Does health insurance cover GLP-1 medications for weight loss?

What GLP-1 drugs are commonly prescribed for weight loss?

There are numerous glucagon-like peptide-1 receptor agonists (GLP-1 drugs) approved by the U.S. Food and Drug Administration (FDA) to treat type 2 diabetes.³ But they have also proven to be effective in helping people lose weight, and four GLP-1 drugs – Wegovy, Zepbound, Saxenda, and Foundayo⁴ – have FDA approval to be used for chronic weight management.⁵

Other GLP-1 drugs – such as Mounjaro, Ozempic, Trulicity, Rybelsus and Victoza (including a generic version)⁶ – are approved for the treatment of type 2 diabetes, but not specifically for weight management.

If you’ve been diagnosed with type 2 diabetes, or cardiovascular disease along with obesity or overweight, your doctor may prescribe a GLP-1. You’ll want to check with your health plan to see which GLP-1 drugs are covered, as health plans create their own formularies (covered drug lists) and do not have to cover all versions of a given category or class of drugs.

If you have been diagnosed with obesity or overweight – but not diabetes or cardiovascular disease – and your doctor wants to prescribe weight-loss medication, it’s less likely that your health plan will cover it, but it is possible.

Do Marketplace plans cover GLP-1 drugs for weight loss?

Most Marketplace plans do not cover GLP-1 drugs prescribed for weight loss. According to a 2024 KFF analysis, the majority of Marketplace plans covered various GLP-1 medications to treat diabetes, but only 1% covered Saxenda or Wegovy for weight loss, and none covered Zepbound for weight loss.⁷

According to another recent analysis of 2026 plans, only 26 carriers, out of 300 nationwide, provide coverage for GLP-1 medications to treat obesity. These plans are not available at all in most states, and most of the carriers that offer this coverage restrict it to enrollees with a BMI of at least 40⁸ (about 240 pounds if the person is 5’5”, and about 300 pounds if the person is 6 feet tall).⁹

So coverage rules for medications prescribed specifically for weight loss (as opposed to treatment of another condition such as diabetes) are up to each state.

EHB benchmark plans are chosen and modified by each state. Most states’ requirements have not been updated since the 2017 plan year,¹⁰ before modern GLP-1 medications were in use.

North Dakota is the only state with an EHB benchmark plan that specifically includes coverage for GLP-1 medications to treat weight loss (for morbid obesity), due to a change that took effect in 2025.¹¹¹²

(See below for details of current state legislation on this issue. Note that CMS finalized a rule in 2026 that requires states to defray the cost of adding new services to their EHB benchmark plans.)¹³

It should also be noted that health plans are always free to offer coverage that goes above and beyond the EHB benchmark plan. So consumers should always check with their plan to see what medications are covered and carefully consider their coverage options during the annual open enrollment period.

Do employer-sponsored health plans cover weight-loss drugs?

Some employer-sponsored health plans cover weight-loss medications, even if the patient doesn’t have diabetes or cardiovascular disease.

Based on 2026 survey responses from 307 U.S. employers, 60% said that they cover GLP-1 drugs for the treatment of diabetes, and 36% (unchanged from 2025) said that they cover GLP-1 drugs for both diabetes and weight loss.¹⁴

Additional 2026 surveys found that 5% to 10% of employers that currently cover GLP-1 medications for weight loss are planning to drop that coverage as of 2027.¹⁵

Self-insured plans, which cover the majority of people with employer-sponsored health insurance,¹⁶ are designed by the employer and are regulated under ERISA, not state-level insurance laws or regulations. These plans vary considerably from one to another, and coverage of weight-loss drugs will depend on each specific employer’s approach.

For employers that purchase coverage in the large-group market or small-group market, the coverage options will depend on the plans that insurers make available to these employers. In the small-group market, plans have to provide at least the same benefits as the EHB benchmark plan. But as described above, the vast majority of those do not cover GLP-1 drugs used for weight loss.

Does Medicare cover GLP-1 drugs used for weight loss – such as Ozempic and Wegovy?

Medicare, including Medicare Part D, does not cover these prescription drugs if they’re being used for weight loss rather than to treat another medical condition.¹⁷ But a new pilot program is making certain GLP-1 medications available to Medicare Part D beneficiaries for $50/month.

