Open enrollment is a good time to make sure your insurance plan still works for you and your medical needs. At the start of the new year, deductibles reset and insurance plans may make changes to their benefits and cost arrangements that take effect on January 1, so whether you are sticking with your current plan or considering different plans, this is a good time to review your coverage and benefits for 2027.
If you take a GLP-1 medication, or you and your clinician are considering one, open enrollment is the most important time of year to check your coverage to help you avoid surprises in January. Here’s how to do it, what to ask, and what your options are if the answer isn’t what you hoped.
Why GLP-1 coverage is changing for 2027
Staying with the plan you have today doesn’t guarantee your benefits will stay the same. Cost-pressures are driving many employers and plans to look at their plan design and pharmacy benefits. Employer coverage for weight loss medications like GLP-1s is shrinking. WTW’s 2026 Best Practices in Healthcare Survey found that the share of employers covering GLP-1s for weight loss dropped from 57% to 53%. Among those still covering the drugs, 30% are considering eliminating coverage, and 91% of employers that have dropped or are weighing dropping coverage cited cost. A separate survey from the Business Group on Health found that 67% currently cover GLP-1 medications for weight management. Of those, only 72% said they were likely to maintain that coverage in 2027.
Some employers aren’t dropping coverage outright. Instead they’re adding stricter requirements for coverage, such as higher BMI, step-therapy requirements, or enrollment in a lifestyle program.. WTW’s survey showed that 8% of employers have gone this route, and 28% were planning or considering it.
None of this means your plan has changed. Many plans will send written notice if you are impacted by any restrictive coverage changes, but it’s worth proactively checking to stay ahead of any changes that might affect your care plan.
Is my GLP-1 covered for weight management, or only for diabetes?
GLP-1 coverage depends on three things: your specific plan, the condition the medication is prescribed for, and the specific drug.
Coverage for type 2 diabetes is common and fairly stable, but coverage for weight management varies much more and is changing for 2027. The only reliable way to know is to check each plan’s 2027 formulary and confirm with your pharmacy benefit manager before you enroll.
Many plans draw the line by diagnosis, not by drug class. The same active ingredient can be sold under different brand names for different FDA-approved uses, and a plan may cover one brand and exclude the other.
As one analysis put it, a plan that covers Ozempic and Mounjaro but excludes Wegovy and Zepbound is drawing that line, not dropping the drug class. Some plans also cover GLP-1s for related conditions, such as cardiovascular risk reduction or obstructive sleep apnea, even when weight management alone isn’t covered.
How to check GLP-1 coverage during open enrollment
- Find the 2027 formulary for every plan you’re considering. HR usually posts it alongside your Summary of Benefits and Coverage (SBC). Make sure it’s next year’s version, since coverage you have today may not carry over.
- Search for your exact medication by brand name. Also search the terms “GLP-1,” “weight management,” and “anti-obesity,” since plans often use that last label. If your drug isn’t listed, it’s generally considered non-formulary.
- Note the condition it’s covered for. A drug can be listed but covered only for diabetes.
- Check the tier. Plans group drugs into three to five cost tiers. A higher or specialty tier can mean coinsurance of hundreds of dollars a month, even though the drug is technically “covered.”
- Look for restrictions. These include prior authorization, step therapy, quantity limits, specialty or mail-order pharmacy requirements, and required participation in a wellness or lifestyle program.
- Call your pharmacy benefit manager. The number is on the back of your insurance card. Ask in writing or take notes on the date, the representative’s name, and the answer.
- Ask your clinician’s office to run a benefits check. Many practices can verify coverage for a specific medication before the plan year begins.
Questions to ask HR or your PBM
Use these questions word for word:
- “Will [drug name] be covered for weight management on January 1, 2027, or only for diabetes?”
- “If coverage is ending, is there a continuation-of-therapy exception for people already taking it, and for how long?”
- “Is prior authorization required? What are the 2027 criteria, and how long does approval last?”
- “When is my current prior authorization valid until?”
- “Is step therapy required first?”
- “What tier is it on, and what will I pay per fill?”
- “Is there a quantity limit or mail-order requirement?”
- “Does the company offer a separate weight management program or reimbursement account instead of drug coverage?”
- “If I pay cash, will it count toward my deductible?”
