💲Estimating Medication Costs

Cash pay is always an option if:

• GLP-1 medication is not a covered benefit under your plan.

• Prior authorization is denied, and there are no other options for coverage.

• You're uninsured or do not want to go through insurance (and also do not have a government health plan).

• You want medication quickly and are interested in compounded semaglutide (which is $450 per month and is not covered by insurance).

• You’re willing to pay about $900–$1,500 a month for branded GLP-1s like Ozempic, Zepbound, Wegovy, and Saxenda.

It depends on which medication is prescribed:

• Compounded semaglutide costs $450 per month of treatment.

• Branded GLP-1s (like Ozempic, Zepbound, Wegovy, and Saxenda) typically cost about $900–$1,500 per month of treatment without insurance.

There are savings cards that branded GLP-1 drug manufacturers may provide to help reduce costs. Each pharmacy may apply these savings cards differently, so your final costs can vary depending on where the medication is ultimately filled.

Out-of-pocket costs from copays or cost sharing can range substantially. These costs depend on your insurance coverage and fulfilling pharmacy. Your insurance company may share out-of-pocket cost estimations with us (but this only sometimes happens). If they do, we'll share it with you.

Insurance companies don't always share estimates with us. But if we get an out-of-pocket estimate, we’ll share it with you. If not, you can reach out to your insurer directly.

Remember, any number we share with you is an estimate and may differ from the final cost you’ll receive at the pharmacy that fills your prescription.

Your insurance company may share a dose’s estimated out-of-pocket cost with us. This estimate is based on your insurance plan and how much is left until you reach your deductible (the amount you pay before your insurance kicks in). When you reach your deductible, your medication's monthly cost will decrease to your fixed co-pay or cost sharing amount. Keep in mind that plans vary and some plans won’t have deductibles, copays, or coinsurance.

Any out-of-pocket estimates we’re able to share are only for a month’s worth of medication. They may be high if you haven't hit your deductible or out-of-pocket maximum responsibility. If you hit those, the monthly cost of your medication will go down.

Using your insurance information and plan details, you may be able to estimate the monthly cost for yourself. (But keep in mind that plans vary and some plans won’t have deductibles, copays or coinsurance. This calculation may not apply to your individual plan depending on your plan details.)

To do the calculation, you’ll need your:

• Out-of-pocket estimate

• Deductible (how much you pay until your insurance kicks in and starts to pay)

• Amount you’ve already paid toward your deductible

• Your fixed co-pay or coinsurance (may apply even if your deductible is hit)

• Out-of-pocket maximum

You’ll likely pay the out-of-pocket estimate until your deductible is met. Then, you’ll start to pay the co-pay or coinsurance amount until you hit your out-of-pocket maximum.

Here’s an example using hypothetical numbers:

• GLP-1 out-of-pocket estimate: $900

• Deductible: $2,000

• Amount paid toward deductible: $0

• Co-pay: $50

• Out-of-pocket maximum: $10,000

Given the information above, the monthly medication costs may look like this:

• Month 1: $900

• Month 2: $900

• Month 3: $200 (deductible met)

• Month 4: $50 (co-pay kicks in)

• Month 5: $50

• Month 6+: $50 (until you reach your out-of-pocket maximum)

Cost information you receive from your fulfilling pharmacy can differ from your insurer’s estimate. We know this may be frustrating and confusing, so here are a couple of questions you can ask the pharmacy for clarity:

• Does this cost include my insurance coverage?

• Does this cost include any eligible savings card discount?

You may be able to use your HSA or FSA to pay for your branded GLP-1s like Ozempic, Zepbound, and Wegovy. Inquire with the pharmacy that’s filling your prescription to learn more.

You also may be able to use your HSA or FSA to pay for compounded semaglutide. Reach out to your insurer for more information on limitations and requirements.

Some drug manufacturers offer savings cards that can help offset the price of the medication. Review the information in the link carefully to see if you're eligible for savings.

For Ozempic, you cannot use the savings card from Novo Nordisk when you pay out of pocket — only for insurance-approved prescriptions. Eligible patients can save up to $150/month on Ozempic when using the savings card.

For Zepbound, Eli Lilly is offering a savings card program through the end of 2024. Through the program:

• People who have commercial insurance that covers Zepbound may be eligible to save up to $150/mo.

• People who have commercial insurance but don’t have coverage for Zepbound may be eligible to save up to $563/mo off of the full list price.

Savings cards are not guaranteed and may vary by pharmacy. When coordinating payment for your medication, let the pharmacist know that you'll be using a savings card. Pharmacists usually require that you provide certain information detailed on the card.

Because compounded semaglutide is not made by the manufacturer of branded semaglutide, there are no savings cards available.