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What’s changing in GLP‑1 coverage in 2026 and 2027?

Every dated change to Medicare, Medicaid, employer, military and federal coverage of Wegovy, Zepbound, Ozempic and the other GLP‑1s, in date order, each with its source.

GLP Guidebook teamPublished Oct 14, 202611 min read42 sourcesWritten from published sources
What we checked42 sources, each one opened and linked to the sentence it supportsLast checked Oct 14, 2026 · Next review due Jan 14, 2027 · How we write

Written for the United States, from US sources.

The short answer

Two dates matter most. On January 1, 2027, Medicare’s $274 negotiated price for Ozempic, Rybelsus and Wegovy starts and the Part D cap rises to $2,400. On December 31, 2027, the $50 Medicare GLP‑1 Bridge ends. Medicaid weight coverage fell to 10 states in 2026, and federal employee plans add a therapy rule.

Key takeaways

  • Medicare’s negotiated price for Ozempic, Rybelsus and Wegovy, $274 for a 30-day supply, starts on January 1, 2027, and it is the plan’s price, not your copay.1
  • The Medicare Part D yearly out-of-pocket cap rises from $2,100 in 2026 to $2,400 in 2027, and the highest allowed deductible rises from $615 to $700.2,4
  • Medicare’s $50 GLP‑1 Bridge for weight started on July 1, 2026, and CMS extended it to December 31, 2027, when it delayed the BALANCE Model in Part D.6,7
  • State Medicaid coverage of GLP‑1s for weight fell from 13 states in January 2026 to 10 on October 14, 2026, after Utah, Massachusetts and Rhode Island stopped.9,10
  • For the 2027 plan year, federal employee and Postal Service plans must require documented intensive behavioral therapy before and during anti-obesity medicines.21
Before you go further
  • Plans differ, and many change on January 1. The insurer and benefit-manager documents below are dated examples, not your plan’s rules. Check your own plan’s drug list for next year.
  • This page lists published changes. It can’t say whether you qualify: your prescriber and your plan decide that.
  • Prices here are official list or negotiated prices with dates, not what you will pay. GLP‑1 medicines carry real risks: see our side effects guide.
On this page
  1. What changes, and when?
  2. What changes for Medicare in 2027?
  3. What changed in Medicaid in 2026?
  4. What is changing in employer and state plans?
  5. What changed for military and federal plans?
  6. Which label changes affect coverage?
  7. Questions people ask
  8. How we researched this
  9. Sources

What changes, and when?

The biggest dates are January 1, 2027, for Medicare prices and federal plans, and December 31, 2027, when the Medicare GLP‑1 Bridge ends.1,6,21

The list runs in date order, oldest first, from mid-2025 to the end of 2027. Each entry says who it affects and links its source.

Filled dot: already happened (as of Oct 14, 2026). Hollow dot: still to come.

2025: the background

  1. Jul 1, 2025Benefit managerCVS Caremark’s standard commercial drug lists prefer Wegovy and remove Zepbound.26
  2. Aug 2025LabelWegovy’s label changes its approved uses. The current label lists MASH, a fatty liver disease with scarring.36
  3. Aug 31, 2025MilitaryTRICARE stops covering weight-loss drugs for members outside TRICARE Prime and Select, which includes TRICARE For Life.23,22
  4. Dec 2025LabelWegovy’s approved uses change again, and its label now covers tablets as well as the injection. Mounjaro adds children 10 and older with type 2 diabetes.36,37

