For many, a New Year brings resolutions, hope, and excitement. But in the United States it brings something else as well: a change in health insurance plans. Whether you have health insurance through your employer or buy it on the marketplace, there's a good chance you'll see some changes to your plan in 2026.
A common change that has a lot of people worried is how plans are handling GLP-1 medications — diabetes and weight loss drugs you may know better by their common brand names, like Ozempic, Wegovy, Mounjaro, and Zepbound.
What's New with GLP-1 Coverage in 2026
While GLP-1 agonists have been around for over a decade now, they've seen a big jump in popularity in the last couple of years. They were primarily prescribed for diabetes at first, but many patients have started to turn to them for additional uses that include cardiovascular health and — especially — weight loss.
In fact, KFF found that one in eight adults use GLP-1s, and one in five have tried them at some point. The main reason some people stop taking them? Cost.
GLP-1 agonists are pricey. They're one of the reasons insurance companies have given for raising premiums on marketplace plans this year. The more people use an expensive drug, the bigger the impact it has on the entire health insurance market.
In response to the increased use of these drugs and the costs that come with it, some insurance companies are making changes to how they cover them. Namely:
- No longer covering GLP-1s for weight loss: Several insurers have made the choice to stop providing coverage for these drugs when used specifically for weight loss, while still covering them for other uses like diabetes.
- Making them harder to access: Alternatively, some insurers are still offering coverage, but with caveats. They may require prior authorizations or step therapy, which means proving to the insurance company that you’ve tried and failed other medications first. In both cases, patients face a higher administrative burden and the potential for longer wait times to access their meds.
In the case of many large employer plans, insurance companies leave the choice up to the employer. They can choose a higher-cost plan for their employees that includes GLP-1 coverage, or choose to save money by dropping the coverage.
And some government programs are also changing how they handle things. Several states are dropping weight loss coverage of GLP-1s from their version of Medicaid, including California's Medi-cal program.
What This Means for Patients who Use GLP-1s
Health coverage varies a lot across different regions, providers, and plans. So what this means for you personally depends on a lot of factors. But for people who currently use medications like Wegovy and Ozempic for weight loss, you may face one of the following issues that have become common across the U.S.
You may have to jump through more hoops to get your prescription covered.
According to GoodRx, 88% of patients who still have coverage for GLP-1 agonists will face additional requirements to access them. That means it won't be as simple as your doctor sending a prescription into your local pharmacy. You may have to ask your doctor to provide a prior authorization, which requires extra time and work. If they deny your prior authorization, you face the option of filing an appeal — meaning even more time and work.
Or your provider may require you to show evidence that other strategies have failed first (e.g. step therapy). If you don't have a history of trying other medical interventions for weight loss, you might have to start now and confirm that those other options don't work for you before GLP-1s will be an option for you again.
In other words, be prepared to put in a lot of effort to convince your provider you really do need this medication.
You may lose insurance coverage for the meds completely.
As frustrating as all the hoop-jumping sounds, it's better than losing coverage outright. According to GoodRX, the number of patients with commercial insurance that no longer have any coverage of Wegovy is 41 million — a 42% increase since last year. For Zepbound, 109 million people have lost their coverage, up 12% from last year.
If you fall in this category: we're sorry. We know it's a blow. But 2026 does bring some alternative options, you can jump ahead to our What Else is New section to learn more.
Understanding a Plan's Coverage — And Shopping for the Best Plan
While it may be too late for most people to sign up for a new plan on the marketplace in 2026, to prepare you for next year's open enrollment or your next qualifying life event, here's how to research prescription coverage when choosing a plan:
- Check the drug formulary: Health insurance plans provide a list of all the drugs they cover called a formulary. Before choosing your insurance plan, ask to see their formulary. Or to save time, you can ask the insurance company directly if your particular drug is included in their formulary.
- Look up which tier your medication is on: Insurance formularies are typically divided into multiple tiers that impact what your cost will look like. Tier 1 is for low-cost generic drugs you can expect to get at a low price, while the other tiers go up for higher-cost and harder to access drugs that will cost you more. GLP-1s are the kind of drugs likely to be on a higher tier, so ask your insurance provider what tier they're on and what that will mean for your cost.
If you know you want a plan that covers GLP-1 drugs like Wegovy and Ozempic, doing this research in advance is your best bet.
What This Means for Small Business Health Insurance
While many big businesses are making the decision about whether to include GLP-1s for their employees on a mass scale, small businesses actually have the power to be more flexible. ICHRA (Individual Coverage Health Reimbursement Arrangement) lets you provide tax-free health insurance benefits, while letting your employees select their own plans.
