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 84 days
LillyDirect self-pay price
Foundayo™ (orforglipron) 2.5 mg moves from $149 to $199/month. ↑ $50/mo
- in 84 days
LillyDirect self-pay price
Foundayo™ (orforglipron) 5.5 mg moves from $199 to $299/month. ↑ $100/mo
- in 84 days
Retail list price (reference) price
Ozempic® (semaglutide) moves from $1,028 to $675/month. ↓ $353/mo
- in 84 days
Retail list price (reference) price
Wegovy® (semaglutide injection) moves from $1,349 to $675/month. ↓ $674/mo
Already in effect
CVS Caremark policy
Zepbound returns to standard commercial template formularies as an additional preferred option
Elevance Health / Anthem (CarelonRx) policy
Zepbound single-dose pen goes Tier 3 -> non-formulary on the California DMHC National and DMHC Essential lists — the KwikPen took Tier 2 on those same two lists on Aug 1, so DMHC members switch presentation or lose cover; no other Anthem list changes
Medicaid (state-by-state) policy
Rhode Island Medicaid stops covering Foundayo, Saxenda, Wegovy and Zepbound when prescribed solely for weight loss, under its enacted FY2027 budget; obesity coverage runs through Sept 30, 2026. Continued treatment for an indication other than weight loss needs a new prior authorization, and requests for members under 21 are reviewed for medical necessity under EPSDT
LillyDirect self-pay price
Foundayo™ (orforglipron) 2.5 mg moves from $199 to $149/month. ↓ $50/mo
LillyDirect self-pay price
Foundayo™ (orforglipron) 5.5 mg moves from $299 to $199/month. ↓ $100/mo
Optum Rx (UnitedHealthcare) policy
Weight-loss PA policy P 1114-22 adds Foundayo (orforglipron) to the covered drug list at 6 months initial authorization, footnoted as possibly excluded at launch on some plans
NovoCare Pharmacy self-pay price
Wegovy® tablets (oral semaglutide) 4 mg moves from $149 to $199/month. ↑ $50/mo
Medicaid (state-by-state) policy
BALANCE state application deadline passed; participant list not yet published
Medicaid (state-by-state) policy
MassHealth stopped covering drugs for the treatment of obesity or overweight (Wegovy, Zepbound, Saxenda, Xenical, phentermine); approved weight-loss PAs expired July 2. Coverage continues for type 2 diabetes and other approved indications. Brings the covering-state count to 11
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
Medicaid (state-by-state) policy
Utah's obesity GLP-1 pilot ended; Utah no longer covers GLP-1s for weight management
Kaiser Permanente policy
NW Zepbound criteria re-issued, keeping the 6-month semaglutide-first step
Express Scripts (Evernorth / Cigna) policy
Cigna replaced the single weight-loss GLP-1 prior authorization policy with one policy per drug — the criteria did not change, but if you are citing the old combined document in an appeal it now returns a dead link, so quote the policy for your own drug instead
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. CMS now states both in its own words: the BALANCE page answers 'Will the Medicare GLP-1 Bridge continue into 2027?' with 'Yes. The Medicare GLP-1 Bridge has been extended through December 31, 2027', and both that page and the Bridge page carry a question about the impact of 'the BALANCE Model not launching in Medicare in 2027', saying the extension lets CMS collect GLP-1 utilisation data to share with Part D sponsors ahead of potential implementation of BALANCE in Part D
Discount card at retail (GoodRx and similar) price
Wegovy® tablets (oral semaglutide) 4 mg moves from $149 to $199/month. ↑ $50/mo
Elevance Health / Anthem (CarelonRx) policy
Saxenda moved Tier 3 -> non-formulary on the National Drug List and the National Direct, Direct Plus and Direct Preferred lists; generic liraglutide is the covered alternative
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)
Elevance Health / Anthem (CarelonRx) policy
Generic liraglutide (weight management) moved non-formulary -> Tier 1 on all four California lists, becoming the covered anti-obesity GLP-1 there after Wegovy and Saxenda came off in July 2025
Express Scripts (Evernorth / Cigna) policy
2026 NPF year began — 48 new exclusions, GLP-1 anti-obesity class core retained
Express Scripts (Evernorth / Cigna) policy
Saxenda excluded from the National Preferred Formulary for the 2026 plan year; generic liraglutide is the covered agent
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 kept two doors open after dropping weight-loss GLP-1s from the Medi-Cal Rx contract list: members under 21 can still have a weight-loss request reviewed for medical necessity under the federal EPSDT benefit, and Wegovy for MASH or cardiovascular disease and Zepbound for obstructive sleep apnea remain reviewable by prior authorization for everyone. Otherwise Wegovy, Zepbound and Saxenda deny with Reject Code 70 and existing approvals expired
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
Medicaid (state-by-state) policy
Michigan Medicaid reduced obesity GLP-1 coverage under Public Act 22 of 2025 (FY2026 budget) rather than eliminating it: liraglutide, Saxenda, Wegovy and Zepbound keep their other covered indications unchanged, while a request to treat obesity now needs the patient classified as morbidly obese, documented failure of all other clinically appropriate weight-loss interventions including the preferred anti-obesity agents, and a prescriber attestation that the drug is considered only as a measure to avert the need for higher-cost bariatric surgery. Authorizations approved before Jan 1, 2026 were honored for their remaining six months, and Saxenda and Wegovy became non-preferred on the Single PDL for their other indications, which carries a $3 copayment instead of $1
Medicaid (state-by-state) policy
Pennsylvania Medical Assistance also dropped Saxenda (liraglutide) for EVERY indication, not only for obesity — a withdrawal none of the multi-state trackers carry. Its own bulletin confirms GLP-1s stay covered for all other medically accepted indications with prior authorization, adds a GLP-1 therapeutic class to the Statewide PDL, and keeps non-GLP-1 obesity agents such as phentermine covered, preferred ones without PA
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
Elevance Health / Anthem (CarelonRx) policy
Wegovy tablets added non-formulary -> Tier 2 on the national and Essential lists
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)
Elevance Health / Anthem (CarelonRx) policy
California lists diverged from the national ones: Wegovy Tier 2 -> non-formulary and Zepbound Tier 2 -> Tier 3 on all four (CDI and DMHC, National and Essential)