2026

  1. Jan 1, 2026MedicareThe Part D yearly out-of-pocket cap becomes $2,100, up from $2,000 in 2025.3
  2. Jan 1, 2026MedicaidCalifornia, New Hampshire, Pennsylvania and South Carolina stop covering GLP‑1s for weight alone. Michigan narrows its rules.11,12,13,10
  3. Jan 1, 2026Benefit managerExpress Scripts’ national preferred drug list adds Zepbound vials to its exclusions.28
  4. Jan 1, 2026State employeesKansas’s state employee plan requires a BMI of 35 or more for weight prescriptions issued or renewed from this date.33
  5. Apr 1, 2026LabelThe FDA approves Foundayo, a daily pill, for weight in adults.38,39
  6. Apr 2026VAThe VA’s national criteria for Wegovy lower the bar to a BMI of 27 with a weight-related condition, from 30 in August 2025.24,25
  7. Apr 21, 2026MedicareCMS extends the GLP‑1 Bridge to December 31, 2027. It delays the BALANCE Model in Part D for 2027 “pending further evaluation and data collection”.7,6
  8. Jun 1, 2026Benefit managerCVS Caremark lifts its new-drug block on Foundayo where plans approve coverage.27
  9. Jun 30, 2026MedicaidUtah Medicaid’s weight coverage, a pilot set by the legislature, ends.14
  10. Jul 1, 2026MedicareThe Medicare GLP‑1 Bridge starts: $50 a month for some weight GLP‑1s, outside Part D.6
  11. Jul 1, 2026Benefit managerOptum Rx’s Premium formulary excludes Zepbound KwikPens and vials, naming Wegovy and single-dose Zepbound pens as alternatives.30
  12. Jul 1, 2026State employeesMassachusetts’s state employee plan stops covering GLP‑1s for weight alone.31 Delaware’s raises the copay for weight GLP‑1s to $200 per 30-day supply for non-Medicare members.32
  13. Jul 3, 2026MedicaidMassHealth stops covering GLP‑1s used only for obesity or overweight.15
  14. Jul 31, 2026MedicaidDeadline for state Medicaid programs to apply to the BALANCE Model.7
  15. Aug 2026LabelMounjaro’s label adds lowering heart risk in type 2 diabetes.37 A Michigan plan says Rybelsus is being replaced by Ozempic tablets.19
  16. Oct 1, 2026Benefit managerCVS Caremark adds Zepbound back to its commercial lists as a preferred option.27
  17. Oct 1, 2026MedicaidRhode Island Medicaid stops covering GLP‑1s for weight loss.16
  18. Oct 15 – Dec 7, 2026MedicareMedicare Open Enrollment. Plan changes start January 1.5
  19. Nov 1, 2026 – Jan 15, 2027MarketplaceHealthCare.gov Open Enrollment for 2027 plans. Enroll by December 15 for coverage from January 1.42
  20. Nov 9 – Dec 14, 2026FederalFederal Benefits Open Season for 2027 plans.21

2027

  1. Jan 1, 2027MedicareThe $274 negotiated price for Ozempic, Rybelsus and Wegovy starts, and Part D plans must list these drugs.1 Use for weight loss alone stays outside Part D.6
  2. Jan 1, 2027MedicareThe Part D cap becomes $2,400 and the highest deductible $700.2,4
  3. Jan 1, 2027List priceNovo Nordisk cuts the list price of Wegovy, Ozempic and Rybelsus to $675 a month.17
  4. Jan 1, 2027Benefit managerExpress Scripts’ 2027 exclusion list keeps Zepbound KwikPens and vials off its national preferred list.29
  5. Jan 1, 2027State lawColorado requires large-group plans to cover obesity treatment, and insurers must offer the policyholder, usually the employer, the option to add anti-obesity medicines.34
  6. Jan 1, 2027MedicaidLast date for state Medicaid programs to start in the BALANCE Model.7,8
  7. 2027 plan yearFederalFederal and Postal Service plans require intensive behavioral therapy before and during anti-obesity medicines. Open Season changes take effect January 1, 2027, for Postal Service members and annuitants, and January 10 for most federal employees.21
  8. Late Jan 2027BrandLast Saxenda shipments to wholesalers.18
  9. Dec 31, 2027MedicareThe Medicare GLP‑1 Bridge ends.6

What changes for Medicare in 2027?