That means any employee who wants a plan that covers GLP-1s can do the research to find the best option on the marketplace, without it impacting the cost of health benefits for the rest of your team. And if you work with StretchDollar, we can help your employees out with that research, making the process easy on both them and you.
What Else is New with GLP-1s
While much of the news about health insurance coverage for GLP-1s is bad, there's good news too. A few changes in the world of GLP-1 agonists are making the drugs more accessible to people, even if their health care plans don't cover them.
Introducing: An Oral GLP-1
A medication that has to be taken in shot form is inconvenient and unpleasant for patients, and also tends to come with a higher price tag than meds you can take as a pill. That's why it's such a big deal that Novo Nordisk has recently released the first GLP-1 in pill form. The Wegovy pill is already available in pharmacies across the nation, with a starting cost of $150 a month for those without insurance coverage (going up to $300 a month for the larger dose many move up to).
Even if your insurance plan won't help you out, this makes GLP-1 access more accessible and affordable to many people across the nation.
Additional Use Cases in the Pipeline
GLP-1s were a big deal for diabetes, then became a bigger deal for weight loss. But their efficacy doesn't stop there. Researchers are studying how they impact a range of different health issues including (but not limited to):
- Sleep apnea
- Metabolic disorders
- Neurodegenerative disorders
- Substance use disorders
- Liver disease
- Arthritis
- Inflammatory bowel disease
Completing research studies and gaining FDA approval for new use cases takes time, but it looks likely that GLP-1s could be prescribed as treatment for a growing list of health issues in the coming years.
DTC (Direct-to-Consumer) Options Here Already
With a growing number of people cut off from accessing GLP-1s through insurance, an alternative option is arising to meet the need: direct-to-consumer access. The two main manufacturers for GLP-1s, Novo and Lilly, both provide DTC options that can make the meds more affordable to patients who can't use their insurance for them.
Novo offers a savings card you can use at retail pharmacies to bring the cost of Wegovy and Ozempic down, along with the option to order it online from them directly with NovoCare. The new Wegovy pill starts at $149/month for the lowest dose (1.5 mg), increasing to $199/month for the 4 mg dose and $299/month for the higher 9 mg and 25 mg doses. The Wegovy pen (injection) is more expensive: new patients can access the first two months at a promotional rate of $199/month, but standard pricing is $349/month for all doses.
Lilly offers telemedicine options and free home delivery of Zepbound through Lilly Direct. You can either have your doctor send your prescription to them, or set up an appointment with a telehealth provider on their platform. Prices there start at $299 a month.
An Alternative Low-Cost Option: Kongo
If brand-name GLP-1s are out of reach—whether due to cost, insurance restrictions, or access—compounded medications offer another path forward. Kongo partners with U.S.-based compounding pharmacies that are NABP-accredited and LegitScript-verified to provide medications containing semaglutide, the same active ingredient found in Wegovy and Ozempic. Pricing is a flat $99/month—up to 70% less than brand-name alternatives like Wegovy ($149–$349/month) and Zepbound ($299/month).
“We started Kongo because too many people were being priced out of medications that could genuinely change their lives. The insurance system wasn’t built for transparency—it was built for complexity. We wanted to offer something different: clear pricing, real clinical oversight, and direct access without the runaround.” - Lucas Reynolds, CEO and Founder of Kongo.
That’s why StretchDollar has partnered with Kongo—to give employees using StretchDollar a straightforward, affordable way to access GLP-1 medications without the insurance headaches.
Here’s how it works:
- Sign up at stretchdollar.kongo.care
- Complete a health questionnaire reviewed by a licensed healthcare provider (in some states, you’ll have a brief virtual appointment)
- Get your medication shipped to your door—with free delivery
Kongo’s formulation includes Vitamin B12, which some patients and providers prefer. And unlike manufacturer DTC programs, Kongo offers optional lab testing to help monitor your health throughout treatment—adding a layer of clinical oversight many alternatives don’t provide.
No insurance required. No prior authorizations. Transparent pricing.
Compounded medications are prepared by licensed pharmacies based on a provider’s prescription and are not FDA-approved products.
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The insurance and pharmacy system we have now in the U.S. too often makes getting a prescription into a frustrating, exhausting obstacle course. You shouldn't feel like you have to cross a (metaphorical) battlefield every time you need to refill your meds. If you're ready to opt out of that system and find a simpler way, see if Kongo looks right for you.
→ Get started at stretchdollar.kongo.care
