How to get a GLP-1: the prescription, then the four ways to pay

The approved uses decide which drug a prescriber can write, and insurance follows the same lines ^[5]:

Wegovy and Zepbound are the weight products; Ozempic and Mounjaro are the diabetes products with the same molecules. Being prescribed the diabetes version for weight is off-label, which is legal for a prescriber to do and is a common reason insurance refuses to pay.

Three routes, and they differ mostly in what happens afterward.

Your own doctor. A primary-care clinician can prescribe any of these. This is the route that keeps one record of your care and the one most likely to end in an insurance claim rather than a cash payment.

A telehealth visit. Online weight-loss services connect you with a clinician licensed in your state. The medical part is usually straightforward; what varies is what the company sells you afterwards, which is where our provider reviews and price index come in. Some sell the branded drug; some sell a compounded one (§ 05).

The makers' own referral pages. Both LillyDirect and NovoCare will point you to independent virtual or in-person clinicians. They do not employ them and do not guarantee a prescription ^[1][2].

Whoever writes it, expect questions about your BMI and weight-related conditions, your personal and family history of medullary thyroid cancer and MEN 2 (both are reasons not to take these drugs), pancreatitis, gallbladder disease and any other medicines, especially insulin or a sulfonylurea ^[5]. Our page on side effects covers why.

Coverage for the diabetes products is common; coverage for weight is patchy and depends on the employer's plan. If your plan covers a GLP-1 for weight, it usually requires prior authorization: a BMI threshold, documented weight-related conditions and sometimes a documented attempt at diet and exercise first.

Both makers run copay savings cards for people with commercial insurance that covers the drug. Lilly's brings the Zepbound single-dose pen to as little as $25 a month for up to a three-month prescription ^[1]; Novo's brings Wegovy to as little as $25 a month, with a maximum saving of $100 a month ^[2]. Both exclude anyone on a government plan: Medicare, Medicaid, Part D, Medicare Advantage, VA, TRICARE ^[1][2].

Both companies now sell direct at prices well below the list price, if you pay yourself and skip insurance.

LillyDirect, for Zepbound ^[1]. The KwikPen and the single-dose vial both cost $299 a month at the 2.5 mg starting dose, $399 at 5 mg, and $449 at 7.5 mg through 15 mg if you reorder within 45 days. Miss that window and the higher doses are $499 to $699. A month means 28 days, so a year is thirteen of them. Needles and syringes are bought separately.

NovoCare, for Wegovy ^[2]. The pen is $199 a month at the 0.25 and 0.5 mg doses for patients new to the offer, for two fills, through 31 December 2026, and $349 a month after that for every dose up to 2.4 mg, or $399 for the 7.2 mg strength. The tablets are priced by dose: $149 at 1.5 mg, $199 at 4 mg and $299 at 9 and 25 mg, where a month is one bottle of 30 tablets.

Ozempic, through the same Novo offer ^[7]. New self-pay patients pay $199 a month for the first two fills at 0.25 or 0.5 mg, through 31 December 2026, then $349 a month at 0.25, 0.5 or 1 mg and $499 at 2 mg.

TrumpRx ^[7]. A federal site that lists these manufacturer prices in one place, under the Most-Favored-Nation pricing agreements. It sells nothing and dispenses nothing: it shows a price and then either a coupon card you present at a retail pharmacy, as for Wegovy and Ozempic, or a link to the maker's own pharmacy, as for the Zepbound vial through LillyDirect. It is free, needs no account, and the prescription still goes to the pharmacy you choose rather than to the site. Its listed prices are the cash prices above: Wegovy tablets from $149 a month, the Wegovy pen and Ozempic from $199, Zepbound from $299, against list prices of $1,028 to $1,349 ^[7].

One condition runs through all of it: these are cash prices for people paying out of pocket. TrumpRx states that its pricing is for cash-paying patients only and tells insured patients to compare it with their own copay ^[7], and both makers' savings cards exclude government plans ^[1][2].

In every case the price is a program the company can change or withdraw ^[1][2][7]. Our price index tracks these alongside the telehealth sellers, and what's in a GLP-1 price explains the sentences that move the number.

Medicare Part D has not generally covered weight-loss drugs. Since 1 July 2026 a CMS demonstration called the Medicare GLP-1 Bridge has filled part of that gap, and it runs to 31 December 2027 ^[3].

• What it costs. $50 a month ^[3].
• What it covers. Foundayo (orforglipron) tablets, Wegovy injection or tablets, and the Zepbound KwikPen. Not the single-dose Zepbound vial or pen ^[4].
• Who can use it. People 18 or over with Medicare drug coverage, including standalone Part D plans, Medicare Advantage plans with drug coverage, Special Needs Plans, employer group plans and LI NET ^[4].
• The medical criteria, at the time treatment starts: BMI of 35 or more; or 30 or more with diastolic heart failure, uncontrolled high blood pressure or chronic kidney disease at stage 3a or above; or 27 or more with prediabetes, a previous heart attack or stroke, or peripheral artery disease with symptoms ^[4].
• Who cannot. Anyone whose Part D plan already covers their GLP-1, and anyone using it for type 2 diabetes, moderate-to-severe sleep apnea or fatty liver disease, since Part D may cover those ^[4].
• The paperwork. Your prescriber sends the prescription and completes a prior authorization, and certifies that you are in a diet-and-exercise program. The approval is good through the end of 2027 unless you switch to a different GLP-1 ^[4].

One catch worth knowing: because the Bridge sits outside the normal Part D benefit, the $50 does not count toward your deductible or your yearly out-of-pocket limit, Extra Help cannot lower it, and it cannot be spread over the year with the Medicare Prescription Payment Plan ^[3][4].

For most of 2024 the shortages let pharmacies make copies of semaglutide and tirzepatide, and a market grew on that. FDA declared the shortages over, and that permission ended on 22 April 2025 for 503A pharmacies and 22 May 2025 for outsourcing facilities ^[6].

What remains is narrow: a 503A pharmacy may still make a patient-specific preparation when a prescriber documents that it makes a significant difference for that patient, and some sellers argue that a different route, such as a tablet under the tongue, is not a copy. Neither is settled. Compounded versus branded sets out what you are choosing between, and what to ask before your first order lists the questions to put to any seller.