If you have Medicare: the GLP-1 Bridge Program
Medicare began covering certain GLP-1 drugs for weight management starting July 1, 2026, if you meet eligibility criteria and have Medicare Part D, you’ll pay a $50 copayment. The program, called the Medicare GLP-1 Bridge, runs through December 31, 2027.
Which drugs it covers: The oral tablet Foundayo (orforglipron), Wegovy (semaglutide) pills and injections, and the Zepbound (tirzepatide) KwikPens. Zepbound single-use pens and vials are not included.
Who qualifies: Eligibility is based on BMI and related health conditions: a body mass index (BMI) of 35 or greater; a BMI of 30 or greater with a diagnosis of either heart failure with preserved ejection fraction (HFpEF), uncontrolled hypertension, or chronic kidney disease; or a BMI of 27 or greater with a diagnosis of either pre-diabetes, previous heart attack, previous stroke, or symptomatic peripheral artery disease.
How you get it: You need active Part D coverage, and your clinician submits a prior authorization. If you’re choosing a Part D plan now, keep in mind that Medicare’s open enrollment runs through December 7th.
There are two important caveats: First, your $50 copay doesn’t count towards your yearly Medicare drug plan deductible or out-of-pocket limit. Second, if your GLP-1 is already covered through Part D for a condition like type 2 diabetes, you’ll keep getting it through your plan rather than the Bridge.
What to do if your GLP-1 isn’t covered in 2027
A coverage change can feel stressful, especially if your medication has been working for you. You have more options than it may seem.
Ask about different covered GLP-1 or non-GLP-1 alternatives. Another drug in the same class may be on your plan’s preferred list.
Compare other plan options. An employer dropping GLP-1 coverage on one plan does not always drop it on every plan.
Self-pay options. knownwell offers the lowest prices for GLP-1s. Learn more about out-of-pocket pricing.
Plan your HSA or FSA contribution. Prescribed GLP-1s are generally an eligible expense, so if you expect to pay out of pocket, factor that into this year’s election.
Don’t stop on your own. Stopping a GLP-1 suddenly can lead to weight recurrence and changes in related health conditions. If your coverage is changing, talk with your clinician about a plan for the transition. That might mean adjusting timing, switching medications, or strengthening the nutrition and lifestyle parts of your care.
Not sure which path is right for you? Schedule a visit with your knownwell clinician and we’ll figure it out together.
How knownwell can help
At knownwell, FDA-approved medications like GLP-1s are one tool in a comprehensive, personalized weight management plan. We accept insurance and charge no membership fees. Our care team can help you understand your coverage, handle prior authorizations and appeals, and build a plan that works whatever your 2027 benefits look like. You’ll see the same team of clinicians, registered dietitians, and health coaches whether your visits are virtual or in-clinic.
Frequently asked questions
Does insurance cover GLP-1s for weight management?
Sometimes insurance covers GLP-1s for weight management, but it depends on your employer and plan. About half of employers with 100 or more employees cover GLP-1s for weight management, and many add requirements like prior authorization. Check each plan’s 2027 formulary during open enrollment.
Why is my GLP-1 covered for diabetes but not weight management?
Many plans cover GLP-1s for type 2 diabetes but exclude them for weight management alone. Coverage often depends on the diagnosis and the brand name (for example, Ozempic versus Wegovy), even when the active ingredient is the same.
Can my employer drop GLP-1 coverage in the middle of the year?
Most changes take effect at plan renewal, usually January 1. Formularies can change mid-year, though, and plans generally must notify you in advance. Watch for letters from your PBM.
What’s the difference between prior authorization and step therapy?
Prior authorization means your clinician must get the plan’s approval before the drug is covered. Step therapy means you must try a different, usually lower-cost medication first.
Does Medicare cover GLP-1s for weight management?
Yes, for eligible enrollees. Through the Medicare GLP-1 Bridge, certain people with Part D coverage pay $50 a month for specific GLP-1s through December 31, 2027.
Can I use my HSA or FSA for GLP-1s?
Yes, you can generally use your Health Savings Account (HSA) or Flexible Spending Account (FSA), when the medication is prescribed. That can lower the cost of paying out of pocket.
What happens if I stop taking my GLP-1?
Weight recurrence is common after stopping. Before making any change, talk with your clinician about a plan that protects your progress.
