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GLP1 insurance coverage

(updated 1/30/26), subject to change at anytime

For most accurate, up to date information, please contact your insurance plan directly as the following information may not apply to you and your plan

 

BCBS

Starting January 1, 2026, Wegovy, Saxenda, and Zepbound will be excluded from coverage for weight loss

No changes to coverage for GLP-1s for type 2 diabetes

Exceptions:

  • Coverage for GLP-1s for weight loss will end with plan renewal (for some patients, this may be as of June 30, 2026)
  • Employer groups with more than 100 employees have the option of adding coverage for weight-loss drugs for an additional cost

(Please reach out to your employer directly to see if you are still covered) 

For more information: GLP-1 FAQs BCBS

BCBS FEP

  • Saxenda and Wegovy may still be “covered” based on level of FEP plan
  • However, the copay will likely be much higher than the self-pay cost of the drugs (over $400 per month)
  • Contact your plan for more information
  • Zepbound is not a covered drug under this plan

BILH insurance

  • Ozempic preferred GLP-1 agent for weight loss, must trial for 180 days before switching to Mounjaro unless having side effects
  • BMI 35 and >: automatically qualifies for coverage
  • BMI 27-34.9 with 1 or more comorbidities (OSA, HTN, dyslipidemia, CAD, CKD, etc.): automatically qualifies for coverage
  • BMI 30-34.9 without qualifying comorbidity: requires trial and failure of >90 days of an oral weight loss agent unless all oral meds are contraindicated.

- Oral med options approved: bupropion, Contrave, diethylpropion, naltrexone, orlistat, phentermine, phendimetrazine, topiramate, Qsymia

- Will then approve GLP-1 if less than 5% weight loss after the 90 days

- This oral trial can be waived if:

  • The patient tried but could not tolerate an oral weight-loss medication.
  • There is a medical contraindication to all oral agents.

Mass General Brigham

  • Starting on January 1, 2026, coverage is ending for GLP-1s for obesity or weight
    management for individual commercial members and small employers
  • Coverage for GLP-1s approved to treat type 2 diabetes is not changing
  • Employer accounts with 50 or more enrolled subscribers will have the option to add
    coverage of GLP-1s for weight management when their plans renew in 2026 (Please check with your employer regarding this)
  • Patients with Caremark as their prescription benefits may still be covered for Wegovyplease
    reach out to your insurance for more information

GLP-1 Coverage | Mass General Brigham Health Plan

Mass General Brigham

New GLP-1 criteria for weight loss effective February 17, 2026:
  1. Mass Health GLP Criteria 2026
  2. Wellsense MassHealth
  3. Fallon MassHealth

 

Medicare

  • Wegovy is covered for patients with established cardiovascular disease along with a
    BMI of 27 or greater (Patients must have a diagnosis of established cardiovascular disease, such as
    a prior heart attack, stroke, or peripheral arterial disease)
  • Zepbound is covered for patients with a confirmed moderate to severe obstructive
    sleep apnea diagnosis along with a BMI 27 or greater

Ozempic, Mounjaro, and Rybelsus are covered for patients with a diagnosis of Type 2
diabetes, however step therapy may be required

Tufts Health Direct

  • Starting on January 1, 2026, ALL weight loss drugs/GLP-1s are excluded from
    coverage (this includes coverage for weight loss drugs for cardiovascular conditions
    and sleep apnea)
  • GLP-1 medications specifically prescribed for type 2 diabetes will continue to be
    covered.
  • Any active prior authorization for weight loss drugs will no longer be effective as of Jan
    1, 2026

Prescription weight loss drug coverage changes | Tufts Health Plan

Wellpoint GIC and other GIC insurances

  • Patient’s will need to establish with a Vida Health provider and obtain new
    prescription for GLP-1 by March 31, 2026 for continued insurance coverage
  • This process went into effect January 1st and there is a 90-day grace period for
    patients to switch their care
  • Patients with type 2 diabetes are not required to switch to Vida Health
  • Please contact Vida Health for more information

Commonwealth of Massachusetts Group Insurance Commission - Vida

Wellsense Clarity

  • Drugs prescribed for weight loss, including GLP-1 medications, will no longer be
    covered by Wellsense Clarity plans in Massachusetts as of January 1, 2026

Prescriptions | MA Clarity Plans | WellSense Health Plan

Harvard Pilgrim, United Healthcare, Aetna, Cigna, all others

Please check with your plan and/or employer directly regarding GLP-1 coverage for
weight loss 

Self-pay options for GLP-1s

  • Zepbound injection (Available as vial and needle)

Current prices: (2.5 mg- $299 per month) (5 mg- $399 per month) (7.5, 10, 12.5, and 15 mg- $449 per month)

  • Wegovy injection (Available as self-injectable pen) 

All doses (0.25 mg-2.4 mg) are $349 per month

  • Wegovy Pill 

current prices: (1.5 mg- $149/month (temporary discounted price) (4 mg- $199/month) (9 mg and 25 mg- $299/month)

For more information regarding self-pay options of Zepbound and Wegovy,
including promotional prices and coupons, please visit their websites:

Savings Options | Zepbound® (tirzepatide)

Wegovy® Cost & Coverage Information | Wegovy® (semaglutide)