Getting a prescription in the US, and the medicines

Who can prescribe a GLP-1 in the US?

Any prescriber licensed in your state with the authority to prescribe. There's no rule that it has to be a specialist.

All GLP-1 medicines need a prescription.¹ Prescribers include doctors (MD or DO) and, depending on your state's rules, nurse practitioners and physician assistants. A telehealth prescriber generally needs a license in the state where you are when you get care.⁶

Semaglutide, tirzepatide, liraglutide and dulaglutide are not on the federal list of controlled substances, so there's no federal rule that you must be seen in person first. Phentermine, an older weight-loss pill, is on that list.²

For weight, the FDA labels cover adults with a BMI of 30 or more, or 27 to under 30 with at least one weight-related condition.^1,7 For type 2 diabetes, Ozempic, Mounjaro and the others are prescribed by your own doctor or diabetes team, usually covered as a diabetes medicine.³

Will my employer or private plan cover it?

Maybe. Covering GLP-1s for weight loss is optional for employers, and most don't. If yours does, expect paperwork first.

In 2025, 19% of firms with 200 or more workers covered GLP-1 medicines mainly for weight loss. Among the largest firms, with 5,000 or more workers, it was 43%.³ Coverage for type 2 diabetes is more common; weight loss is where the gap is.³

• Prior authorization. Approval from your plan before it will pay for a prescription.⁸ Plans that cover GLP-1s for weight usually require it.³ Your prescriber sends your BMI, your conditions and anything else the plan asks for.
• Step therapy. A type of prior authorization where you must first try a cheaper drug on the plan's list before it will cover a more expensive one.⁹
• The drug list (formulary). Your plan, or the pharmacy benefit manager (PBM) that runs its drug benefit, decides which brands it covers, and it can change them. Ask which brand is preferred.⁹
• Savings cards. If your commercial plan covers the medicine, the makers' savings cards can bring your copay down: as little as $25 a month, up to set limits. They can't be used with government insurance such as Medicare or Medicaid.^14,15,16

Other plans for veterans, the military and federal or state employees each set their own rules; ask yours directly. How prior authorization works, step by step.

Does Medicare cover it? The GLP-1 Bridge

Not for weight loss alone: federal law bars Medicare drug plans from covering medicines used for weight loss. A temporary program, the Medicare GLP-1 Bridge, works around that until the end of 2027.^4,5

For other approved uses, Medicare drug plans (Part D) can cover them: type 2 diabetes, heart protection with Wegovy, sleep apnea with Zepbound, and MASH (a scarring fatty liver disease).⁴ The Bridge is not for people with type 2 diabetes, moderate to severe sleep apnea or MASH; they go through their own drug plan instead.⁵

The makers' savings cards can't be used with Medicare.^14,16 A separate model that would have let Part D plans cover these medicines in 2027 will not go ahead; CMS extended the Bridge through 2027 instead.³⁶ The GLP-1 Bridge explained.

Does Medicaid cover it?

It depends on your state. Federal law lets states leave weight-loss drugs out, and most do.¹⁰

As of January 2026, 13 state Medicaid programs covered GLP-1s for obesity, down from 16 in October 2025. California, New Hampshire, Pennsylvania and South Carolina ended coverage. Where it's covered, it usually needs prior authorization.¹⁰ Type 2 diabetes is covered as a diabetes medicine.

CMS also offered states a voluntary model in which it negotiates prices with the makers. We could not find an official list of which states joined. Ask your state Medicaid program, or see Medicaid and GLP-1s.³⁷

What if I pay myself?

The makers now sell directly to people paying cash, at their own self-pay prices, which are far below the list price.^14,15,16

• Eli Lilly (Zepbound, Foundayo) sells through its own LillyDirect pharmacy and other pharmacies.^15,16
• Novo Nordisk (Wegovy) sells through NovoCare Pharmacy, and the self-pay offer can be used at other pharmacies.¹⁴
• TrumpRx.gov is a government website that lists these self-pay prices and sends you on to partner pharmacies or the makers' programs. It doesn't sell medicines itself.¹⁷

You still need a prescription from any licensed prescriber. People with Medicare or Medicaid can pay the self-pay price outside their insurance, Novo says.¹⁴ The prices, with dates, are below. We list the makers' prices only; we don't list or compare any pharmacy's or telehealth service's prices. GLP-1 costs without insurance.

What about compounded semaglutide and tirzepatide?

Compounded versions are not FDA-approved. The FDA does not review their safety, effectiveness or quality before they're sold, and they are not the same as generics.¹⁹ We don't recommend them.

