Cost & Insurance

Updated May 19, 2026: The BALANCE Model Part D pilot was canceled April 21, 2026 — the Medicare GLP-1 Bridge is now the ONLY federal Medicare obesity pathway through December 31, 2027. Four drugs covered at a $50/month flat copay: Foundayo, Wegovy injection, Wegovy oral tablet, and Zepbound KwikPen. The $50 does NOT count toward the Part D deductible or the $2,100 out-of-pocket cap. Prior auth routes to Humana (the CMS-designated central processor, operating via LI NET infrastructure). Eligible plan types: PDP, MA-PD, SNP, EGWP, and LI NET. Complete enrollment guide.

Updated May 2026: FDA proposed on April 30 to permanently remove semaglutide, tirzepatide, and liraglutide from the 503B Bulks List — effectively closing the door on large-scale compounding if finalized. 503A enforcement began April 22, 2025. 503B enforcement May 22, 2025. 3-4 million patients affected. Legal alternatives: compounded tirzepatide ($149-299/mo, medical-necessity only), Wegovy $349/mo via NovoCare, or Foundayo $649/mo.

How much do GLP-1 medications cost in 2026? Wegovy, Zepbound, Ozempic, Mounjaro & Foundayo range from $25–$1,350/month. With insurance + savings card: $25/mo. Without insurance: $115/mo compounded sema (Enhance MD), $149/mo Foundayo pill, $299–449/mo brand injectable (LillyDirect, NovoCare). Medicare: $50/mo starting July 2026. Prices verified April 17, 2026 across 48 providers.

Verified April 2026: Medicare Part D begins covering Wegovy and Zepbound for weight loss July 1, 2026 via the Medicare GLP-1 Bridge program. Flat $50/month copay. 3.4 million beneficiaries eligible. Runs through Dec 31, 2026, then permanent BALANCE Model launches January 2027.

Verified April 2026: Tirzepatide costs $149/mo via Enhance MD (compounded), $299/mo via LillyDirect (brand Zepbound 2.5mg vial), $449/mo for LillyDirect 5mg+ vials, $25/mo with Zepbound savings card, or $1,086/mo retail list price. Full price breakdown with 47 verified providers.

Verified April 2026: Tirzepatide compounding enforcement began March 2025 after FDA removed it from the shortage list. Narrow medical-necessity exemptions still allow legal compounded tirzepatide at $149-300/mo (vs $1,086/mo retail Zepbound). Complete legal framework, safety, and verified pricing.

Verified April 2026: Zepbound savings card cuts copay to $25/fill ($1,300 max annual savings) with commercial insurance. Mounjaro savings card offers $25 copay for T2D. Both expire Dec 31, 2026. Activate in 2 minutes at zepbound.lilly.com/savings. Full eligibility + backup options.

Verified April 11, 2026: 81 days until the Medicare GLP-1 Bridge launches July 1, 2026. Complete prep checklist: Part D enrollment verification, BMI documentation, comorbidity coding, prior auth prep. Free Medicare Eligibility Checker tool inside.