From July 1, 2026 through December 31, 2027, people with Medicare Part D (including stand-alone Part D plans or Medicare Advantage with integrated Part D coverage) can access certain GLP-1 medications for $50/month:¹⁸

• Foundayo (oral tablet)
• Wegovy (injection or oral tablet)
• Zepbound (KwikPen only; other Zepbound products are not included)

To qualify for this program, a Medicare beneficiary must meet all of the following requirements:

• Have Medicare Part D coverage and be at least 18 years old.
• Not be eligible to receive GLP-1 coverage through the Part D plan.
• Not have type 2 diabetes, moderate-to-severe sleep apnea, or fatty liver disease.
• Have a BMI in the following ranges:
  • At least 35.
  • At least 30 in conjunction with certain types of heart failure or uncontrolled high blood pressure or chronic kidney disease.
  • At least 27 in conjunction with prediabetes, or having had a heart attack, stroke, or artery blockages in your arms or legs.

Note: The $50/month copay for the GLP-1 medications through the Medicare pilot program does not count toward the Part D deductible or out-of-pocket maximum. So these costs will be in addition to the up to $2,100 that Part D enrollees could pay in 2026 for covered medications.

Medicare Part D can cover GLP-1 medications such as Ozempic and Wegovy if they’re prescribed for other medical conditions, such as diabetes or cardiovascular disease along with obesity or overweight.¹⁹

CMS reiterated that stance in a March 20, 2024 memo,²⁰ which clarified that Medicare Part D continues not to cover medications used for weight management. But the same medications can be covered by Medicare Part D if they “receive FDA approval for an additional medically accepted indication” and are prescribed for non-obesity conditions, such as diabetes.

CMS had proposed a rule change in late 2024 that would have allowed Medicare Part D to cover weight loss drugs starting with plan year 2026.²¹ But when the final rule was published in April 2025 (under a new administration), CMS opted not to finalize that portion of the proposed rule.²² So GLP-1 drugs continue to only be covered by Medicare Part D if they’re prescribed to treat another condition, like diabetes. They are not covered if they’re prescribed to treat obesity alone.

But as noted above, a new pilot program is providing some Part D enrollees with access to certain GLP-1 medications for $50/month, outside of the normal Part D benefit.²³

Across three GLP-1 drugs approved to treat diabetes, total Medicare Part D spending was 100 times higher in 2022 than it had been in 2018.²⁴ And spending has increased significantly since then: Total gross Part D spending on GLP-1 medications stood at $5.7 billion in 2022, and had grown to $27.5 billion by 2024 (although with rebates, net spending was roughly half that amount).²⁵

Does Medicaid cover drugs used for weight loss – such as Ozempic and Wegovy?

In most states, Medicaid only covers GLP-1 drugs if they’re prescribed to treat a condition such as diabetes or heart disease, rather than for weight loss alone.

Sixteen states covered GLP-1 medications for weight loss under their Medicaid programs as of 2025. But four of them – California, New Hampshire, Pennsylvania and South Carolina – ended that coverage in 2026, and Michigan began requiring a BMI of at least 40 for the drugs to be covered for weight loss.²⁶ Starting in October 2026, Rhode Island will also eliminate Medicaid coverage for GLP-1 drugs prescribed for weight loss or weight management.²⁷

Under federal Medicaid drug coverage rules,²⁸ states can exclude coverage of weight-loss drugs. (This exclusion would no longer have been allowed under the rule change that CMS proposed in late 2024,²⁹ but that proposal was not finalized.)²² But while federal Medicare Part D rules expressly prohibit coverage of weight-loss drugs, the Medicaid rules leave that decision up to each state.

Again, as with the categories described above, coverage of a drug for weight loss is different from coverage of the same drug to treat diabetes or reduce cardiovascular risk. So Medicaid coverage of weight-loss drugs will depend on the reason why the drug is being prescribed, as well as the state where the person lives and whether their coverage is administered by the state (fee-for-service) or by an insurance company (Medicaid managed care).

How do state laws affect coverage of weight-loss drugs?