Medicare gets a lower negotiated price for semaglutide, a higher yearly cap and a higher deductible, while the ban on covering weight loss alone stays.1,2,6

The negotiated price is the “maximum fair price” set under the Medicare drug price law. For Ozempic, Rybelsus and Wegovy it is $274 for a 30-day supply, against a 2024 list price of $959.1 By law, Part D plans must include drugs with a negotiated price on their drug lists.1

It is the price plans work from, not your copay. After any deductible, you pay 25% of the cost until you reach the yearly cap. After the cap, you pay nothing for covered drugs for the rest of the year.4

  • Yearly cap: $2,100 in 2026, $2,400 in 2027.2,4
  • Deductible: no plan can charge more than $615 in 2026 or $700 in 2027.2,4
  • Weight loss alone: still outside Part D. Only the GLP‑1 Bridge covers it, at $50 a month, through December 31, 2027.6

The Bridge was meant to hand over to the BALANCE Model in Part D. On April 21, 2026, CMS delayed that for 2027 “pending further evaluation and data collection”, and extended the Bridge instead.7 CMS said Part D plans had told it a longer Bridge would give them more data before BALANCE.7 What the copay could look like is in Ozempic’s $274 Medicare price. How to compare plans is in checking a Part D plan at open enrollment. The full rules are in how Medicare covers GLP‑1 medicines.

What changed in Medicaid in 2026?

Seven states ended Medicaid coverage of GLP‑1s for weight alone during 2026, leaving 10; the diabetes, heart and sleep apnea uses stay required.9,10

KFF, a health-policy research group, counted 13 states covering GLP‑1s for weight in January 2026. That count already left out the four states that stopped on January 1.9 Our check of each program’s own notices found 10 on October 14, 2026.10

  • January 1, 2026: California, New Hampshire, Pennsylvania and South Carolina stopped. Michigan kept coverage only for severe obesity.11,12,13,10
  • June 30, 2026: Utah’s pilot ended.14
  • July 3, 2026: MassHealth stopped coverage for weight alone. Under-21s can still get it when medically necessary.15
  • October 1, 2026: Rhode Island stopped, according to one of its Medicaid plans.16

The BALANCE Model lets states use prices CMS negotiates with the makers. States could apply until July 31, 2026, and must start by January 1, 2027.7 CMS’s model page named no participating states when we checked.8

Each state’s rules are in does Medicaid cover Wegovy or Zepbound in your state. Why the heart and sleep apnea uses stay covered is in which uses of GLP‑1s insurance covers.

What is changing in employer and state plans?

Employer changes usually start at plan renewal, often January 1, and they come through drug-list changes, state laws and the employer’s own choices.27,34,35

A benefit manager (pharmacy benefit manager, or PBM) runs drug lists for employers and health plans. Their lists changed several times:

  • CVS Caremark preferred Wegovy and removed Zepbound on July 1, 2025, then added Zepbound back as a preferred option on October 1, 2026.26,27 Employers using its lists can still change them.27
  • Express Scripts excludes Zepbound KwikPens and vials on its 2027 list and names single-dose Zepbound pens and Wegovy among the alternatives.29
  • Optum Rx excluded Zepbound KwikPens and vials from July 1, 2026, on its Premium formulary.30

State employee plans moved both ways. Massachusetts stopped weight coverage on July 1, 2026, but kept heart, sleep apnea and MASH uses.31 Delaware raised its weight copay to $200 per 30-day supply.32 Colorado’s law adds obesity treatment to large-group plans from January 1, 2027.34

Cost is the reason given. Mercer, a benefits consultancy, says some employers needing quick savings dropped GLP‑1 weight coverage for 2027.35 Questions to ask HR are in employer and Marketplace plans in 2027, and each benefit manager has its own page: CVS Caremark, Express Scripts, Optum Rx.

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What changed for military and federal plans?

