Ask for
the whole bill.

A medicine-price example, with the small print.

For brand-name weight-loss and diabetes medicines, the published list price, price paid without insurance, and your share through insurance can differ.

The list price is the manufacturer’s published figure; when you use insurance, your share of the cost is called a copay.

As of September 26, 2026, semaglutide (Ozempic) injections had an offer without insurance starting at $199 apiece for the first two monthly supplies.

Through December 31, 2026, that offer applied only to the two lowest injection strengths for new U.S. patients who were 18 or older.

After those first supplies, the advertised monthly price was $349 for the three lower injection strengths or $499 for the highest strength.

The amount of medicine in a prescribed dose is its strength. Check with the pharmacy that your prescribed strength is included in the offer. Those are medicine prices only. Ask what your particular medicine costs in its prescribed form, tablet or injection, plus any separate charges for visits or tests.

The price information checked September 26, 2026 showed many opening offers and savings cards ending December 31, 2026.

Ask for the offer’s current written terms before counting on that price.

Make the quote answer these questions.

Use the same questions for an in-person clinic and a service offering care by video, phone, or online messages. Put the answers side by side before choosing.

Ask the insurer about this drug for this use.

An insurer’s formulary is its list of medicines covered by the plan.

With prior authorisation, the plan must approve payment in advance.

Have the medicine’s name ready, along with why it is being prescribed. Ask the insurer whether it pays for that use, what paperwork is needed, and what your share will be.

Ask the service who handles any paperwork. Keep the plan’s answer with the quote.

For Medicare readers

Medicare Part D is the usual Medicare coverage for prescription drugs; its rules exclude weight-loss use as of September 26, 2026.

Depending on the product, diagnosis, and plan, coverage may instead apply to treatment for type 2 diabetes or to lowering heart attack and stroke risk.

Ask whether your particular medicine and health problem qualify; a possible use does not guarantee that your plan pays.

GLP-1 is a hormone made within the body that helps manage blood sugar and appetite.

Two medicines copy that hormone: semaglutide, with the brands Ozempic and Wegovy, and tirzepatide, with the brands Mounjaro and Zepbound.

The separate, temporary Medicare GLP-1 Bridge offers some weight-loss medicines at $50 for a monthly supply. Its opening date is July 1, 2026; the programme ends December 31, 2027.

It runs outside the usual Part D drug coverage.

The September 26, 2026 rules require both your health situation and the specific medicine to qualify, down to the injection pen.

Could the Bridge price apply to you?

Programme approval, a prescription, and a qualifying Medicare drug plan are required, and you must be 18 or older.

A stand-alone Part D plan is one option; a Medicare Advantage plan can also qualify when it covers medicines and coordinates your care.

Your starting body mass index (BMI), calculated from height and weight when you began this kind of medicine, is used for the health checks.

With BMI at 35 or above, no extra health condition is required to meet the weight rule.

At BMI 30 or higher, an additional qualifying health condition is needed.

Heart failure with normal squeezing strength can qualify, as can kidney disease at stage 3a or beyond.

It can also be blood pressure above 140 for the upper reading or 90 for the lower reading despite two blood-pressure medicines.

At BMI 27 or higher, blood sugar above normal but below diabetes can qualify, as can a previous heart attack or stroke.

Another qualifying condition at that weight is poor blood flow through the arteries in your arms or legs that causes symptoms.

Type 2 diabetes rules out the Bridge; ask about ordinary Part D coverage for that use instead.

Moderate or severe obstructive sleep apnea also excludes you; this condition causes repeated pauses in breathing during sleep.

A liver condition called MASH also rules it out when there is moderate or advanced scarring without cirrhosis, the most severe scarring stage.

For a prescription aimed at lowering stroke or heart attack risk, use ordinary Part D instead.

A 2026 payment from Part D for your GLP-1 medicine prevents you from using the Bridge in 2026.

The prescription must be part of ongoing changes to food and physical activity, including an organised food plan.

Have whoever prescribes your medicine compare these rules with your health records and plan before you rely on that price.

Which medicine and pen qualify?

As of September 26, 2026, Bridge coverage included Foundayo (orforglipron) tablets and Wegovy (semaglutide), as tablets or injections, plus Zepbound (tirzepatide) only in its KwikPen.

Zepbound single-dose pens and single-dose vials, the small medicine bottles, are excluded.

Ask the pharmacy to check the exact package on your prescription; the medicine name alone is not enough.

Your $50 Bridge payment is left out when adding up your own medicine costs toward the annual Part D limit.

Even once you reach that Part D limit, the Bridge still costs you $50 a month.

The payment also leaves your Part D deductible unchanged; you cannot use discount coupons with it.

Ask the person prescribing it and the pharmacy to confirm your monthly payment before the prescription is filled.

Endnotes for this chapter

• Government price directory: cash-offer terms

  The introductory semaglutide offer and the prices after it.

• Medicare: the temporary Bridge programme

  The separate payment route and who it is designed for.

• Medicare: who and what qualify

  The health, prescription, medicine, and injection-pen rules.

• Medicare: payment rules for plans

  How the copay interacts with ordinary coverage and coupons.

• Medicare: weight-loss drug coverage

  A patient-facing route for checking current rules.