The state of coverage right now
As of April 2026, roughly 40% of large employer-sponsored health plans cover at least one GLP-1 medication approved specifically for chronic weight management — up from an estimated 25% in early 2024, according to benefit surveys from the Employee Benefit Research Institute and Mercer. That figure sounds like progress, but it masks a critical distinction: coverage for obesity alone remains far narrower than coverage for the same drugs prescribed for Type 2 diabetes or cardiovascular risk reduction. Semaglutide (Ozempic) and tirzepatide (Mounjaro) — the diabetes-labeled versions — continue to enjoy substantially broader formulary access than their obesity-labeled counterparts, Wegovy and Zepbound.
What actually changed in early 2026
Two developments shifted the landscape meaningfully this year. First, the American Medical Association's updated obesity coding guidance, which took effect January 1, 2026, made it easier for employers and insurers to classify weight management treatment as a chronic disease intervention rather than an elective benefit — a distinction that matters for self-insured ERISA plans trying to justify the actuarial cost. Second, UnitedHealthcare and Cigna both revised their commercial formularies in Q1 2026 to include Zepbound as a Tier 3 preferred specialty drug for members with a BMI of 30 or above, or 27 or above with at least one documented comorbidity. Aetna's comparable update, announced in February, applies only to fully insured group plans in 22 states, leaving self-insured employers on Aetna's administrative platform to opt in separately — and many have not yet done so.
Where Medicare stands
Medicare Part D's coverage picture remains constrained by statute, though less so than two years ago. The Treat and Reduce Obesity Act, which passed in modified form as part of a broader reconciliation package in late 2025, authorized Medicare Part D plans to cover FDA-approved obesity medications beginning in plan year 2026 — but participation by Part D sponsors is voluntary, not mandatory. As of March 2026, CMS reported that approximately 60% of stand-alone Part D plans and 55% of Medicare Advantage prescription drug plans had added at least one obesity-indicated GLP-1 to their formularies. For enrollees whose plan has not opted in, Wegovy's publicly listed list price remains approximately $1,350 per month before any manufacturer savings programs, and Zepbound's is approximately $1,060 per month, based on Novo Nordisk and Eli Lilly published wholesale acquisition costs. The out-of-pocket cap introduced by the Inflation Reduction Act — $2,000 annually for Part D enrollees starting in 2025 — applies only to covered drugs, offering no relief for those whose plan excludes these medications entirely.
Medicaid coverage is a state-by-state lottery
For the roughly 80 million Americans on Medicaid, access depends almost entirely on which state they live in. As of this month, 19 states explicitly cover Wegovy or Zepbound for obesity under their Medicaid fee-for-service programs, with prior authorization requirements that typically include documentation of a BMI threshold, failed behavioral interventions, and a comorbid condition. Twelve additional states cover the drugs only when prescribed for cardiovascular risk reduction under labeling aligned with the SELECT trial indication. The remaining states either exclude the drugs outright or have coverage decisions pending. Federal matching funds do not compel states to cover obesity drugs, and CMS has not issued a national coverage determination that would change that calculus.
What this means for out-of-pocket costs
For people whose insurance does cover these drugs, cost-sharing varies widely. Members in plans that classify Wegovy or Zepbound as Tier 3 specialty drugs typically face coinsurance of 20% to 33% after deductible, which can still translate to several hundred dollars per month depending on plan design. Both Novo Nordisk and Eli Lilly maintain savings card programs that reduce monthly costs for commercially insured patients — Novo's current program caps out-of-pocket costs at $0 for eligible patients, while Lilly's Zepbound savings program has capped costs at $550 per month for commercially insured patients, based on each company's publicly posted program terms as of April 2026. These programs explicitly exclude Medicare and Medicaid beneficiaries. For those without any coverage path, telehealth-prescribed compounded semaglutide and tirzepatide — which surged in availability during the shortage period — face an uncertain regulatory future following FDA's updated guidance, and their long-term pricing and legal status remain in flux.