are not therapeutically equivalent to FDA-approved products. Brand-name and compounded doses are not interchangeable, and there is no dose conversion between them; your provider determines the right dose based on your history.

The Essential Plan for compounded semaglutide injections prescribed through Cora Health is $99/month ($1,188 billed upfront every 12 months); $120/month ($720 billed upfront every 6 months); $145/month ($435 billed upfront every 3 months); $175/month ($175 billed monthly). Plans renew automatically until you cancel. Prices may change. Includes licensed-provider consultation, medication, pharmacy fulfillment, expedited shipping and ongoing monitoring. A licensed provider decides eligibility. Cancellation and refund policy. Compounded medications are not FDA-approved. They are prepared by state-licensed pharmacies based on a valid prescription from a licensed provider. Compounded medications are not therapeutically equivalent to FDA-approved products.

The Premium Plan for compounded tirzepatide injections prescribed through Cora Health is $135/month ($1,620 billed upfront every 12 months); $175/month ($1,050 billed upfront every 6 months); $199/month ($597 billed upfront every 3 months); $225/month ($225 billed monthly). Plans renew automatically until you cancel. Prices may change. Includes licensed-provider consultation, medication, pharmacy fulfillment, expedited shipping and ongoing monitoring. A licensed provider decides eligibility. Cancellation and refund policy. Compounded medications are not FDA-approved. They are prepared by state-licensed pharmacies based on a valid prescription from a licensed provider. Compounded medications are not therapeutically equivalent to FDA-approved products.

What else should you ask about GLP-1 coverage in 2027?

Will CVS Caremark plans cover Zepbound in 2027? CVS Health announced that Zepbound would return to CVS Caremark's commercial formularies as an additional preferred option on October 1, 2026, but only for plan sponsors that elect to cover these medications. Ask your plan whether it covers Zepbound for weight loss in 2027.

Does CVS Caremark cover Foundayo? CVS Health said CVS Caremark would remove its new-to-market block on Foundayo (orforglipron) effective June 1, 2026, where plans approve it for coverage. Whether your plan covers it for weight loss is your plan sponsor's decision, so ask your plan.

Will the Zepbound Savings Card work in 2027? Not under its current terms: the card expires and savings end on December 31, 2026, and the same date applies to Lilly's KwikPen self-pay program (Savings Card terms checked September 24, 2026; KwikPen terms checked October 16, 2026). Among Lilly's Zepbound offers, the vial self-pay prices show no end date.

My state Medicaid program stopped covering GLP-1s for weight loss. What else is there? Ask your Medicaid plan whether any of your health conditions still qualify, since some states cover narrower uses. Lilly's Zepbound Savings Card excludes people in government programs, including Medicaid, and Novo Nordisk says government-insured patients can use its Wegovy self-pay pricing only if they pay outside their insurance. Ask LillyDirect directly whether its self-pay pricing is available to you.

Sources

Manufacturer self-pay prices and Medicare Bridge terms verified October 16, 2026. Older employer, commercial-insurance, enrollment and Medicaid reporting retains its original source dates; the CVS Caremark passages were last checked October 10, 2026. Prices, formularies and program terms change; confirm with the source before you decide. This article is general information, not medical, legal or insurance advice. Wegovy®, Zepbound®, Ozempic® and Rybelsus® are registered trademarks of their respective owners; NovoCare, LillyDirect, KwikPen and Foundayo™ are trademarks of their respective owners. Cora Health is not affiliated with Novo Nordisk or Eli Lilly.

CMS — Bridge information for Part D plans (August 6, 2026; verified October 16, 2026): cms.gov
CMS — Bridge information for providers (August 6, 2026; verified October 16, 2026): cms.gov
Medicare.gov — weight-loss drugs (verified October 16, 2026): medicare.gov
Medicare — GLP-1 Bridge fact sheet 12234 (June 2026; verified October 16, 2026): medicare.gov
CMS — separate IRA negotiated prices effective January 1, 2027: cms.gov
LillyDirect — Foundayo self-pay terms (September 15, 2026; verified October 16, 2026): lilly.com
LillyDirect — Foundayo (September 2026; verified October 16, 2026): lilly.com
NovoCare — Wegovy tablet pricing (verified October 16, 2026): novocare.com
NovoCare — Wegovy eligibility and terms (verified October 16, 2026): novocare.com
NovoCare — Wegovy savings offer (verified October 16, 2026): novocare.com
TrumpRx — manufacturer listings (verified October 16, 2026): trumprx.gov
Novo Nordisk — January 2027 list-price announcement (February 24, 2026; verified October 16, 2026): prnewswire.com
Reuters: more US employers drop weight-loss drugs for 2027 (August 25, 2026). reuters.com
SHRM: growing number of employers dropping GLP-1 coverage (September 1, 2026). shrm.org
Business Insider: Starbucks cuts GLP-1 coverage for weight loss (August 7, 2026). businessinsider.com
The Irish Times (Financial Times): PwC US to drop cover for weight-loss drugs (May 1, 2026). irishtimes.com
ABC News: companies and GLP-1 weight-loss coverage (August 29, 2026). abcnews.com
Mass.gov: June update on Vida Health program and GLP-1 coverage (June 8, 2026). mass.gov
CVS Health: CVS Caremark GLP-1 weight management coverage options (May 28, 2026). cvshealth.com
Eli Lilly and Company: Foundayo and Zepbound now covered for millions of Americans (May 28, 2026). investor.lilly.com
FDA: FDA approves first new molecular entity under National Priority Voucher program (Foundayo approval, April 1, 2026). fda.gov
KFF: Medicaid coverage of and spending on GLP-1s (January 16, 2026). kff.org
KFF Health News, as published by the New Hampshire Union Leader (January 13, 2026); Medi-Cal Rx member notice; NH Healthy Families notice; Pennsylvania Bulletin, Vol. 55, No. 52.
MassHealth Pharmacy Facts #271 (March 12, 2026, corrected). mass.gov
CMS: BALANCE (Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth) Model page (updated September 29, 2026). cms.gov
CMS: Medicare GLP-1 Bridge (checked October 16, 2026). cms.gov
Eli Lilly: LillyDirect Zepbound self-pay pricing (checked October 16, 2026). lilly.com
Eli Lilly: KwikPen self-pay program terms (checked October 16, 2026); Zepbound Savings Card terms (checked September 24, 2026). zepbound.lilly.com
Novo Nordisk: NovoCare Pharmacy Wegovy pricing and Wegovy savings offer (checked October 16, 2026). novocare.com
Medicare.gov: Joining a plan (checked September 24, 2026). medicare.gov
HealthCare.gov: Dates and deadlines for 2027 coverage (checked September 24, 2026). healthcare.gov

Cora Health Content Team

Written by the Cora Health content team. This article covers business, pricing, or comparison information and was not medically reviewed; for clinical guidance, see articles labeled "Medically Reviewed."

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Insurance stopped covering your GLP-1 in 2027? Your options