Lawmakers in several states are considering legislation related to coverage of weight-loss drugs by state-regulated private health plans, Medicaid, state employee health plans, or some combination of those, or for studies to determine the feasibility of mandating such coverage. Legislation has been recently enacted or is under consideration in the following states in 2026:

• Alabama (enacted in 2026, but not a coverage requirement. The bill calls for Alabama Medicaid to evaluate the cost of covering GLP-1 medications for weight loss and determine whether it would result in cost savings for the program.)³⁰
• Arizona (enacted in 2025, creates a study committee)³¹
• California³²
• Colorado (enacted in 2025, requires large-group plans to give enrollees the option to purchase coverage for weight loss medication, including at least one GLP-1 medication)³³
• Illinois³⁴
• Louisiana (enacted in 2026, applies to Medicaid and state employee plans)³⁵
• Maryland (enacted in 2026, authorizes state to seek approval to add weight-loss medication coverage to Medicaid)³⁶
• New Jersey³⁷
• Pennsylvania³⁸
• Utah (enacted in 2026, applies to the health plan for state employees)³⁹

What if my insurance doesn't cover my medication?

If your doctor is suggesting a GLP-1 medication and your insurance won’t cover it, there are several steps you can take:

Check with your plan to be sure you understand its rules. Here are some questions to ask:

• Will the plan only cover GLP-1 medications if the prescription is for something other than weight loss?
• Does the plan cover GLP-1 medications for weight loss, but only if the person has a certain BMI?
• Does the plan cover other GLP-1 drugs, but not the one that your doctor has recommended? You might find, for example, that your plan covers Wegovy, but not Ozempic or Mounjaro, or vice versa.
• Does the plan cover GLP-1 medications if prior authorization is obtained? If so, you can work with your doctor to submit the necessary documents and see if your plan will approve the coverage.
• Does the plan cover GLP-1 medications under a step therapy protocol, meaning you have to try less expensive options first, and provide proof that they didn’t work? If so, you can work with your doctor to see if there are alternatives that will fit the plan’s rules.

If your health plan still denies coverage for the GLP-1 drug, you and your doctor can appeal that decision.

If there’s no way to get your health plan to cover a GLP-1 medication for your circumstances but your doctor says you need it, you can check to see if you might qualify for a manufacturer’s copay card or patient assistance program. Eligibility rules vary from one manufacturer to another, so don’t give up if you don’t qualify for the first one you check.

You can also obtain free coupons from GoodRx that will help to lower your costs for a GLP-1 drug.⁴⁰

If you’re enrolled in Medicare Part D and your plan won’t cover a GLP-1, you can check to see if you’re eligible for the Medicare pilot program (described above) that provides access to certain GLP-1 drugs for $50/month.

How much do GLP-1 weight-loss drugs cost?

The U.S. list prices in 2026 for some of the most common GLP-1 medications used for weight loss range from more than $900/month to more than $1,300/month,⁴¹ which is largely unchanged from three years ago.⁴² But Foundayo, an oral GLP-1 medication that was approved by the FDA in April 2026,⁴³ has a much lower list price that ranges up to about $350/month.⁴⁴

Some GLP-1 manufacturers have begun offering direct-to-consumer sales for people who pay cash rather than using health insurance coverage. This includes a significant discount, but the medications can still cost several hundred dollars per month.⁴⁵

It’s easy to see how the cost of GLP-1 drugs can be out of reach for many people without insurance coverage, although many of the manufacturers offer coupons or patient assistance programs that can reduce the monthly cost.

If a health plan does cover these medications – either to treat diabetes, lower cardiovascular risk, or treat obesity – the out-of-pocket costs will vary by plan. They will depend on the formulary tier the plan uses for that medication, whether the out-of-pocket cost is a copay (flat amount) or coinsurance (percentage of the total cost), and whether the plan has a separate deductible for prescriptions.

If the specific medication your doctor recommends is not on your health plan’s formulary, you and your doctor can file an appeal, asking the plan to cover the drug anyway. If the plan denies the request but has other similar medications on its formulary, you can have a discussion with your doctor about whether one of the covered drugs might work for you.

The Medicare GLP-1 pilot program described above can be a way for some Medicare Part D beneficiaries to access Foundayo, Wegovy, or the Zepbound KwikPen by paying $50/month.