Commercial
Employer and commercial plans
Employer coverage is mostly a function of how big your employer is. Large employers cover these drugs far more often than small ones.
If your plan does cover them, expect prior authorization with a BMI floor, a documented lifestyle attempt, and a weight-loss target you have to hit to keep the coverage.
What the rules actually say
Among firms that offer health benefits AND have 200 or more workers: 16% of those with 200 to 999 workers, 30% of those with 1,000 to 4,999, and 43% of those with 5,000 or more covered GLP-1 agonists used primarily for weight loss in 2025. Firms under 200 workers were not asked this question at all.
KFF Employer Health Benefits Survey, effective October 2025 · source
Among firms with 200 or more workers that cover these drugs for weight loss, 34% require enrollees to meet with a dietitian, case manager or therapist, or to join a lifestyle program for the drug to be covered.
KFF Employer Health Benefits Survey, effective October 2025 · source
Cigna's published criteria require a trial of behavioral modification and dietary restriction for at least three months, plus a baseline BMI of 30 or more, or 27 or more with a weight-related condition. Continuing coverage requires documented weight loss: at least 5% of baseline for Wegovy, Zepbound and Foundayo, and at least 4% for Saxenda.
Cigna, effective revised through April 2026 · source
UnitedHealthcare publishes the same BMI structure, with reauthorization requiring 5% weight loss for Wegovy and an initial six-month authorization for Zepbound. Its own document calls this an optional program that applies only where the employer elected to cover weight-loss products, which is why your colleague at another company can get a different answer.
UnitedHealthcare, effective September 2026 · source
Do not assume one BMI number applies to you. The same insurer publishes different floors for different employer benefit options: Cigna publishes both a 30 and a 32 threshold, and UnitedHealthcare's document contains a stricter tier at 40.
Cigna, effective April 2026 · source
What to do
Get your plan's own criteria, not a general answer
Ask member services for the prior authorization policy for GLP-1 weight-management drugs by name. The document exists and they can send it.
Have your prescriber document the lifestyle attempt
Most denials at this stage are for missing documentation of a three-month lifestyle trial, not for your BMI.
If denied, start the clock
You have 180 days from the denial to file an internal appeal, and four months from the final internal denial to request external review.
Your drug benefit probably runs through a pharmacy benefit manager. If that's CVS Caremark, Express Scripts or Optum Rx, see what each one lists for Zepbound, and what changes on October 1, 2026.
What it costs you
- Zepbound prior authorization: what each insurer requires
- Wegovy prior authorization: what each insurer requires
- Can you appeal your plan's weight-loss drug exclusion?
- What to say when you call your insurer
- Which insurance plans cover Zepbound and Wegovy
- What the Zepbound savings card pays, with and without coverage
- Where brand Zepbound is cheapest if your plan excludes it
- What Foundayo costs, and whether your plan covers it
- What the Wegovy pill costs, with and without insurance
- What Wegovy, Ozempic and Zepbound cost at Costco
- If your plan excludes weight-loss drugs, what's still covered
- Will your plan cover Zepbound for sleep apnea?
- What Ro charges on top of the drug price
If the appeal fails, or you cannot wait
Cash-pay telehealth is the fallback, not the bargain: you pay the whole cost yourself, and a covered prescription is almost always cheaper than any of these. Use this route when coverage has actually been exhausted, or when you need to start while an appeal runs.
These companies pay us a commission if you start care through the links below. That is how this site is funded, and it does not change what is written above. How we pay for this.
