Zepbound coverage gap grows to 114 million people, GoodRx tracker shows

The share of commercially insured Americans with no coverage for Zepbound (tirzepatide) climbed to 60% as of July 2026, up from 51% in 2025, according to a GoodRx Research tracker of commercial and health exchange plans ^[1]. That leaves more than 114 million people without insurance coverage for the weight-loss drug — an increase of about 17 million people, or 18%, in a year ^[1].

Unrestricted coverage, meaning plans that pay without extra requirements, fell from 5% of covered lives to 4%. Restricted coverage fell from 45% to 37% ^[1]. Because both categories shrank, the shift went to people with no coverage at all. The tracker's chart rounds the same figures to 50.5% and 59.5% for no coverage in 2025 and 2026 ^[1].

Restrictions remain common even for people who have coverage. Among those with coverage for a GLP-1 or GIP prescribed for weight loss, 88% still face requirements such as prior authorization, step therapy or both, GoodRx said ^[1]. The pattern holds for diabetes indications too: restrictions apply to 78% of Mounjaro coverage and more than 89% of Ozempic coverage ^[1].

Coverage also tightened for other drugs. For Wegovy (semaglutide), unrestricted coverage slipped from 10% to 9% and restricted coverage rose from 75% to 77%; about 27 million people still lack coverage, though 1.6 million gained some form of coverage in 2026 ^[1]. Foundayo (orforglipron), an oral weight-loss GLP-1 approved by the FDA in April 2026, has more than 66 million people without commercial coverage ^[1]. An additional 8 million people lost coverage for Ozempic, leaving more than 13 million without it, and 102,000 more lost coverage for Mounjaro, leaving over 769,000 without ^[1]. The number without coverage for Victoza rose 26% since 2025, while the number for Saxenda fell 3% ^[1].

Overall, 7% of people with commercial insurance — nearly 13 million — have no coverage for any GIP or GLP-1 prescribed for weight loss, meaning that if they are prescribed Wegovy, Zepbound, Foundayo or Saxenda, their insurance will not pay ^[1].

Why it matters for patients

When a plan offers no coverage, people pay the full retail price. GoodRx says that cost can exceed $1,400 a month even for people who have health insurance ^[1]. The tracker's figures do not account for deductibles, including separate pharmacy deductibles that require paying full price until they are met ^[1].

When coverage is restricted, people can still get a lower price, but they may face delays and administrative work first. GoodRx notes that some people forgo insurance and pay full price, or abandon the prescription altogether ^[1].

Not all denials are the same. A formulary exclusion means the drug is not on the plan's covered list. A prior authorization denial means the drug is covered in principle but the submitted documentation did not meet the plan's criteria. A step therapy requirement means the plan wants a different drug tried first ^[2]. Those are different problems with different remedies ^[2].

What happens next

Coverage can change during the year as plans add or remove drugs from their formularies ^[1]. CVS Caremark plans to add Zepbound back to its standard formulary in October 2026 after removing it last year, while Cigna stopped covering Zepbound and Wegovy for its own employees ^[1]. Whether other large insurers make similar changes in 2027 has not been reported.