TRICARE For Life stopped covering weight-loss drugs in August 2025, and federal employee plans add a behavioral therapy rule for 2027.23,21

  • TRICARE For Life: no weight-loss drug coverage since August 31, 2025. Diabetes GLP‑1s stay covered with prior authorization.23 TRICARE now points members with Medicare to the GLP‑1 Bridge.22
  • TRICARE Prime and Select: may still cover weight-loss drugs when medically necessary, with prior authorization.22
  • VA: the April 2026 criteria for Wegovy start at a BMI of 27 with a weight-related condition, plus a lifestyle program.24
  • Federal (FEHB) and Postal Service (PSHB) plans: must keep at least one GLP‑1 for weight on their drug lists.21 For 2027, they must require documented intensive behavioral therapy, a structured diet, activity and behavior program, before and during treatment.21

OPM says a member’s or prescriber’s statement about past weight-loss attempts should not replace this requirement.20 Plans are expected to cover 12 to 22 therapy sessions a year, depending on progress.21 More detail is in TRICARE, the VA and federal employee plans.

Which label changes affect coverage?

Plans cover drugs for their FDA-approved uses, so a new use on a label can open a coverage route, and a discontinued brand closes one.36,37,18

A label is the official prescribing document the FDA approves. It lists the approved uses.

  • Wegovy: its approved uses changed in August and December 2025. The injection now covers heart-risk reduction, weight and MASH; the tablets cover heart risk and weight.36
  • Mounjaro: children 10 and older with type 2 diabetes added in December 2025, and heart-risk reduction in type 2 diabetes in August 2026.37
  • Foundayo: approved for weight in adults on April 1, 2026.38,39
  • Saxenda: being discontinued; Novo Nordisk says this is not because of safety or quality.18
  • Rybelsus: being replaced by Ozempic tablets. One plan says existing Rybelsus approvals move across automatically.19

A new approved use doesn’t oblige every plan to pay for it. Each plan writes its own criteria; see which uses insurance covers.

RisksThe risks, in brief
  • Stomach effects. In adult weight trials, 44 in 100 people on Wegovy 2.4 mg felt sick (nausea), against 16 in 100 on a dummy injection (placebo).36 On Zepbound it was 25 to 29 in 100, against 8 in 100.40
  • Gallstones affected 1.6% of adults on Wegovy injection, against 0.7% on a dummy injection.36
  • Pancreatitis (an inflamed pancreas): severe stomach pain that won’t go away and may spread to the back. The labels say to stop if it is suspected.36,40
  • Thyroid warning. These labels carry a boxed warning. They are not for people with a personal or family history of medullary thyroid cancer, or MEN 2, a rare inherited condition causing gland tumors.36,40
Full detail in our side effects guide →
Get help now: call 911 if someone collapses, has a seizure, has trouble breathing or can’t be woken. For severe stomach pain that won’t go away, call the prescriber straight away. Poison Control is 1-800-222-1222.41,36

Questions people ask

Will Medicare cover Wegovy for weight loss in 2027?

Only through the Medicare GLP‑1 Bridge, which charges $50 a month and runs until December 31, 2027. Part D plans still can’t cover weight loss alone.6

Does the $274 Medicare price mean I pay $274?

No. It is the price Medicare plans pay for a 30-day supply. You pay your plan’s deductible and coinsurance, up to the $2,400 yearly cap in 2027.1,4

What happens when the Medicare GLP‑1 Bridge ends?

CMS hasn’t said what replaces it. It delayed the BALANCE Model in Part D for 2027 and said it would share more about BALANCE later.7

Which states stopped Medicaid coverage for weight loss in 2026?

California, New Hampshire, Pennsylvania and South Carolina on January 1, Utah on June 30, Massachusetts on July 3 and Rhode Island on October 1.10

Is my employer dropping GLP‑1 coverage in 2027?

