Covered only after the disease it can help prevent.
Donna Morris, Walmart’s chief people officer, sent employees a letter on October 13th, ahead of open enrollment. Starting in 2027, the company will cover certain GLP-1 drugs for type 2 diabetes at no cost. The drugs on the list, which require prior authorization, are Ozempic and Mounjaro. Walmart already covered them for diabetes, but now employees won’t have to pay anything at all. According to SHRM, the plan still won’t pay for the drugs when they’re prescribed solely for weight loss.
Ozempic and Wegovy contain the same drug, semaglutide. Mounjaro and Zepbound both contain tirzepatide. In a three-year trial of adults with obesity and prediabetes, 1.3% of people on tirzepatide developed type 2 diabetes, compared with 13.3% on placebo. But the plan won’t make the drug free until someone has the disease the drug can help prevent.
How many employers are dropping coverage of GLP-1s for weight loss?
In a Business Group on Health survey of big employers, coverage of these drugs for obesity fell from 72% last year to 60% this year. Starbucks ended coverage for weight loss in October. Cigna, a health insurer, dropped it for its employees on July 1st. In Massachusetts, 112,000 fewer people with commercial insurance used a GLP-1 for weight loss in early 2026 than in 2025, a drop of 52%.
The employers have the cost data on their side. Economists at Indiana University, the University of Wisconsin, and the University of Southern California followed 288,907 people with job-based insurance for five years after they started a GLP-1. Their other medical spending increased by about 22 cents for every dollar spent on the drug before rebates. Daniel Sacks, one of the authors, told me that counting rebates makes that number larger. Rebates shrink the drug’s cost to patients while leaving the extra spending untouched. Most of those patients started older GLP-1s between 2017 and 2019. For semaglutide, the drug in Ozempic and Wegovy, other medical spending didn’t clearly rise or fall over two years. Sacks says it will take a few more years to learn how tirzepatide, the drug in Mounjaro and Zepbound, compares.
Three other studies found no savings either. Duke’s Jonathan Zhang, who co-wrote one of those studies, says the only studies showing savings are simulations projecting a decade or more into the future.
Are the health benefits worth paying for?
If the drugs don’t save money, the case for covering them rests on health benefits alone, and the health benefits are real. In a trial of 17,604 adults with cardiovascular disease and excess weight but no diabetes, semaglutide cut the combined rate of heart attacks, strokes, and cardiovascular deaths by 20%.
Most of those benefits fade when people stop. In one trial, people who stopped semaglutide regained about two-thirds of the weight they’d lost within a year. Their blood pressure and blood sugar drifted back up, too.
Will Medicare save money on GLP-1 drugs?
Medicare went the other way on GLP-1 drug coverage this summer. Since July, eligible enrollees can get Wegovy, Zepbound, or Lilly’s new pill, Foundayo, for $50 a month through a program called the GLP-1 Bridge. Under the program’s rules, drugmakers supply the drugs to Medicare at $245 a month. Chris Klomp, chief counselor at the Department of Health and Human Services, said this month that about 1.1 million people have signed up. Medicare’s open enrollment runs through December 7th, and the Bridge requires Medicare drug coverage.
CMS Administrator Dr. Mehmet Oz explained the logic on Face the Nation in August. At $50 a month, he said, “all the downstream costs that would have been incurred no longer happen.” When the Congressional Budget Office studied permanent Medicare coverage in 2024, it projected $35 billion in added federal spending over nine years, at the prices it expected then. The study of veterans, whose average age was about 65, found no savings.
So Medicare is also paying for health that doesn’t pay for itself, just at a lower price than employers get. Lilly sells Zepbound directly to employers for $449 a month. Jenny Goins, leads the National Alliance of Healthcare Purchaser Coalitions, said that price “doesn’t appear to be much lower” than what many employers were already paying after rebates. Medicare’s price came from a White House deal with the drugmakers, while employers rely on pharmacy benefit managers whose rebate contracts are confidential.
What happens to people who lose GLP-1 coverage?
A spokesperson for the Massachusetts Health Policy Commission told me it believes that some of the 112,000 fewer people with commercial insurance coverage for GLP-1s now pay cash, at roughly $4,200 to $5,400 a year. Dr. Laura Davisson, who runs the weight management program at West Virginia University, estimates that more than half her patients initially stopped when their coverage ended. Some restarted as cash prices fell, while lower-income patients often struggled most to stay on.
And people who keep paying cash may not get credit for it. Cigna told its employees that cash purchases won’t count toward their deductible, according to a document Reuters reviewed. I asked Cigna whether that’s still true. Its statement, which cited “managing affordability,” didn’t say.
Cigna also owns Express Scripts, a pharmacy benefit manager. In a settlement with the Federal Trade Commission, Express Scripts agreed to count TrumpRx purchases toward deductibles once, in the FTC’s words, “necessary legal and regulatory groundwork is laid.”
What should you ask during open enrollment?
Does my 2027 plan cover GLP-1s for weight loss, or only for diabetes? Look for Wegovy and Zepbound by name on the plan’s drug list, called a formulary. In SHRM’s 2026 benefits survey, 47% of employers covered GLP-1s for type 2 diabetes, and 15% covered them for weight management.
If my plan covers them, what does it take to qualify? Ask about prior authorization, weight cutoffs, and any required coaching program. Goins told me 68% of employers in her group’s 2026 survey limited access to certain patients or were considering it.
If I pay cash, will it count toward my deductible? Get the answer in writing, because plans differ. Stacie Dusetzina, a health policy professor at Vanderbilt, puts cash prices for the injections at $350 to $450 a month.
Which pharmacy benefit manager runs my plan? That company manages the drug list and negotiates confidential rebates with drugmakers. Express Scripts has agreed to credit TrumpRx purchases once the legal groundwork is laid.
What happens if my coverage ends? Your doctor can help you plan before your last covered fill. Dr. Davisson’s clinic tried behavioral programs, other weight-loss pills, and less frequent doses to slow the regain.
I’m on Medicare. How long will the $50 price last? The Bridge requires Medicare drug coverage, and Medicare’s open enrollment runs through December 7th. The Bridge ends December 31, 2027, and CMS hasn’t said what comes after it.