Your GLP-1 coverage changed. Here’s what to do next.
If your insurance stopped covering Wegovy, Zepbound or another GLP-1 medication, check your options in this order: ask your prescriber about resubmitting the prior authorization or appealing, compare the manufacturers’ self-pay prices, see whether you qualify for Medicare’s GLP-1 Bridge ($50 copayment for a one-month supply), and then consider other routes, including compounded medication prescribed by a licensed provider. Compounded medications are not FDA-approved and are not therapeutically equivalent to FDA-approved products. Before you change or stop anything, talk to your prescriber; the right next step depends on your history.
Last verified: September 24, 2026. Prices and program terms change; confirm with the source before you decide.
My insurance is ending weight-loss GLP-1 coverage. What should I do?
If your employer or insurer is dropping coverage of GLP-1 medications for weight loss, usually at your plan’s renewal date (January 1 for many plans), start with the notice itself: note the exact end date and whether the plan will still cover GLP-1s for other conditions, such as type 2 diabetes. Then ask your prescriber whether your medical history meets any criteria the plan will continue to cover. If you can choose between plans at open enrollment, including a spouse’s plan, check each plan’s 2027 formulary before you pick one. If your coverage does end, compare the manufacturers’ self-pay prices listed below, check whether you qualify for Medicare’s GLP-1 Bridge, and then consider other routes, including compounded medication prescribed by a licensed provider. Compounded medications are not FDA-approved and are not therapeutically equivalent to FDA-approved products.
What changed in 2026, what’s coming in 2027, and the dates to know
My prior authorization or renewal was denied. What now?
A denied prior authorization is not always final. Start with the denial letter, which should state the reason and explain how to appeal. Renewals are often denied because your BMI is now below the plan’s starting criteria, because the plan adopted new criteria for the plan year, or because it requires you to try a different drug first. Ask your prescriber whether a resubmission can document your weight history before treatment and any related health conditions, and whether a formulary alternative is covered. If the resubmission fails, most plans must offer an internal appeal and then an external review by an independent third party (HealthCare.gov); Medicare and some older plans follow different rules. If the appeal does not succeed, compare manufacturer self-pay prices, and consider other routes, including compounded medication prescribed by a licensed provider. Compounded medications are not FDA-approved and are not therapeutically equivalent to FDA-approved products.
I lost my job, or my COBRA coverage is ending. What are my options?
Losing job-based insurance usually ends your GLP-1 coverage with it, unless you keep the same plan through COBRA, which generally means paying the full premium for a limited time. Note the exact date your coverage ends, and check the formulary of every plan you could move to, such as a spouse’s employer plan or a Marketplace plan. HealthCare.gov open enrollment for 2027 coverage runs November 1, 2026 to January 15, 2027, and December 15 is the last day to enroll for coverage that starts January 1 (per HealthCare.gov, checked September 24, 2026; state-run marketplaces can differ). Losing job-based coverage can also qualify you for a Special Enrollment Period outside those dates. If no plan covers your medication, compare manufacturer self-pay prices. You can also ask a licensed provider whether a different treatment, including compounded medication, is appropriate for you. Compounded medications are not FDA-approved and are not therapeutically equivalent to FDA-approved products.
I’m turning 65 or moving to Medicare. Will my GLP-1 still be covered?
Manufacturer copay savings cards can’t be used with Medicare coverage: Lilly’s Zepbound Savings Card excludes people in government programs, and Novo Nordisk says government-insured patients can use its Wegovy self-pay pricing only if they pay outside their insurance. Check Medicare’s GLP-1 Bridge first. Through December 31, 2027, it charges a $50 copayment for a one-month supply of Wegovy (injection or tablets), Foundayo or the Zepbound KwikPen, not Zepbound vials or single-dose pens (CMS, checked September 24, 2026). It is not automatic: you need Part D and must meet BMI and health criteria, and your provider must submit a prior authorization and certify you’ll use it alongside a reduced-calorie diet and exercise. People already getting a GLP-1 through Part D are not eligible. People with type 2 diabetes, moderate-to-severe sleep apnea or fatty liver disease are excluded; ask your Part D plan whether it covers a GLP-1 for your condition. At a $50 copayment for a one-month supply, the Bridge is likely to cost less than any cash-pay price on this page, including Cora’s plans for compounded medication, which is not FDA-approved and is not therapeutically equivalent to FDA-approved products.
I’m switching telehealth providers. How do I avoid a gap?
