Analysis finds 12 million people lost coverage for Zepbound and 12 million for Wegovy

Twelve million people lost commercial insurance coverage for Zepbound (tirzepatide) over the past year, and the same number lost coverage for Wegovy (semaglutide), according to research by the drug discount site GoodRx reported by NPR on April 22, 2026 ^[1].

The GoodRx analysis relied on formulary data from the health care analytics firm MMIT. Formularies are the lists of drugs a health plan covers, and the MMIT data reflects coverage for more than 190 million people ^[1]. Amanda Nguyen, a senior health economist at GoodRx, said that without adequate insurance the drugs cost people hundreds of dollars a month. "For many Americans, they can't afford that," she said. "That's the difference between for many people taking the medication that their doctor wants them to take and having to forgo it." ^[1]

The same research found that 88% of people who do have coverage for a GLP-1 face some kind of restriction ^[1]. Those usually take the form of prior authorization before a prescription is covered, or a requirement that a patient have a body mass index of 40 — well above the BMI of 30 that clinically defines obesity ^[1]. Some people with coverage still pay hundreds of dollars a month because their plans pay only a small share of the drug's price ^[1].

GoodRx also publishes its own coverage tracker, last updated July 10, 2026 ^[2]. It reports that 59.5% of covered lives had no insurance coverage for Zepbound in 2026, up from 50.5% in 2025, an 18% increase that leaves more than 114 million people without coverage ^[2]. For Wegovy, 14.2% had no coverage and 76.7% had restricted coverage; 1.6 million people gained some form of coverage in 2026, but 27 million still lack it ^[2]. Foundayo (orforglipron), the oral GLP-1 approved in April 2026, had no coverage for 34.5% of covered lives and restricted coverage for 57.5%, leaving more than 66 million people without coverage ^[2]. The tracker also counts more than 13 million people without coverage for Ozempic (semaglutide) and over 769,000 without coverage for Mounjaro (tirzepatide), both prescribed for Type 2 diabetes ^[2]. Altogether, nearly 13 million people — 7% of those with commercial insurance — have no coverage for any GLP-1 or GIP drug prescribed for weight loss ^[2]. The April figure and the later tracker figure for Zepbound do not match, and the difference has not been explained ^[1][2].

NPR reported on one patient's experience. Meghan Lena, a special education teacher in Massachusetts, was paying a $30 monthly copay for Zepbound and had lost 50 pounds in a year when CVS Caremark told her it was dropping the drug from coverage in July. She switched to Novo Nordisk's Wegovy, CVS Caremark's preferred obesity drug, and then in October her employer's health plan dropped Wegovy too. Her monthly premium rose 20% the same month, and the school district's insurance trust wrote that the increase was because of expensive GLP-1s. She now takes a compounded medication that costs her about $300 a month, compared with Eli Lilly's $450 cash price for her dose of brand-name Zepbound. Compounded drugs are not generics and do not go through the Food and Drug Administration's approval process; they are made with the same active ingredient by a specialized pharmacy rather than a drug company ^[1].

Survey data points in both directions. The International Foundation of Employee Benefit Plans found that employers saying they covered GLP-1 drugs for weight loss and Type 2 diabetes rose from 34% in 2024 to 36% in 2025. The KFF Employer Health Benefits Survey found that employers offering obesity drug coverage rose from 18% to 19%, while those saying they did not offer it rose from 52% to 57% ^[1].

The Pharmaceutical Care Management Association says employers and their pharmacy benefit managers have made "huge progress" despite cost challenges. Spokesman Greg Lopes said "it's clear employers are working to expand coverage for their employees." CVS Caremark spokesman Phillip Blando said the "egregiously high list prices set by drug manufacturers of GLP-1s for weight loss are the single biggest barrier to patient access." Tracy Zvenyach of the Obesity Action Coalition, which receives financial support from drugmakers including Eli Lilly and Novo Nordisk, said "essentially every insurance carrier is just making it up" in a way that reduces the eligible population ^[1]. Dr. Catherine Varney, obesity medicine director at UVA Health, said she has about 1,000 patients on obesity drugs and about 60% pay out of pocket ^[1].

Why it matters for patients

Insurance coverage decides what people pay. Someone whose plan does not cover the drug pays the full cost, which can exceed $1,400 a month even though the person has health insurance ^[2]. Restricted coverage can still bring a lower price, but it can mean delays and paperwork; GoodRx notes that some people choose to pay full price instead, or abandon the prescription altogether ^[2]. Restrictions also apply when these drugs are prescribed for Type 2 diabetes — 78% of the time for Mounjaro and more than 89% of the time for Ozempic ^[2]. Coverage can change during the year. Cigna stopped covering Zepbound and Wegovy for its own employees in June 2026, and CVS Caremark has said it will add Zepbound back to its standard formulary in October 2026 after removing it in 2025 ^[2].

What happens next

CVS Caremark says it will restore Zepbound to its standard formulary in October 2026 ^[2]. GoodRx says it updates its coverage tracker regularly as plans revise their formularies ^[2]. How other large insurers and employers will set coverage for 2027 has not been reported.