Weight Loss Medication Coverage Changes & Treatment Options (2026)

Updated January 2026

Many insurance plans made changes effective January 1, 2026, and weight loss medication coverage was one of the most affected benefits. If you have recently received a denial, higher copay, or notice that your plan no longer covers weight loss medications, you are not alone.

Our goal is to make sure you understand your options and feel supported—whether that involves insurance-covered treatment, self-pay alternatives, or non-medication approaches.

Plans Commonly Affected by 2026 Changes

Based on what we are seeing locally, some of the plans most commonly affected by weight loss medication coverage changes in 2026 include Toyota-sponsored plans and certain Kentucky state employee plans.

Download the Weight Loss Options Guide (PDF)

Important Insurance Coverage Information

While some insurance plans no longer cover GLP-1 medications specifically for weight loss, they may still cover these medications for other FDA-approved indications, depending on your diagnosis and plan.

You may qualify for insurance coverage if you have:

Moderate to severe obstructive sleep apnea
Zepbound® (tirzepatide) is FDA approved for this indication
A history of heart attack, stroke, or peripheral vascular disease
Wegovy® (semaglutide) is FDA approved to reduce cardiovascular risk
MASH (metabolic dysfunction–associated steatohepatitis)
Wegovy® is FDA approved for treatment

If you have one of these conditions, coverage may still be possible. We are happy to review your medical history and benefits with you.

Brand-Name GLP-1 Medication Options

Wegovy® (Semaglutide)

Weekly injection or daily oral tablet
Average weight loss: ~15% of body weight

Self-pay pricing (when insurance does not cover):

Injection

0.25 mg & 0.5 mg: $199/month
1 mg, 1.7 mg, 2.4 mg: $349/month

Oral tablet:

Recent clinical studies have shown that the oral form of Wegovy® (semaglutide) — taken once daily — can be as effective as the weekly injection for weight loss when taken consistently and as prescribed.

First two dose levels (1.5mg and 4mg): $149/month
Higher dose levels (9mg and 25mg): $299/month

Provider/program fee: $74.99

Zepbound® (Tirzepatide)

Weekly injection
Targets two pathways (GIP + GLP-1)
Average weight loss: ~20–22% of body weight

Self-pay pricing:

2.5 mg: $299/month
5 mg: $399/month
7.5 mg, 10 mg, 12.5 mg, 15 mg: $449/month
Provider/program fee: $74.99

Compound GLP-1 Options

Non-GLP Prescription Options

For patients who are not candidates for GLP-1 medications or prefer alternatives:

Contrave®

Combination of bupropion and naltrexone
Helps reduce appetite and cravings
Typical effectiveness: ~5–9% weight loss
Cost: $99/month via specialty pharmacy if insurance does not cover
Provider fee: $74.99

Qsymia®

Combination of phentermine and topiramate
Appetite suppression and craving control
Typical effectiveness: ~8–12% weight loss
Cost: $99/month via specialty pharmacy if insurance does not cover
Provider fee: $74.99

Phentermine (Short Term Option)

Phentermine is a stimulant appetite suppressant intended for short-term use only.

Important considerations:

Controlled substance
Not recommended for long-term weight loss
Weight regain is common after stopping

Kentucky requirements include:

Video visit
Recent lab work
Blood pressure and heart rate

Cost:

Medication: typically $15–$20/month with GoodRx coupon
Visit fee: $74.99

Compounded medications are prescription medications prepared by licensed compounding pharmacies.

Customized compounded medications are an alternative for qualifying patients, such as those who:

Need individualized dosing not available with brand-name products
Benefit from added ingredients like B12 for energy or fatigue
Benefit from pyridoxine (vitamin B6) to help reduce nausea

Compounded pricing (packages include medication, supplies, shipping, and provider fee):

Compounded semaglutide + B12: starting at $200/month
Compounded tirzepatide + B12: starting at $290/month

No Medication Option

Download the Weight Loss Options Guide (PDF)

Weight loss medications are not required for success.

We offer a structured meal replacement program that:

Can be done with or without medications
Provides clear guidance and accountability
Supports calorie control and adequate protein intake

This option works well for patients who prefer a non-medication approach or want to start without medications.