What Foundayo costs, and who will pay for it

Lilly, April 1, 2026: "the U.S. Food and Drug Administration (FDA) approved Foundayo™ (orforglipron) for adults with obesity, or overweight with weight-related medical problems." "Eligible people with commercial insurance may pay as little as $25 per month with the Foundayo savings card. Individuals opting for self-pay can access Foundayo starting at $149 per month for the lowest dose. Additionally, eligible Medicare Part D individuals may be able to get Foundayo for $50 per month, beginning as soon as July 1, 2026."

Eli Lilly and Company, news release, effective April 2026 · source

Foundayo's self-pay terms and LillyDirect list a one-month (30-day) price for each strength: 0.8 mg $149; 2.5 mg $149 (regular price $199, reduced "through December 31, 2026"); 5.5 mg $199 (regular price $299, reduced through December 31, 2026); 9 mg $299; 14.5 mg and 17.2 mg $299 under the "Self-Pay Journey Program" if you refill within 45 days, otherwise $349. A prescription is required, the card may be used for up to 10 fills per calendar year, and it ends December 31, 2026.

Eli Lilly and Company, Foundayo coverage and savings (self-pay terms) and LillyDirect: Foundayo, effective August 2026 · source

Foundayo savings card for commercial insurance: "You must have commercial drug insurance that covers Foundayo … to pay as little as $25 for a 1-month, 2-month, or 3-month prescription fill of Foundayo," with "maximum monthly savings of up to $100 per 1-month prescription, $200 per 2-month prescription, or $300 per 3-month prescription fill and a separate maximum annual savings of up to $1,000 per calendar year. Card may be used for a maximum of up to 10 prescription fills per calendar year." "Card expires and savings end on 12/31/2026." It excludes anyone enrolled in "Medicaid, Medicare, Medicare Part D, Medicare Advantage, Medigap, DoD, VA, TRICARE®/CHAMPUS" or another government program. A commercially insured patient whose plan doesn't cover Foundayo pays the self-pay prices under the card.

Eli Lilly and Company, Foundayo coverage and savings (commercial terms), effective August 2026 · source

CMS: "an eligible GLP-1 drug is any of the following products when used to reduce excess body weight and maintain weight reduction: Foundayo®, Wegovy® (injection and tablets), and Zepbound® (KwikPen®)." The page notes: "This was updated on April 6, 2026, to include Foundayo® following FDA approval."

Centers for Medicare & Medicaid Services, Medicare GLP-1 Bridge: information for Part D plans, effective August 2026 · source

CMS: the Bridge gives access "between July 1, 2026, and December 31, 2027." "Eligible beneficiaries will have a $50 copay … the Part D deductible will not apply, no part of the $50 copay counts towards the beneficiary's TrOOP costs, and there is no low-income subsidy (LIS) provided for LIS beneficiaries."

Centers for Medicare & Medicaid Services, Medicare GLP-1 Bridge, effective July 2026 · source

Lilly's release of May 28, 2026, subheaded "CVS Caremark begins covering Foundayo June 1 and resumes Zepbound coverage by October 1", says "all three of the nation's largest pharmacy benefit managers (PBMs) will cover Lilly's full obesity medicine portfolio" and that "For eligible patients with commercial coverage, both medicines are available for as little as $25 a month." A footnote reads "Terms and conditions apply."

Eli Lilly and Company, news release, effective May 2026 · source

Caremark's Performance Drug List – Standard Control headed "October 2026" lists, under ANTIOBESITY: liraglutide, orlistat, phentermine-topiramate, Foundayo, Qsymia, Wegovy, Wegovy HD and Zepbound. The list also warns that "plan design may not cover certain products or categories, regardless of their appearance in this document." The July 2026 edition of the same list carried Zepbound in its excluded-drug table, with liraglutide, orlistat, Qsymia and Wegovy as the alternatives.

CVS Caremark, Performance Drug List – Standard Control, October 2026, effective October 2026 · source

Express Scripts' 2026 National Preferred Formulary exclusions list (footer "EXCL-NPF-26 (07/01/2026)") lists, under Weight Loss, the excluded drugs "ZEPBOUND KWIKPENS, ZEPBOUND VIALS" and the preferred alternatives "liraglutide, FOUNDAYO, WEGOVY HD, WEGOVY PENS, WEGOVY TABLETS, ZEPBOUND PENS." It adds: "Not all the medications listed are covered by all prescription plans; check your benefit materials."

Express Scripts, 2026 National Preferred Formulary Exclusions, effective July 2026 · source

Anthem's own formulary update records these drugs changing tier at least nine times, in both directions, each with its own effective date: Zepbound from Tier 2 to Tier 3 (7/1/2025); Wegovy from Tier 2 to non-formulary (7/1/2025); Saxenda from Tier 3 to non-formulary (7/1/2025, and again 4/1/2026); Qsymia from Tier 3 to non-formulary (7/10/2025); the Wegovy tablet from non-formulary to Tier 2 (12/23/2025); liraglutide, listed as generic Saxenda, from non-formulary to Tier 1 (1/1/2026); Foundayo from non-formulary to Tier 2 (5/15/2026); the Zepbound KwikPen from not-covered to Tier 2 (8/1/2026); and the Zepbound standard pen from Tier 3 to non-formulary (10/1/2026).

Anthem, Formulary Update (unbranded, quarterly rolling) · source

First approvals are short and renewal is measured. The program issues five months for "Wegovy injection or tablet, Wegovy HD", six for "Foundayo, Xenical or Zepbound", four for Contrave, Qsymia or Saxenda, and three for the older stimulant appetite suppressants. To reauthorize, most drugs need "Weight loss of ≥ 5% of baseline body weight" — 3 percent for Qsymia, 4 percent for Saxenda — plus continued lifestyle modification, and the renewal then runs twelve months.

UnitedHealthcare, Clinical Pharmacy Programs, "Prior Authorization/Notification – Plans with Weight Loss/Appetite Suppression Medication Coverage" (2026 P 1114-22), effective September 2026 · source

Foundayo's label: "indicated in combination with a reduced-calorie diet and increased physical activity to reduce excess body weight and maintain weight reduction long term in adults with obesity or adults with overweight in the presence of at least one weight-related comorbid condition."

DailyMed (National Library of Medicine), Foundayo prescribing information, revised July 2026, effective July 2026 · source

TrumpRx lists Foundayo ("Orforglipron by Eli Lilly and Company") at the same six strengths, 30 tablets, marked "This is an out-of-pocket price", and sends the purchase to LillyDirect.

TrumpRx.gov, Foundayo · source

Lilly, April 9, 2026: "approximately half of Americans with employer-sponsored insurance lack coverage for obesity management medications."

Eli Lilly and Company, news release, effective April 2026 · source · PR Newswire

Bridge eligibility is attested by your prescriber and needs a BMI of 35 or more; or 30 or more with heart failure with preserved ejection fraction, uncontrolled hypertension, or chronic kidney disease stage 3a or worse; or 27 or more with pre-diabetes, a prior heart attack, a prior stroke, or symptomatic peripheral artery disease.

Centers for Medicare & Medicaid Services, effective August 2026 · source

You are not eligible for the Bridge if you have type 2 diabetes, obstructive sleep apnea or MASH — those route to ordinary Part D coverage instead — or if you already filled a GLP-1 through Part D in 2026.

Centers for Medicare & Medicaid Services, effective August 2026 · source