Before you cancel your current provider, gather your records: the medication name, your current dose, the date of your last dose, and a photo of the pharmacy label or your prescription. Check your current provider’s cancellation terms and next renewal date so you are not billed for a shipment you no longer want; the GLP-1 Telehealth Cancellation & Refund Policy Index lists the published terms of 18 providers. Share your full history with the new provider. 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, including how long it has been since your last dose. Compounded medications are not FDA-approved and are not therapeutically equivalent to FDA-approved products. If your reason for switching is price, compare the manufacturer self-pay prices below too.
Switching? What to have ready, and how to avoid a gap in treatment
I’m restarting after a break. What dose do I start at?
Your provider determines the right restart dose based on your history, including how long you have been off, the dose you were on, and how you tolerated it. Do not restart at your previous dose on your own. Before your appointment, write down the medication and dose you last took, the date of your last dose, and why you stopped. If the break was caused by coverage, ask your prescriber whether a prior authorization needs to be resubmitted. If you pay out of pocket, compare the manufacturer self-pay prices below. At LillyDirect, if more than 45 days pass after your previous delivery, Zepbound 7.5 mg to 15 mg moves from $449 to the regular price of $499 (7.5 mg) or $699 (10 mg to 15 mg). Compounded medication prescribed by a licensed provider is another option. Compounded medications are not FDA-approved and are not therapeutically equivalent to FDA-approved products.
My GLP-1 price went up. Why, and what can I do?
Find out which of three things changed. First, your insurance: a new plan year can move a drug to a higher tier or add a deductible, so ask your plan what you will pay in 2027. Second, a manufacturer offer: Lilly’s Zepbound Savings Card and its KwikPen self-pay program both end December 31, 2026, NovoCare’s $199 Wegovy price covers only a new patient’s first two monthly fills, and NovoCare says its pricing will be updated after December 31, 2026. Third, refill timing: LillyDirect’s $449 price for Zepbound 7.5 mg to 15 mg applies on the first fill and on refills within 45 days of your previous delivery; after that, regular prices of $499 to $699 apply. If a telehealth provider raised your price, compare the total monthly cost, including any membership fee. Compounded medication prescribed by a licensed provider is one option to compare. Compounded medications are not FDA-approved and are not therapeutically equivalent to FDA-approved products.
The routes to check, in the order to check them
These are the routes to check, in the order most people should check them. Each one stands on its own; skip any that do not apply to you.
1. Resubmit or appeal with your prescriber
Your first call is to the prescriber who submitted the original prior authorization. Ask for the plan’s written coverage criteria and the exact reason for any denial, then ask whether a resubmission can include your weight history before treatment and any related health conditions. If the plan denies it again, most plans must offer an internal appeal and then an external review by an independent third party, according to HealthCare.gov. Medicare and some older grandfathered plans follow different rules; your denial letter and plan documents explain the steps and deadlines for your plan.
2. Buy directly from the manufacturer
Eli Lilly (LillyDirect) and Novo Nordisk (NovoCare Pharmacy) sell Zepbound and Wegovy directly to self-paying patients with a valid prescription. These are the published prices, per Lilly’s LillyDirect and Zepbound savings pages and Novo Nordisk’s NovoCare pages, checked September 24, 2026:
| Medication | Seller | Self-pay price per month |
|---|---|---|
| Zepbound vial, 2.5 mg | LillyDirect | $299 |
| Zepbound vial, 5 mg | LillyDirect | $399 |
| Zepbound vial, 7.5, 10, 12.5 or 15 mg | LillyDirect | $449 on the first fill and on refills within 45 days of your previous delivery; otherwise $499 (7.5 mg) or $699 (10, 12.5 or 15 mg) |
| Zepbound KwikPen, 2.5 mg, 5 mg, or 7.5 to 15 mg | LillyDirect | $299, $399 or $449 (same 45-day rule) through Lilly’s KwikPen self-pay program, which ends December 31, 2026 and allows up to 11 fills a year |
| Wegovy pen 0.25 mg or 0.5 mg, new patients | NovoCare Pharmacy | $199 for the first two monthly fills, through December 31, 2026 |
| Wegovy pen 0.25 mg to 2.4 mg | NovoCare Pharmacy | $349 |
| Wegovy HD 7.2 mg | NovoCare Pharmacy | $399 |
| Wegovy pill | NovoCare Pharmacy | $149 (1.5 mg), $199 (4 mg), $299 (9 mg or 25 mg) |
- LillyDirect defines a month as 28 days: four single-dose vials or one KwikPen. Injection supplies are sold separately: pen needles for the KwikPen, and needles and syringes for vials.