What "compounded" means. A compounding pharmacy mixes its own version of a medicine. In the US, that's allowed for a patient's individual need, and more widely during a shortage of the approved drug.¹⁸ Some pharmacies (called 503A) compound for individual prescriptions; larger "outsourcing facilities" (503B) make bigger batches.^18,20

• The shortages are over. The FDA declared the tirzepatide shortage resolved in December 2024 and the semaglutide shortage in February 2025. The grace periods for compounders ended between February and May 2025.¹⁸ Since then, pharmacies may not regularly make what are essentially copies of an approved drug.²⁰
• The FDA has warned sellers. It sent warning letters to dozens of companies in September 2025, 30 telehealth companies in March 2026, and 25 more in June 2026, over claims such as "same active ingredient" or "clinically proven".^21,22 In February 2026, it said it would act against non-FDA-approved GLP-1s being mass-marketed.²³
• Side-effect reports. By May 31, 2026, the FDA had 990 reports of side effects with compounded semaglutide and more than 730 with compounded tirzepatide. It has also had reports of dosing mistakes.¹⁹
• Salt forms. The FDA says it knows of no lawful basis for compounding with semaglutide sodium or acetate, which are different from the approved medicine.¹⁹
• More change is coming. In April 2026 the FDA proposed stopping outsourcing facilities from compounding semaglutide, tirzepatide and liraglutide from bulk ingredients. We found no final decision yet.²⁰

What rules do telehealth services follow?

The same as any prescriber: a license in your state, a real assessment, and a prescription for an approved medicine.

• State license. The prescriber must be licensed where you are when you get care. Compacts between states make extra licenses faster to get, but don't remove the need.⁶
• No federal in-person rule for GLP-1s, because they are not controlled substances. Some states have their own rules on telehealth prescribing.²
• Honest pricing. The Federal Trade Commission (FTC) has acted against a telehealth weight-loss company that advertised monthly prices leaving out the medicine, lab and consultation costs, and hid long commitments.²⁴ Guide 7 covers what to check.

How do I check a pharmacy and a prescriber?

Look them up with the state boards that license them. It takes a few minutes.

The pharmacy

The FDA says a safe online pharmacy:²⁵

• always requires a prescription;
• gives a physical address and phone number in the US;
• has a licensed pharmacist to answer your questions;
• is licensed with a state board of pharmacy. You can check it in the board's license database using the FDA's BeSafeRx locator; if it isn't listed, don't use it.²⁵

The prescriber

Your state medical board (or nursing board, for nurse practitioners) lists who is licensed. The Federation of State Medical Boards' free DocInfo.org search shows a doctor's license history across states and any action by a state medical board.²⁷

What should a proper consultation include?

Questions about your health and medicines, your weight checked properly, and a plan for follow-up.

There's no single official checklist for a GLP-1 consultation. This list brings together what the medicines' labels say a prescriber should check.^1,7

• Your history. Medullary thyroid cancer or MEN 2 (multiple endocrine neoplasia type 2, a rare inherited condition) in you or your family rules these medicines out.¹ Past pancreatitis or gallstones matter too.¹
• Your other medicines. Insulin, or diabetes pills called sulfonylureas, can cause low blood sugar when combined with a GLP-1.¹ The dose of those may need to drop.
• Your weight, checked. Not just typed into a form. Guide 1 explains the numbers.
• Eyes, if you have diabetes. The label warns about worse eye disease (retinopathy) in people who already have it.¹
• Pregnancy and birth control. Stop Wegovy at least 2 months before a planned pregnancy. On tirzepatide, switch from the pill or add a condom for 4 weeks after starting and after each dose increase.^1,7
• Any surgery or procedure coming up. These medicines slow how fast the stomach empties, so food can still be there under anesthesia. Tell the team doing the procedure that you take one.¹
• A follow-up plan. Who you contact with side effects, and how your progress will be reviewed.

What are the red flags with a pharmacy, clinic or app?

Walk away if you can't check who they are, if nobody assesses you properly, or if the product isn't FDA-approved.

• No prescription neededSafe pharmacies always require one.²⁵
  Dispenses only against a prescription from a licensed prescriber.
• Not licensed with a state boardOr no US address, phone number or pharmacist.²⁵
  Shows its license and address, and both check out with the state board.
• "Same as Ozempic", "generic", "clinically proven"The FDA has said compounded products can't be described as generics or the same as approved drugs.^21,23
  Names the exact FDA-approved brand and dose it will dispense.
• "Research use only" or "not for human use"The FDA has warned sellers of these products.¹⁹
  An FDA-approved pen, vial or pill in its sealed pack.
• A low monthly price with no detailThe FTC has acted against ads that left out the cost of the medicine, labs and consultations.²⁴
  Shows the full monthly cost, including the medicine, in writing, and how to cancel.
• Prices that seem too good to be trueThe FDA lists deep discounts as a warning sign of an unsafe pharmacy.²⁵
  Prices you can compare with the makers' published self-pay prices.

Which GLP-1 medicines are FDA-approved, and for what?

Five medicines. Semaglutide, tirzepatide, orforglipron and liraglutide have brands for weight; Ozempic, Rybelsus, Mounjaro, Trulicity and Victoza are for type 2 diabetes.

