Medicare Part D GLP-1 Spend by Brand
Annual Medicare Part D spend on GLP-1 drugs by brand. Medicare covers GLP-1 only for non-obesity indications (T2D, CV, CKD, OSA), so label expansions drive the curve.
Updated at 2026-05-22
CMS Medicare GLP-1 Bridge Program
CMS Medicare GLP-1 Bridge: a $50/month copay for eligible cardiovascular patients, July 2026 to Dec 2027, with the eligibility pool narrowing from 51.5M to about 3.9M.
Eligibility funnel (millions of US Medicare beneficiaries)
All Medicare beneficiaries (Part D enrolled)
51.5M
With obesity or overweight (BMI 27+)
22.6M
With covered cardiovascular indication (post-MI, stroke, established CVD)
12.4M
Eligible for GLP-1 Bridge (active CV + GLP-1 candidate)
7.8M
Projected uptake at full enrollment (~50% of eligible)
3.9M
Program milestones
2025-01
PolicySemaglutide selected for IRA negotiation (effective 2027)
2025-08
PolicyBALANCE Model proposed (later indefinitely delayed)
2026-04
ImplementationCMS finalizes Bridge program structure
2026-07
LiveBridge launches: $50/month copay
2027-01
PolicyIRA semaglutide negotiated price effective
2027-12
SunsetBridge program scheduled end date
Updated at 2026-05-22
State Medicaid Coverage of GLP-1 for Obesity
State-by-state status as of May 2026. Roughly 8 states cover semaglutide and tirzepatide for obesity under standard Medicaid; about 9 states have partial or pilot programs; the majority cover only T2D, CV, CKD, and OSA. T2D coverage is essentially universal.
Full obesity coverage
8 statesCovers semaglutide 2.4mg (Wegovy) and/or tirzepatide for obesity with prior authorization. Approximate count; specific PDLs vary.
CaliforniaMassachusettsPennsylvaniaMinnesotaVirginiaDelawareRhode IslandNew York
Partial / pilot coverage
9 statesCoverage under specific managed-care plans, pilot programs, or with very strict prior authorization (e.g., BMI 40+ plus comorbidities).
North CarolinaMississippiMichiganMarylandNew HampshireWashingtonMontanaKansasVermont
T2D and CV indications only (no obesity)
33 statesCovers semaglutide and tirzepatide only for T2D, CV indication (post-March 2024 Wegovy CV approval), CKD (post-January 2025 sema CKD), and OSA (post-December 2024 Zepbound OSA). Obesity-alone indication excluded.
TexasFloridaOhioGeorgiaTennesseeAlabamaOklahomaArizona+ 25 more
Updated at May 2026
Large Employer Coverage of GLP-1 for Obesity
Share of large US employers (500+ employees, self-insured) covering GLP-1 for obesity. The 'no coverage' share dropped from 74% in 2022 to ~42% in 2026; the 'with criteria' (prior auth, BMI thresholds, step therapy) share is the largest growth category.
Updated at 2026-05-22
Cash-Pay Pricing by Channel
Approximate monthly cash-pay GLP-1 price by channel (LillyDirect, NovoCare, telehealth, compounding). Direct-manufacturer vials introduced sub-$500 pricing in 2024.
Updated at 2026-05-22
PBM Formulary Tier Placement by Year
Approximate formulary tier placement for major GLP-1 brands at the three largest US PBMs, 2022-2026, with step-therapy and prior-auth modifiers noted.
| PBM | Molecule | 2022 | 2023 | 2024 | 2025 | 2026 |
|---|---|---|---|---|---|---|
| CVS Caremark | Ozempic | Tier 2 + ST | Tier 2 + ST | Tier 2 + ST | Tier 2 + ST | Tier 2 + ST |
| CVS Caremark | Wegovy | Excluded | Tier 3 + PA | Tier 3 + PA | Tier 2 (preferred for obesity) | Tier 2 (preferred for obesity) |
| CVS Caremark | Mounjaro | Tier 3 + PA | Tier 2 + ST | Tier 2 + ST | Tier 2 + ST | Tier 2 + ST |
| CVS Caremark | Zepbound | N/A | N/A | Tier 3 + PA | Tier 3 + PA (some employers) | Tier 3 + PA (most plans) |
| CVS Caremark | Rybelsus | N/A | N/A | N/A | N/A | N/A |
| Express Scripts | Ozempic | Tier 2 + ST | N/A | Tier 2 + ST | N/A | Tier 2 + ST |
| Express Scripts | Wegovy | N/A | N/A | Tier 3 + PA + BMI | Tier 3 + PA + BMI | Tier 3 + PA + BMI |
| Express Scripts | Mounjaro | N/A | N/A | Tier 2 + ST | N/A | Tier 2 + ST |
| Express Scripts | Zepbound | N/A | N/A | Tier 3 + PA + BMI | Tier 3 + PA + BMI | Tier 3 + PA + BMI |
| Express Scripts | Rybelsus | N/A | N/A | N/A | N/A | N/A |
| OptumRx | Ozempic | N/A | N/A | Tier 2 + ST | N/A | Tier 2 + ST |
| OptumRx | Wegovy | N/A | N/A | Tier 3 + PA | Tier 2 (preferred obesity) | Tier 2 (preferred obesity) |
| OptumRx | Mounjaro | N/A | N/A | Tier 2 + ST | N/A | Tier 2 + ST |
| OptumRx | Zepbound | N/A | N/A | Tier 3 + PA | Tier 3 + PA + ST | Tier 3 + PA + ST |
| OptumRx | Rybelsus | N/A | N/A | N/A | N/A | N/A |
Updated at 2026-05-22
International Pricing: Wegovy (semaglutide 2.4mg)
Approximate monthly cost (USD) of Wegovy (semaglutide 2.4mg) across major markets. The US list price (~$1,349) is the global outlier.
Updated at 2026-05-22
IRA-Negotiated Prices vs Prior List
IRA-negotiated Medicare maximum fair prices vs prior list for the semaglutide family (Ozempic, Wegovy, Rybelsus), about 68 to 70% lower, effective Jan 1, 2027.
Updated at 2026-05-22