- Only LillyDirect’s vial self-pay prices show no end date. Lilly’s KwikPen self-pay program and its Zepbound Savings Card for people with commercial insurance both end December 31, 2026.
- NovoCare states that its pricing will be updated after December 31, 2026. Novo Nordisk says government-insured patients may use its Wegovy self-pay pricing if they pay outside their insurance.
3. Medicare’s GLP-1 Bridge, if you have Part D
From July 1, 2026 through December 31, 2027, Medicare’s GLP-1 Bridge charges a $50 copayment for a one-month supply (28 or 30 days) of Wegovy (injection or tablets), Foundayo, or the Zepbound KwikPen. Zepbound vials and single-dose pens are not included. With a $50 copayment for a one-month supply, it is likely to cost less than any cash-pay price on this page, including Cora’s plans for compounded medication, which is not FDA-approved and is not therapeutically equivalent to FDA-approved products. Terms per CMS and Medicare.gov, checked September 24, 2026.
It is not automatic. You must be enrolled in Part D, and your provider must submit a prior authorization, which stays valid through December 31, 2027 unless the drug changes, and must certify that you will use the medication alongside a reduced-calorie diet and exercise. You must be 18 or older and, when you start, have a BMI of 35 or higher; or a BMI of 30 or higher with heart failure with preserved ejection fraction, uncontrolled high blood pressure, or stage 3a or later chronic kidney disease; or a BMI of 27 or higher with prediabetes, a prior heart attack or stroke, or symptomatic peripheral artery disease.
People already getting a GLP-1 through their Part D plan are not eligible. People with type 2 diabetes, moderate-to-severe sleep apnea or fatty liver disease are excluded from the Bridge; if that is you, ask your Part D plan whether it covers a GLP-1 for your condition.
The Part D deductible does not apply, but the $50 copayment for a one-month supply does not count toward your Part D out-of-pocket cap, and Extra Help does not lower it.
4. Compounded medication through a licensed provider
Some people ask a licensed provider whether compounded semaglutide or compounded tirzepatide is appropriate for them. 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. A licensed provider decides whether compounded medication is appropriate for you. 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. If you consider this route, ask who prescribes, which pharmacy prepares the medication, and exactly what the monthly price includes.
Where Cora fits
Cora Health connects patients with licensed providers at Wasef Health, PC, who may prescribe compounded semaglutide or compounded tirzepatide when it is appropriate. A US-licensed 503A compounding pharmacy prepares and dispenses the medication, which is shipped to your door. Cora does not prescribe or compound medication, and not everyone qualifies; if a provider finds you medically ineligible, you receive a full refund.
Compounded semaglutide starts at $99/month on the annual plan ($1,188 billed every 12 months) and is $175 month-to-month. Compounded tirzepatide starts at $135/month on the annual plan ($1,620 billed every 12 months) and is $225 month-to-month. Prices may change. Each price includes the provider consultation, the medication, pharmacy fulfillment, shipping and ongoing provider monitoring, with no separate membership fee, and it does not change with your dose. Plans renew automatically until you cancel or pause. Cora does not bill insurance; HSA and FSA cards are accepted.
Compounded semaglutide and compounded tirzepatide are not FDA-approved and are not therapeutically equivalent to FDA-approved products. Cora Health does not prescribe or compound medication; licensed providers make all prescribing decisions. This page is general information, not medical, legal or insurance advice. Wegovy® and Zepbound® 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.
Where these facts come from
Every manufacturer price, Medicare Bridge rule and enrollment date on this page was checked at the source listed below. Last verified: September 24, 2026.
- Eli Lilly — LillyDirect Zepbound self-pay pricing (checked September 24, 2026)
- Eli Lilly — Zepbound Savings Card and KwikPen self-pay program terms (checked September 24, 2026)
- Novo Nordisk — NovoCare Pharmacy Wegovy pricing (checked September 24, 2026)
- Novo Nordisk — Wegovy savings offer (checked September 24, 2026)
- CMS — Medicare GLP-1 Bridge (checked September 24, 2026)
- Medicare.gov — Weight-loss drug coverage (checked September 24, 2026)
- Medicare.gov — Joining a plan: Open Enrollment dates (checked September 24, 2026)
- HealthCare.gov — Dates and deadlines for 2027 coverage (checked September 24, 2026)
- HealthCare.gov — Appealing a health insurance company decision (checked September 24, 2026)
Coverage changes FAQ
Compare every option before you decide
If compounded medication is one of the options you are weighing, a licensed provider decides whether it is right for you. Compounded medications are not FDA-approved and are not therapeutically equivalent to FDA-approved products.