The medicine is what works in your body; the brand is the name on the box. Acetaminophen is a medicine; Tylenol is a brand of it. One medicine can have several brands, each approved for different uses.

Diabetes approved for type 2 diabetes Weight approved for weight management

Medicine pages: Semaglutide Tirzepatide Liraglutide Dulaglutide

Brand or generic: what's the difference?

A generic is an FDA-approved copy made by another company once the patent ends. In the US, only liraglutide has generics so far.^30,31

The first generic liraglutide, a copy of Victoza for type 2 diabetes, was approved in December 2024.³⁰ The first generic for weight loss, a copy of Saxenda, was approved and launched in August 2025.³¹

There is no FDA-approved generic semaglutide or tirzepatide. Compounded versions are not generics, and the FDA has told sellers not to call them that.^19,23 Is there a generic Wegovy or Zepbound?

Switching between brands is a prescriber's decision. Even brands of the same medicine aren't always swapped dose for dose: the label for Ozempic tablets and Rybelsus says they are not interchangeable milligram for milligram.¹²

Pen, vial or pill: does it matter?

US GLP-1 injections come in pre-filled pens, and Zepbound also in FDA-approved vials. Pills need a routine, which differs by brand.

Pen or vialPre-filled pens, or vials you draw upWegovy and Zepbound come in single-dose pens; Wegovy FlexTouch and the Zepbound KwikPen hold 4 weekly doses. Zepbound also comes in vials, which you draw up with a syringe.^1,7 Never share a pen, even with a new needle.¹

PillDaily, with brand-specific rulesWegovy pill: on an empty stomach in the morning with up to 4 oz (120 ml) of water, then wait at least 30 minutes before eating, drinking or taking other pills.¹ Foundayo: once a day, with or without food.²⁸

How do I spot a fake, and store it right?

Fake Ozempic pens have been found in the US drug supply chain. Only use a pack from a state-licensed pharmacy, against your prescription.²⁶

The FDA warned about counterfeit Ozempic in December 2023, April 2025 and December 2025. For the December 2025 fakes, the expiry date and lot number printed on the left side of the label were the giveaway.²⁶ If you're unsure about a Novo Nordisk pen, you can call the maker on 1-800-727-6500.²⁶

What are the official prices?

There are two kinds: the list price, which is what insurers' prices start from, and the makers' own self-pay prices for people paying cash. All checked Oct 12, 2026.

List prices (before rebates), for a month

As shown on TrumpRx.gov, checked Oct 12, 2026.¹⁷ Novo Nordisk says it will cut the list price of Wegovy, Ozempic and Rybelsus to $675 a month from January 1, 2027, and that this doesn't change its self-pay prices.³⁵

Foundayo (orforglipron): Lilly self-pay prices

Lilly, Foundayo coverage and savings page, checked Oct 12, 2026. A month is 30 days.¹⁶

Wegovy (semaglutide): Novo Nordisk self-pay prices

NovoCare Wegovy self-pay offer, checked Oct 12, 2026. A month is 4 pens or 30 tablets.¹⁴

Zepbound (tirzepatide): Lilly self-pay prices, single-dose vial or KwikPen

Lilly, Zepbound coverage and savings page, checked Oct 12, 2026. If a refill is later than 45 days, Lilly's regular prices apply.¹⁵

What does a year cost?

It depends on who pays. With Medicare's GLP-1 Bridge, $50 a month while it runs. Paying yourself, the medicine alone comes to about $5,000 to $5,600 a year for Zepbound, depending on your dose.

With insurance. Your plan's copay, which a savings card may lower, if your plan covers it.^3,15 With the Medicare GLP-1 Bridge, $50 a month, or $600 a year, until it ends on December 31, 2027.⁵

Paying yourself. Here is a worked example for Zepbound, using Lilly's self-pay prices above and counting a month as 4 weekly doses: 6 fills is 24 weeks and 13 fills is a year. The label starts at 2.5 mg for 4 weeks, then 5 mg; after that the dose can rise by 2.5 mg at a time, at least 4 weeks apart, up to 15 mg.⁷ This is an example for the sum, not a suggestion; your prescriber decides your dose.

Staying on 5 mg: $299 + 5 × $399 = $2,294; a year is $299 + 12 × $399 = $5,087. Rising to 15 mg: $299 + $399 + 3 × $449 (7.5, 10, 12.5 mg) = $2,045 for the first 5 fills, then $449 a fill: $2,494 by 6 fills and $2,045 + 8 × $449 = $5,637 by 13. Assumes every refill within 45 days; excludes any consultation, membership or shipping fees.^15,7

Budget in years, not months: Guide 9 covers what happens when you stop. Lilly says HSA or FSA eligibility may vary by plan; check with your benefits administrator.¹⁶

Questions people ask