Only your plan can tell you. Changes usually start when the plan renews. Mercer says some employers dropped weight coverage for 2027 to cut costs.35

How we researched this

On October 14, 2026, we read:

  • CMS’s negotiated-price fact sheet and its 2026 and 2027 rate announcements;
  • CMS’s Bridge and BALANCE pages, and its April 21, 2026, notice to plans;
  • Medicare.gov;
  • OPM’s 2027 call letter and open season guide;
  • the current US labels.

Each one is listed under Sources.1,2,3,6,7,8,20,21,36,37

State Medicaid dates come from each program’s own notices, collected on our state-by-state page.10 Benefit-manager changes come from their own drug lists and releases.26,27,28,29,30 We name insurers and benefit managers only for their published, dated documents, and we rank none.

Before you move on

  • On Medicare, compare 2027 drug plans by December 7, 2026.
  • Note that the Bridge ends December 31, 2027.
  • On Medicaid, check your state’s current rules.
  • At work, ask HR what changes at renewal.
  • On Saxenda or Rybelsus, ask your prescriber about the switch.
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More on insurance

USUnited StatesHow does Medicare cover GLP‑1 medicines like Ozempic, Wegovy and Zepbound?USUnited StatesDoes Medicaid cover Wegovy or Zepbound in your state?USUnited StatesWhich uses of GLP‑1s does insurance cover: weight, diabetes, heart, sleep apnea, PCOS?
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An independent guide to GLP‑1 medicines. We don’t sell medicines, take drug-company money, earn commissions or link to any provider. Once a month: FDA approvals and warnings, Medicare and Medicaid changes, and makers’ price changes. How we write

