How GLP-1 pricing actually works
The sticker price of GLP-1 medications is almost meaningless for most patients. What you actually pay is determined by a confusing stack of discounts, rebates, insurance negotiations, and manufacturer programs — most of which you have to know to ask about.
There are effectively four different pricing tracks: list price (what nobody pays), insurance-negotiated price (what your plan pays after rebates), your out-of-pocket cost (after your deductible and copay), and cash-pay alternatives (compounded or Lilly Direct vials).
Key insight: For commercially insured patients, manufacturer savings cards can reduce Wegovy to as little as $0/month and Zepbound to $550/month — but only if your plan covers the drug. If your plan doesn't cover it, the savings card doesn't apply.
Costs by medication (2026)
Wegovy (semaglutide 2.4mg)
Wegovy is FDA-approved for chronic weight management. Its list price is approximately $1,349/month. Novo Nordisk's savings card reduces this to $0/month for eligible commercially insured patients (income and plan restrictions apply). For uninsured patients, Novo Nordisk's Patient Assistance Program may provide the medication free to those earning under approximately $100,000 for a household of four.
Zepbound (tirzepatide)
Zepbound's list price is approximately $1,059/month. Lilly's savings card brings this to $550/month for commercially insured patients. Lilly also offers a unique cash-pay option through their LillyDirect program: Zepbound vials for $349/month (self-administered with syringes — same drug, different delivery format). This is currently the cheapest FDA-approved GLP-1 option for uninsured patients.
Compounded semaglutide and tirzepatide
Telehealth platforms including Hims, Ro, Noom Med, and Found offer compounded versions of both medications at dramatically lower prices — typically $99–$350/month for semaglutide and $250–$500/month for tirzepatide. These are not FDA-approved and their quality can vary by pharmacy. The FDA declared the semaglutide shortage resolved in early 2025, which legally limits compounding pharmacies from producing copies of shortage-listed drugs — availability of compounded semaglutide is now legally restricted in many states.
Important 2025 update: The FDA ended the semaglutide shortage designation in early 2025. This means compounding pharmacies can no longer legally compound copies of semaglutide (Wegovy/Ozempic) under the shortage exception. Telehealth platforms are navigating this, and availability is changing rapidly. Tirzepatide compounding is still more broadly available.
Full cost comparison table
| Option | Monthly (no ins.) | Monthly (w/ ins.) | FDA approved |
|---|---|---|---|
| Wegovy (semaglutide) | $1,349 | $0–$225* | Yes ✓ |
| Zepbound (tirzepatide) | $1,059 | $550* | Yes ✓ |
| Zepbound vials (LillyDirect) | $349 | $349 | Yes ✓ |
| Compounded semaglutide | $99–$350 | Not covered | No ✗ |
| Compounded tirzepatide | $250–$500 | Not covered | No ✗ |
| Ozempic (off-label, T2D) | $935 | Varies | T2D only |
* With manufacturer savings card + qualifying commercial insurance. Income and plan restrictions apply.
Insurance coverage in 2026
Insurance coverage for GLP-1 weight loss medications has expanded significantly but remains inconsistent. Here's the current landscape:
- Commercial/employer plans: Approximately 40–50% of large employer plans now cover Wegovy or Zepbound for obesity. Coverage depends entirely on your specific plan — call the number on your insurance card and ask specifically about "anti-obesity medications" or the drug by name.
- Medicare: Since 2024, Medicare Part D covers Wegovy for patients with established cardiovascular disease. Coverage for obesity alone remains limited under federal law, though this is being actively debated in Congress.
- Medicaid: Coverage varies by state. States including California, Colorado, Illinois, Maryland, New York, Oregon, and Washington have expanded Medicaid coverage for obesity medications. Most other states still exclude them.
- ACA marketplace plans: Coverage varies by insurer and plan tier. Bronze plans rarely cover GLP-1s; Silver and Gold plans increasingly do.
Patient assistance programs
Both Novo Nordisk and Eli Lilly offer free or reduced-cost medication to qualifying patients through their patient assistance programs:
- Novo Nordisk Patient Assistance Program (PAP): Offers free Wegovy to uninsured or underinsured patients who meet income criteria (approximately 400% of the federal poverty level — about $120,000 for a family of four in 2026). Apply at novonordisk-us.com.
- Lilly Cares Foundation: Offers free or reduced-cost Zepbound to qualifying patients. Eligibility is based on income and insurance status. Apply at lillycares.com.