By Patricia Prewitt
My Personal Rx Advisor
The biggest challenge with GLP-1 medications has not been finding out about them – it has been finding a way to afford them. Popular medicines such as Wegovy, Ozempic, and Zepbound have helped many people manage diabetes and obesity, but monthly costs have often exceeded $1,000 when not covered by a prescription insurance plan.
What is changing?
The good news is several new programs and lower-cost options are having an impact on patients’ out-of-pocket costs. Competition between the GLP-1 manufacturers is putting downward pressure on prices. The newer direct-to-consumer programs that bypass traditional prescription insurance processing can make these products less costly to a patient.
What are direct-to-consumer programs?
Drug manufacturers are increasingly offering direct programs that bypass the traditional pharmacy benefit system. These programs allow eligible patients to purchase medications at discounted cash prices, often substantially below the price when using an Rx insurance benefit.
What is the new MediCare GLP-1 Bridge Program for Medicare enrollees?
Beginning July 1, 2026, the Centers for Medicare and Medicaid Services (CMS) will allow participating companies to provide products at reduced net prices with copays as low as $50 a month. Currently, those products are for specific doses of Wegovy, Zepbound, and the newly approved oral product Foundayo. Starting doses of the new pill form, which avoids the injectable delivery system, may be available for around $150 per month, with higher doses costing more.
How would someone qualify for the program?
There continue to be medical criteria and qualifications for GLP-1 weight-loss medications. According to the CMS, your doctor will be required to submit documents for participation. Additionally there is a prior authorization requirement.
Would Bridge Program costs be applied to my insurance deductibles?
No. According to CMS, no part of the program costs is applied to an eligible beneficiary’s gross covered prescription benefit, and no part of the $50 copay would count toward the true out-of-pocket (TROOP) costs. It is not yet clear if those costs will be allowed by the US tax code for medical expenses. Details of the program may be found here: https://www.cms.gov/medicare/coverage/prescription-drug-coverage/medicare-glp-1-bridge
Are direct-to-consumer programs only for the newer weight-loss products?
Prior to 2026, only a few companies offered a direct-to-patient pricing portal for traditional office-based physicians to use to help patients obtain patented brand name prescriptions directly, bypassing traditional drug stores. The GLP-1 companies are among the first to create a direct connection to a traditional office-based prescriber. There are many telehealth internet platforms that offer prescription products and lifestyle medications via a website. A medical consultation takes place with a licensed telehealth prescriber to verify the condition and need for the prescription. The patient pays via credit card.
What else?
Consumers should remember that the lowest price is not always found at the local pharmacy. Prices can vary depending on insurance coverage, manufacturer programs, and cash-payment options. Be cautious about advertisements for compounded or copycat versions that are not FDA approved. Links are all over the internet and social media platforms. It is advisable to be sure you are interacting with a legitimate company or portal before releasing personal medical information or using a credit card.
The bottom line is encouraging
Expanded coverage options are creating more paths to affordable treatment. For patients for whom these medications were financially out of reach, the next few years might bring lower costs. Consumers should always discuss treatment choice with their healthcare provider and compare all pricing options before making a decision.
Content provided is for educational purposes only and is not intended as a substitute for advice from a qualified medical professional. The opinions expressed within are those of the author.
About the Author: Patricia Prewitt is a local Massachusetts resident who spent more than 30 years in the pharmaceutical industry. Tricia is a consumer education advocate, and loves helping people find ways to save money on their prescriptions. More information and free resources are available on her website at https://mypersonalrxadvisor.com/resources or call her at 508-507-8840. Favorite Quote: ”Act as if what you do makes a difference. It does.” – William James