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Sources

  1. Centers for Medicare & Medicaid Services (CMS). Medicare Drug Price Negotiation Program: negotiated prices for initial price applicability year 2027 (fact sheet). November 2025. Link
  2. CMS. Announcement of calendar year 2027 Medicare Advantage capitation rates and Part C and Part D payment policies, Table V-2 (Part D benefit parameters). April 6, 2026. Link
  3. CMS. Announcement of calendar year 2026 Medicare Advantage capitation rates and Part C and Part D payment policies, Table V-2. April 7, 2025. Link
  4. Medicare.gov. How much does Medicare drug coverage cost? Checked Oct 14, 2026. Link
  5. Medicare.gov. Joining a plan (Open Enrollment dates). Checked Oct 14, 2026. Link
  6. CMS. Medicare GLP-1 Bridge (program page and FAQs). Page last modified July 13, 2026. Link
  7. CMS. Status update on the Bridge demo and BALANCE Model in Part D for CY2027. HPMS email to Part D plans, April 21, 2026 (copy on the HHS guidance portal). Link
  8. CMS Innovation Center. BALANCE Model. Page last modified Sep 29, 2026. Link
  9. KFF. Medicaid coverage of and spending on GLP-1s. January 16, 2026. Link
  10. GLP Guidebook. Does Medicaid cover Wegovy or Zepbound in your state? State-by-state check of each Medicaid program’s own notices, October 14, 2026. Link
  11. Medi-Cal Rx (California Department of Health Care Services). GLP-1 coverage considerations. Dec 12, 2025, last updated Apr 6, 2026. Link
  12. New Hampshire Department of Health and Human Services, Division of Medicaid Services. Change in Medicaid coverage for GLP-1 medications. Oct 9, 2025. Link
  13. Michigan Department of Health and Human Services. Numbered letter L 25-73: update of pharmacy drug coverage for treatment of obesity. Dec 8, 2025. Link
  14. Utah Medicaid. Pharmacy prior authorization form: GLP-1 medications for weight-related comorbidities. Last updated Jun 1, 2026. Archived copy of Jul 17, 2026. Link
  15. MassHealth (Massachusetts Medicaid). Pharmacy Facts number 276: changes to management of anti-obesity medications. May 13, 2026, corrected. Link
  16. Point32Health. Coverage of GLP-1s for Tufts Health RITogether members (a Rhode Island Medicaid plan). August 2026. Link
  17. Novo Nordisk. Novo Nordisk announces significant reduction in US list price for Wegovy, Ozempic and Rybelsus. Company announcement, February 24, 2026. Link
  18. Novo Nordisk. Saxenda discontinuation notice, Saxenda site for health care professionals. Opened Oct 14, 2026. Link
  19. Priority Health (a Michigan health plan). Diabetes drug Rybelsus discontinued, to be replaced by Ozempic tablets. Provider news, August 31, 2026. Link
  20. US Office of Personnel Management (OPM). FEHB Program Carrier Letter 2026-07: call letter for plan year 2027, section “Prevention and Treatment of Obesity”. March 31, 2026. Link
  21. OPM. Federal Benefits Open Season Highlights, 2027 plan year. Checked Oct 14, 2026. Link
  22. TRICARE (Defense Health Agency). Prescription weight loss drugs: is it covered? Last updated Oct 1, 2026. Link
  23. Express Scripts, TRICARE pharmacy contractor. GLP-1 medications (diabetes and weight management). Checked Oct 14, 2026. Link
  24. VA Pharmacy Benefits Management Services and National Formulary Committee. Semaglutide (Wegovy) injection and tablet for weight management: Criteria for Use. April 2026. Link
  25. VA Pharmacy Benefits Management Services and National Formulary Committee. Semaglutide (Wegovy) injection for weight management: Criteria for Use. August 2025 (earlier version, archived copy). Link
  26. CVS Health. Improving access and affordability to high-cost weight management drugs. June 27, 2025. Link
  27. CVS Health. CVS Caremark delivers affordability and access to GLP-1 weight management medications with expanded coverage options. News release, May 28, 2026. Link
  28. Evernorth (Express Scripts). 2026 National Preferred Formulary: exclusion list changes coming January 1, 2026. File dated August 6, 2025. Link
  29. Express Scripts. 2027 National Preferred Formulary exclusions, version NP Excl (08/01/2026). Checked Oct 14, 2026. Link
  30. Optum Rx. July 1, 2026 Premium Formulary exclusions, Standard (document WF22449508-A, 6/26; copy posted by a client plan). Checked Oct 14, 2026. Link
  31. Massachusetts Group Insurance Commission. June update on Vida Health program and GLP-1 coverage. June 8, 2026. Link
  32. Delaware Department of Human Resources, Statewide Benefits Office. Weight loss medications FAQs. Last updated July 29, 2026. Link (PDF)
  33. Kansas State Employee Health Plan. GLP-1s. Page undated; states the rule for prescriptions issued or renewed after Jan 1, 2026. Checked Oct 14, 2026. Link
  34. Colorado General Assembly. SB25-048, Diabetes Prevention and Obesity Treatment Act: bill summary. Became law June 3, 2025. Link
  35. Mercer. Survey: health benefit costs expected to jump in 2027. August 31, 2026. Link
  36. Novo Nordisk. Wegovy (semaglutide) injection and tablets: US prescribing information. Revised 06/2026. Link
  37. Eli Lilly. Mounjaro (tirzepatide): US prescribing information. Revised 8/2026. Link
  38. Eli Lilly. Foundayo (orforglipron) tablets: US prescribing information. Revised 7/2026. Link
  39. Healio. FDA approves orforglipron, an oral GLP-1, for adults with obesity. April 1, 2026 (news report of the approval). Link
  40. Eli Lilly. Zepbound (tirzepatide): US prescribing information. Revised 8/2026. Link
  41. Poison Control (National Capital Poison Center). Poison help line 1-800-222-1222. Link
  42. HealthCare.gov. Dates and deadlines for 2027 health insurance. Checked Oct 14, 2026. Link

Last checked Oct 14, 2026 · Next review due Jan 14, 2027 · Report an error

How this page was made. Written by the GLP Guidebook team from the sources above. It’s general information, not medical or legal advice. Talk to your doctor, pharmacist or prescriber before starting, stopping or changing any medicine. We don’t sell, prescribe or recommend any brand, insurer or provider. How we write