Updated as the corpus is
GLP-1 coverage changelog
Every formulary move and price change we track, with the date it takes effect and the document it came from. Scheduled changes first, because those are the ones you can still plan around.
Scheduled — not yet in effect
- in 22 days
NovoCare Pharmacy self-pay price
Wegovy® tablets (oral semaglutide) 4 mg moves from $149 to $199/month.
- in 52 days
- in 52 days
CVS Caremark policy
Zepbound returns as additional preferred option (~$25/month for eligible commercial members)
- in 52 days
Elevance Health / Anthem (CarelonRx) policy
Zepbound single-dose pen Tier 3 -> non-formulary (CA National list); presentation switch to KwikPen
Already in effect
Medicaid (state-by-state) policy
BALANCE state application deadline passed; participant list not yet published
Express Scripts (Evernorth / Cigna) policy
NPF document lists Foundayo preferred; Zepbound KwikPens and vials excluded
Medicare (Part D + GLP-1 Bridge) policy
GLP-1 Bridge live at pharmacies; CMS Parts C & D appeals guidance update effective July 6, 2026
Optum Rx (UnitedHealthcare) policy
Weight-loss PA policy updated (P 1114-21): adds Wegovy tablet, MASH pathway
Kaiser Permanente policy
NW Zepbound criteria re-issued, keeping the 6-month semaglutide-first step
Elevance Health / Anthem (CarelonRx) policy
Foundayo added at Tier 2 PA/QL across major lists — fastest add among the majors
Humana policy
BALANCE Part D component indefinitely delayed; Bridge extended through Dec 31, 2027
Medicare (Part D + GLP-1 Bridge) policy
BALANCE Part D component indefinitely delayed; Bridge extended through Dec 31, 2027
Blue Cross Blue Shield Federal Employee Program (FEP) policy
Zepbound split into new policy 5.99.031 (two-oral + preferred-product step) and moved to the Standard excluded list; generic liraglutide added Tier 1; FEP cited 'rapid increase in the use of weight loss GLP-1s' as the cost driver
Elevance Health / Anthem (CarelonRx) policy
Anthem CA Medi-Cal terminated weight-loss GLP-1 coverage (Wegovy keeps MASH/CV pathways, Zepbound keeps OSA; Reject Code 70 otherwise)
Express Scripts (Evernorth / Cigna) policy
2026 NPF year began — 48 new exclusions, GLP-1 anti-obesity class core retained
Kaiser Permanente policy
Medi-Cal carve-out ended weight-loss GLP-1s for KP Medi-Cal members (state action)
Medicaid (state-by-state) policy
California, New Hampshire, Pennsylvania, South Carolina eliminated obesity GLP-1 coverage; North Carolina dropped Oct 2025 then reinstated Dec 2025
Medicare (Part D + GLP-1 Bridge) policy
Part D redetermination window changed 60 -> 65 days; 2026 appeal AIC thresholds $200 / $1,960
Optum Rx (UnitedHealthcare) policy
2026 Premium formulary exclusions (12 drugs) included no GLP-1 changes
Aetna (CVS Health) policy
Zepbound off standard template; Wegovy sole preferred (CVS reported >95% of members transitioned)
CVS Caremark policy
Zepbound removed from standard commercial template formularies; switching among 700,907 tracked patients spiked 17x (0.6% to 10.2%/month, June-July)