Will insurance cover your GLP-1?

Pick your coverage and the drug. See what the label covers, what plans like yours typically ask for, the prior-authorization steps, and a letter to bring to your prescriber.

Tool · Kymata Health Every line sourced · checked Oct 21, 2026 Nothing you pick leaves this browser Sources

Educational, not medical advice

It is not legal advice either. Plans vary: check with your plan. Only your clinician can decide whether a medicine fits you.

Your coverage and drug

Two choices. The result and the letter appear below.

The helper needs JavaScript, which is off in this browser. The sources below list where each plan type’s rules are published.

1Your coverage
2The drug

Pick your coverage and a drug to see the typical criteria and steps.

Paying cash or comparing routes? See what GLP-1 care costs per month over your first 12 months.

Questions

Will insurance cover Zepbound?

It depends on the plan. Many employer plans do not cover GLP-1s for weight loss at all; those that do usually require prior authorization with a BMI rule and a lifestyle program. Medicare covers the Zepbound KwikPen for eligible people through the GLP-1 Bridge (July 2026 to December 2027), and Medicaid must cover it for sleep apnea in adults with obesity. Pick your plan type above for the details and sources.

Will insurance cover Wegovy?

Coverage for weight management depends on the plan: KFF found it on 19% of large employers’ plans in 2025 and on 1% of federal Marketplace plans in 2024. Medicare’s GLP-1 Bridge covers it for eligible people with Part D, and Medicaid must cover its heart-risk use. Pick your plan type above to see the typical criteria and sources.

What is a GLP-1 prior authorization letter?

It is the documentation a clinician sends so the plan can check its criteria: usually the diagnosis codes, measured BMI, related conditions and other treatments tried. The template on this page is a letter you bring to your clinician to ask for that request; your clinician writes and signs the request itself.

What does step therapy mean for GLP-1s?

Some plans approve a drug only after other ones were tried first, such as the plan’s preferred GLP-1 or other weight medicines, unless there is a medical reason not to. Your plan’s policy lists the steps.

Is anything I pick here sent or saved?

No. The plan type and drug you pick stay in this browser tab. The letter has blank placeholders: write personal details only on the printed copy.

Sources

Where each line comes from

19 sources

Numbered as the helper cites them. Plans and programs change their rules; the date is the day we read each one.

  1. FDA label: Wegovy (semaglutide) injection and tablets, revised 6/2026 (DailyMed) (opens in new tab)Checked Oct 21, 2026
  2. FDA label: Zepbound (tirzepatide), revised 8/2026 (DailyMed) (opens in new tab)Checked Oct 21, 2026
  3. FDA label: Ozempic (semaglutide) injection (DailyMed) (opens in new tab)Checked Oct 21, 2026
  4. FDA label: Mounjaro (tirzepatide), revised 8/2026 (DailyMed) (opens in new tab)Checked Oct 21, 2026
  5. Medicare.gov: Weight loss drugs (Medicare GLP-1 Bridge) (opens in new tab)Checked Oct 21, 2026
  6. CMS: Medicare GLP-1 Bridge, FAQs (page modified Jul 13, 2026) (opens in new tab)Checked Oct 21, 2026
  7. KFF: Medicaid Coverage of and Spending on GLP-1s (Jan 16, 2026)Checked Oct 21, 2026
  8. KFF: 2025 Employer Health Benefits Survey release (Oct 22, 2025)Checked Oct 21, 2026
  9. KFF: GLP-1 drugs rarely covered for weight loss by Marketplace plans (Jun 12, 2024)Checked Oct 21, 2026
  10. Plan policy example: FEP Blue (federal employee program) Zepbound prior approval, policy 5.99.031, effective Jul 1, 2026Checked Oct 21, 2026
  11. Plan policy example: FEP Blue antidiabetic GLP-1 and GIP agonists prior approval, policy 5.30.086, effective Jul 1, 2026Checked Oct 21, 2026
  12. VA Pharmacy Benefits Management: Weight Management, A VA Clinician’s Summary (2025) (opens in new tab)Checked Oct 21, 2026
  13. VA Formulary Advisor (opens in new tab)Checked Oct 21, 2026
  14. MOAA: Weight-loss drug coverage ending for TRICARE For Life users (Aug 6, 2025), citing TRICARE.milChecked Oct 21, 2026
  15. HealthCare.gov: How to appeal an insurance company decision (opens in new tab)Checked Oct 21, 2026
  16. TRICARE Formulary Search Tool (Express Scripts)Checked Oct 21, 2026
  17. NovoCare: Wegovy self-pay and savings-offer pricingChecked Oct 18, 2026
  18. LillyDirect: Zepbound self-pay, Journey Program and savings-card termsChecked Oct 18, 2026
  19. TrumpRx.gov: GLP-1 price cards (Wegovy pill, Wegovy pen, Ozempic, Zepbound)Checked Oct 18, 2026

Educational only. Not medical advice. Some links earn us a commission: kymatahealth.com/affiliate-disclosure.