Insurance & Access Guide
WIKI · US-FOCUSED · SEE THE INTERNATIONAL FORUM FOR OTHER REGIONS
Coverage is the hardest part of GLP-1 therapy for most members. This guide collects what consistently works: clean prior authorizations, well-built appeals, and honest math on cash options.
What things actually cost (US, 2026)
| Option | Typical monthly cost | Notes |
|---|
| Wegovy (list) | $1,349 | Before insurance or savings card |
| Zepbound (list) | $1,059 | Before insurance or savings card |
| Manufacturer savings card | $0–650 | Commercial insurance only; caps and eligibility vary |
| Direct-from-manufacturer vials | $349–499 | LillyDirect / NovoCare self-pay tiers |
| 503A compounded (where lawful) | $150–400 | Availability narrowed sharply after shortage resolutions — see Compounding |
Prior authorization — make approval easy
- Document the qualifying diagnosis: BMI ≥30, or ≥27 with a comorbidity (HTN, dyslipidemia, OSA, T2D) — in the chart, not just the form.
- Include weight history and at least one documented lifestyle intervention attempt (many plans require 3–6 months).
- Attach relevant labs: A1C, lipids, plus sleep study or BP readings if claiming comorbidities.
- Use the plan's own criteria language. Ask the insurer for the policy document and mirror its wording.
If you're denied — the appeal ladder
- Ask for the denial reason in writing. Most denials are missing-documentation, not true exclusions.
- First-level appeal: prescriber letter of medical necessity citing trial evidence (SELECT's 20% MACE reduction moved many cardiology-adjacent appeals).
- Peer-to-peer review: your prescriber talks to the plan's physician. Preparation wins these.
- External review: independent reviewer, binding on the insurer. Free in most states; success rates are meaningfully high for well-documented obesity-care appeals.
Members post redacted approval letters, denial codes and appeal templates in
Insurance & Access — search your insurer's name before writing anything from scratch.
Outside the US
Access rules differ wildly: private prescriptions in the UK, regional reimbursement in the EU, PBS limits in Australia. Region threads with current pricing live in the International forum.
⚕ Not medical advice. The GLP Lounge is a community forum. Nothing on this page is a substitute for guidance from a licensed clinician. Always involve your prescriber before starting, stopping, or changing a medication.