The Cost of GLP-1 Drugs — With and Without Insurance
Ozempic, Wegovy, and other GLP-1 drugs have gained popularity, but the cost might come as a surprise to those interested in using them.
Insurance coverage can vary for these medications, and even with coverage, out-of-pocket costs such as copays or coinsurance may apply. Here’s what you need to know.
Understanding Drug Costs
Ozempic currently carries a list price of over $1,000. However, if you are using it for Type 2 diabetes, your insurance may cover it. The actual cost to you will depend on your specific insurance plan. For instance, you may only need to pay a copay ranging from $25 to $50. GoodRX provides a tool on its website to estimate the cost of your medication with your insurance.
Wegovy and Zepbound are FDA-approved drugs for weight management. Wegovy has a list price of over $1,300 for a 28-day supply, but with insurance, you could pay as little as $25 per month. Zepbound’s list price goes up to $1,086 for a 28-day supply, but again, your out-of-pocket cost could be as low as $25 per month with insurance.
It’s important to note that the monthly drug costs are just one aspect of the overall expense, as additional costs like doctor visits and lab work are not included. Moreover, drug prices are subject to change. The list prices of Ozempic and Wegovy are expected to decrease by up to 50% next year to enhance accessibility for insured individuals.
Navigating Insurance Coverage
Insurance complicates drug pricing due to the individualized nature of coverage. Some GLP-1 drugs are only covered for diabetes treatment, while others are covered for weight management. Coverage also depends on the drug’s tier and whether prior authorization is necessary.
Your plan can specify your financial responsibility, which may involve meeting a certain deductible or paying a copay beyond that. Public coverage is also impacted, with the CMS announcing broader access to GLP-1 drugs for weight loss through programs like Medicaid and Medicare Part D under the BALANCE Model.
It’s crucial to assess the annual costs of these medications to determine if your budget can accommodate the additional expense. Tax-advantaged accounts like FSAs and HSAs can provide financial assistance. When budgeting for these drugs, consider the long-term commitment of monthly payments rather than solely focusing on the initial prescription cost.
