GoodRx reports 114 million Americans with no commercial coverage for Zepbound

Commercial insurance coverage for Zepbound (tirzepatide) narrowed sharply over the past year, according to GoodRx's coverage tracker updated July 10, 2026. The share of people with commercial or health-exchange coverage who have no benefit for the weight-loss drug rose from 50.5% in 2025 to 59.5% in 2026 — more than 114 million people, an increase of about 17 million, or 18% ^[1].

The drop hit both kinds of coverage. Unrestricted coverage for Zepbound, meaning a plan pays without extra hurdles, slipped from 4.8% to 3.7% of covered lives ^[1]. Restricted coverage — where a plan pays only after prior authorization, step therapy, or both — fell further, from 44.7% to 36.8% ^[1]. Put together, roughly nine in ten people who still have any Zepbound benefit have to clear an administrative hurdle first. For comparison, in November 2024 only 18.3% of commercially insured people had no Zepbound coverage and 9.2% had unrestricted coverage ^[1].

The picture across other GLP-1 drugs

Wegovy (semaglutide) held steadier. No-coverage fell slightly from 15.0% to 14.2%, and GoodRx says 1.6 million people gained some form of coverage in 2026 — but 27 million still lack it, and unrestricted coverage dropped from 9.9% to 9.1% while restricted coverage grew from 75.1% to 76.7% ^[1].

Foundayo (orforglipron), the oral GLP-1 approved by the FDA in April 2026, entered the market with limited access: 34.5% of commercially insured lives have no coverage — over 66 million people — 57.5% have restricted coverage and 8.0% unrestricted ^[1].

Diabetes drugs fared better but are not untouched. Mounjaro (tirzepatide) still shows only 0.4% with no coverage, though about 769,000 people lack it, 102,000 more than last year ^[1]. Ozempic (semaglutide) saw no-coverage rise from 2.6% to 6.9%, roughly 8 million more people losing coverage, for a total above 13 million ^[1]. Restrictions apply 78% of the time for Mounjaro and more than 89% of the time for Ozempic ^[1].

Across all four weight-loss drugs GoodRx tracks — Wegovy, Zepbound, Foundayo and Saxenda — 88% of people with coverage face restrictions, and 7% of commercially insured people, nearly 13 million, have no coverage for any of them ^[1].

Why it matters for patients

When a plan drops a drug, the patient pays the list price. GoodRx notes out-of-pocket costs for these medicines can exceed $1,400 a month even for people who have health insurance ^[1]. Coverage status also does not account for deductibles; people with a separate pharmacy deductible pay full price until they meet it ^[1].

Restricted coverage is not the same as no coverage, but it carries its own friction. GoodRx describes delays and paperwork that lead some people to skip insurance and pay cash, or abandon the prescription entirely ^[1].

If a pharmacy says a plan will not pay, the reason generally falls into one of three buckets, according to Medical Daily: a formulary exclusion, meaning the drug is not on the covered list at all; a prior authorization denial, meaning it is covered in principle but the submitted documentation did not meet the plan's criteria; or a step therapy requirement, meaning the plan wants a different medication tried first ^[2]. Those are different problems with different remedies ^[2].

One caveat on the source: GoodRx is a prescription discount company and markets its own savings programs alongside this research ^[1]. The underlying coverage data come from Managed Markets Insight and Technology (MMIT) and reflect average shares of commercial and exchange covered lives across all forms and doses ^[1].

What happens next

Formularies keep moving. Cigna recently stopped covering both Zepbound and Wegovy for its own employees, while CVS Caremark is adding Zepbound back to its standard formulary in October 2026 after removing it last year ^[1]. GoodRx says it will keep updating the tracker as plans change; its 2026 snapshot reflects July 2026, compared with August 2025 and November 2024 for prior years ^[1]. How the CVS Caremark change will shift the national numbers is not yet known.