Medicare Part D spend on GLP-1 receptor agonists by brand, 2018 through 2026E. Medicare currently covers GLP-1 only for FDA-approved indications other than obesity alone, so the curve reflects T2D, CV (post-March 2024 Wegovy CV expansion), CKD (post-January 2025), and OSA (post-December 2024). The 2024 to 2026 acceleration reflects label expansions opening new covered patient pools. Total Part D GLP-1 spend has approximately tripled in three years.

The CMS Medicare GLP-1 Bridge program offers a $50/month copay for eligible Medicare beneficiaries with a covered cardiovascular indication, July 1, 2026 through December 31, 2027. Copay does not count toward Part D deductible or out-of-pocket maximum. The program is a transitional bridge between current obesity-coverage exclusion and the broader BALANCE Model that was originally proposed for 2027 (indefinitely delayed). Eligibility funnel above shows the candidate pool narrowing from all Part D enrollees (51.5M) to projected uptake at full enrollment (~3.9M).

State-by-state Medicaid coverage of GLP-1 receptor agonists for obesity as of May 2026. T2D coverage is essentially universal across states. Obesity coverage is fragmented: roughly 8 states cover semaglutide 2.4mg (Wegovy) and/or tirzepatide (Zepbound) under standard Medicaid; about 9 states have partial or pilot programs under specific managed-care plans or strict prior authorization; the remaining majority cover only T2D, CV, CKD, and OSA indications. State-specific Preferred Drug Lists update monthly to quarterly.

Share of large US employers (500+ employees, self-insured) that cover GLP-1 receptor agonists for obesity / chronic weight management. T2D coverage is essentially universal and not tracked here. The "no coverage" share dropped from 74% in 2022 to ~42% in 2026; the "with criteria" share (prior auth, BMI thresholds, step therapy through behavioral interventions) is the largest growth category. Source: Mercer + Aon employer benefits surveys.

Approximate monthly cash-pay price by channel for GLP-1 access. List price ($1,349 for Wegovy) has been stable; direct manufacturer channels (LillyDirect Jan 2024, NovoCare 2025) introduced sub-$500/month vial pricing for select doses. LillyDirect prices stepped down to $349/month for Zepbound starter vials by 2026. Compounded channel pricing during the FDA shortage (2023 to early 2025) ran $230 to $350/month; the channel is being unwound by the April 2026 FDA bulk substances proposal, with prices ticking up slightly as supply tightens. Telehealth-mediated branded prices tracked between $340 and $430/month plus consultation fees.

Approximate formulary tier placement for the major GLP-1 brands across the three largest US PBMs (CVS Caremark, Express Scripts via Cigna, OptumRx via UnitedHealth). Tier 2 is preferred-brand; Tier 3 is non-preferred-brand. Step therapy (ST), prior authorization (PA), and BMI threshold modifiers are noted inline. Formularies typically refresh January 1 each year. Note: actual employer-by-employer formulary choices vary; this table reflects the National Preferred Formulary baseline at each PBM.

Approximate monthly cost in USD across major markets for Wegovy (semaglutide 2.4mg) or equivalent obesity dose. US list price is the global outlier at ~$1,349/month. EU and OECD pricing is substantially lower (~$130 to $380). India's Biocon biosimilar (Glupryze) anchors the lowest tier at ~$80/month with the announced ~40% discount-to-Ozempic strategy. China NMPA-approved domestic options (mazdutide, ecnoglutide) further pressure local pricing. The differential creates personal-importation, medical-tourism, and gray-market dynamics that compound regulators and payers are still working through.

Approximate effect of the IRA Medicare Drug Price Negotiation maximum fair price on monthly cost for semaglutide products. Semaglutide (Ozempic, Wegovy, Rybelsus) was selected for the second negotiation cycle in 2025; the negotiated price takes effect January 1, 2027. Reductions of about 68 to 70% off prior list price across the semaglutide family. Tirzepatide is a candidate for the next cycle (effective 2028 or later). Note: list-to-net is already much lower than list prices shown here due to PBM rebates; the IRA negotiation collapses the gap explicitly on the Medicare side.