Manufacturer Patient Assistance Programs

Novo Nordisk's RxPATH Program (Ozempic, Wegovy, Rybelsus)

Novo Nordisk offers the Novocare RxPATH program, which provides GLP-1 medications at $0 per month for eligible patients. Key details:

• Income eligibility: U.S. residents with household income up to 400% of the federal poverty level (FPL)
• Insurance status: Must be uninsured or have Medicare Part D coverage
• What it covers: Ozempic, Wegovy, and Rybelsus at $0 per month
• How to apply: Visit novocare.com or ask your healthcare provider to submit an application on your behalf
• Note: This program does NOT work for patients with commercial (private) insurance or Medicaid

Eli Lilly's Lilly Cares Program (Mounjaro, Zepbound)

Eli Lilly offers the Lilly Cares Foundation Patient Assistance Program:

• Income eligibility: U.S. residents with household income up to 300% of the federal poverty level
• Medication cost: As low as $0 per month for eligible patients
• Insurance requirements: Must be uninsured or have Medicare
• Application: Available through healthcare providers at lillycares.com
• Zepbound savings: Eli Lilly also offers a savings card for commercially insured patients that can reduce the cost to as low as $25 per month for eligible individuals

Novo Nordisk's Commercial Copay Program

For patients with commercial insurance (not Medicare or Medicaid):

• Savings card: Commercially insured patients may pay as little as $25 per month for Ozempic or Wegovy through the Novo Nordisk Savings Card
• Income limits: Most commercially insured patients with household incomes under $100,000 qualify
• Duration: Covers up to 12 months of treatment
• How to apply: Available at novocare.com; no income verification required for the savings card

Eli Lilly's Zepbound Savings Card

• Commercially insured patients: Pay $25 per month for Zepbound with the savings card
• Income eligibility: Most patients with household incomes up to $150,000 qualify
• Uninsured patients: May qualify for $25 per month through separate income-based program
• How to apply: Available at zepbound.lilly.com

Medicare and Medicaid Strategies

Medicare Part D Coverage

As of 2026, GLP-1 medications are covered under Medicare Part D for patients with:

• Type 2 diabetes (Ozempic, Mounjaro)
• Cardiovascular risk reduction (Ozempic, Wegovy)

Medicaid Coverage

Medicaid coverage of GLP-1 medications varies significantly by state. In 2026:

• Most state Medicaid programs cover Ozempic for type 2 diabetes
• Coverage for weight loss indications varies (some states cover, many do not)
• Prior authorization is required in virtually all Medicaid programs
• Some states have quantity limits on GLP-1 coverage

Insurance Prior Authorization Tips

For patients with commercial insurance, a prior authorization (PA) is often required before GLP-1 coverage is approved. Here is how to improve your chances of approval:

Understand What Insurers Look For

Most insurers require documentation of:

• Type 2 diabetes diagnosis (HbA1c levels) or documented obesity with BMI ≥30 (or ≥27 with comorbidities)
• Failure of or intolerance to prior therapies (metformin, lifestyle modification)
• Enrollment in a weight management or diabetes education program
• Prescription from a relevant specialist (endocrinologist, cardiologist) strengthens the case

Write a Strong PA Letter

Ask your healthcare provider to emphasize:

• Your specific clinical need for a GLP-1 medication over alternatives
• Documented history of failed weight loss or diabetes management attempts
• Comorbidities worsened by obesity or poor glycemic control
• Any contraindications to alternative medications

Appealing Denials

If your PA is denied, you have the right to appeal. Most insurers offer:

• Internal appeal: Your doctor submits additional information within 30–180 days
• External review: An independent third party reviews your case
• Peer-to-peer review: A call between your doctor and the insurer's medical director

Pharmacy Price Shopping

Prices for GLP-1 medications vary significantly between pharmacies. Strategies include:

GoodRx and SingleCare

These platforms can reduce costs at participating pharmacies. Typical savings:

• Ozempic: Up to 30–40% off retail price
• Mounjaro: Up to 25–35% off retail price
• Prices vary by location and pharmacy

Costco and Sam's Club Pharmacies

Membership pharmacies often offer lower prices on GLP-1 medications. Costco pharmacy does not require a Costco membership to use the pharmacy.

Mark Cuban Cost Plus Drug Company

Cost Plus Drugs has expanded into some GLP-1 medications. Check costplusdrugs.com for availability and current pricing.

Compounded GLP-1 Alternatives

Compounded semaglutide from licensed pharmacies can be significantly cheaper ($200–$400/month) than brand-name versions. However:

• Safety concerns: Compounded medications are not FDA-approved and quality varies by pharmacy
• Legality: Ensure the pharmacy is licensed and uses pharmaceutical-grade ingredients
• Efficacy: Compounded versions may not be bioequivalent to brand-name drugs
• Caution: Avoid online pharmacies that do not require a prescription

Clinical Trial Access

Clinical trials for GLP-1 medications often provide free medication and monitoring. To find trials:

• ClinicalTrials.gov: Search for "semaglutide" or "tirzepatide" plus your condition
• TrialJectory: A free matching service for clinical trials
• University hospital research programs: Often run investigator-initiated trials

Employer and Union Plans

If you have employer-sponsored insurance:

• Check whether your plan's formulary covers GLP-1 medications
• Ask HR about step therapy requirements (many employers require trying metformin or other drugs first)
• Some large employers (particularly tech companies and unions) have begun covering GLP-1 medications for weight loss—check your benefits

The Bottom Line on Affordability

Accessing GLP-1 medications affordably requires a multi-pronged approach:

1. Start with manufacturer programs — savings cards and patient assistance programs should be your first call
2. Check insurance thoroughly — understand your formulary, PA requirements, and appeal rights
3. Price shop — GoodRx and Costco can meaningfully reduce costs
4. Consider clinical trials — free medication plus medical oversight
5. Appeal denials aggressively — many initial denials are overturned on appeal

References

• EMA — Mounjaro (tirzepatida), EPAR
• Jastreboff et al., SURMOUNT-1 — NEJM (2022)
• OMS — Obesity and overweight, fact sheet