| Company | What we found on its own site |
|---|---|
| PartnerSprout HealthCheck availability | Compounded semaglutide from $149 a month and tirzepatide from $199, on plans that renew automatically. Also lists brand Wegovy and Zepbound. |
| PartnerWillowCheck availability | Compounded semaglutide at $299 a month (weekly injection or daily tablet) and tirzepatide injections at $399. HSA and FSA accepted; a full refund applies only if you cancel before the prescription reaches the pharmacy. |
| PartnerHumeCare+Check availability | A self-pay membership with no price shown before checkout, renewing automatically. The home page promises your money back if you don't lose 10 percent in six months; the terms limit that to 90 days, first-time users and no measurable loss. |
| PartnerEnhance MDCheck availability | Offers compounded semaglutide and tirzepatide with provider consultations and follow-up. Compounded drugs are not FDA-approved; ask which pharmacy will dispense your prescription and what continuing care includes. |
| PartnerCoreAge RxCheck availability | Compounded semaglutide advertised at $99 a month at every dose. The page our link opens has shown $149 instead, and a consultation fee can be added that may not be refundable. |
| PartnerOakCheck availability | One flat price at every dose, with shipping and supplies included free. |
| PartnerGala HealthCheck availability | One price at every dose. The advertised rate needs a yearly subscription. |
| PartnerDirect MedsCheck availability | One price at every dose from $147, with no monthly membership. The page states its discount two ways ($150 off in the banner, up to $200 off on the tiles), so check the total at checkout. |
| PartnerFoundCheck availability | Bills clinician visits to your insurance where it's in network, with the drug charged separately. Its Medicare offer, brand GLP-1s from $50 a month, doesn't count toward your Part D deductible or out-of-pocket maximum, and Extra Help doesn't apply. |
| PartnerEdenCheck availability | Semaglutide at $99 a month at every dose, with no membership on the page our link opens. Eden's own site pairs the same $99 with a required membership ($39 the first month, then $99), so check which one you're signing up for. |
| PartnerShedRxCheck availability | Injections plus needle-free drops and lozenges. You see a price only after the questionnaire, and the oral forms aren't sold in sixteen states. |
| PartnerHealthRXCheck availability | Compounded semaglutide at $133 a month on a three-month plan ($99 on twelve), tirzepatide from $209 ($179 on twelve). Its member reviews are labeled illustrative composites, not real patients. |
| PartnerMEDGmCheck availability | GLP-1 injections from $179 and tablets from $249. Brand options are a membership plus the drug's own cost: $99 for Zepbound or Wegovy, $171 for Ozempic. It discloses AI content and actor imagery. |
| PartnerBodybuilding Health+Check availability | Compounded tirzepatide at $174.67 to $209 a month, lower the more months you buy at once; semaglutide is tiered the same way. Operated by Dynamo Group LLC. |
| PartnerStrut HealthCheck availability | A telehealth storefront where weight loss is one of six categories. No GLP-1 price is published on the page our link opens. |
| PartnerRxSpan MDCheck availability | Multi-category telehealth that promises transparent pricing, then publishes no GLP-1 price on the page our link opens. |
| PartnerSnagRxCheck availability | Compounded semaglutide at $69 a month and tirzepatide at $119, the same at every dose, with no membership. Both are countdown sale prices, marked down from $299 and $399. Not available in Louisiana. |
| PartnerSkinnyRxCheck availability | Compounded semaglutide and tirzepatide injections at $99 for the first month, tablets at $149 and $199. No second-month price is printed for any of them. |
| PartneryourEraCheck availability | Compounded semaglutide at $79.20 a month and tirzepatide at $159.20. Both are six-month-plan prices, and the plan carries a six-month commitment. |
| PartnerbmiMDCheck availability | Compounded semaglutide from $119 a month and tirzepatide from $179. Both are limited-time sale prices, marked down from $228.60 and $349.20. |
| PartnerCollectiveCheck availability | Compounded semaglutide at $59 a month and tirzepatide at $69 at every dose, plus a required $199 yearly membership. It's free for 21 days, then billed for the full year at once, and it isn't refundable. |
Prices in those notes were read from each company's own site in September 2026, October 2026 and August 2026, and they change often. Check the current number before you buy.
Where this comes from
- KFF Employer Health Benefits Survey, effective October 2025 — Open the document
- Cigna, effective revised through April 2026 — Open the document
- UnitedHealthcare, effective September 2026 — Open the document
- Cigna, effective April 2026 — Open the document
Your state's Medicaid posture is in the coverage matrix, and the appeal routes are on the procedures page. What individual insurers publish about these drugs — and the much smaller thing those documents settle about your own plan — is on the carrier pages.