GLP-1s for type 2 diabetes mimic the action of a natural hormone involved in blood sugar regulation. If you’ve been prescribed a GLP-1, understanding costs and insurance coverage can help you navigate affordability concerns.

GLP-1s, known clinically as glucagon-like peptide-1 receptor agonists, are medications that mimic the action of the natural hormone GLP-1 in your body.

Natural GLP-1 is responsible for several processes related to blood glucose (blood sugar) regulation.

It stimulates your pancreas to release insulin when glucose levels are high; suppresses the hormone glucagon, which can contribute to insulin spikes; and slows gastric emptying (the amount of time food takes to leave your stomach).

It also promotes a feeling of satiety (fullness), which can help reduce your food intake and help you manage your weight.

All these functions are why synthetic (human-made) GLP-1s were developed as medications to help manage type 2 diabetes. Type 2 diabetes is a chronic health condition in which high blood sugar develops when your body becomes resistant to the effects of insulin and/or your pancreas doesn’t produce enough insulin to meet your body’s needs.

Supplementing with GLP-1s in addition to maintaining an appropriate diet and exercise plan can help your body better regulate your blood sugar levels.

Here are some common GLP-1s for type 2 diabetes and their brand names:

Health insurance coverage varies widely depending on the insurance provider and your individual plan. To find out whether GLP-1s for type 2 diabetes are included in your coverage, you can contact your provider directly through the phone number on your policy documents or on the back of your insurance card.

You might also be able to check the formulary (the list of medications your plan currently covers) on the company’s website. Formularies are subject to change, so it’s a good idea to review them often. You can search for specific GLP-1s by their brand names.

Your insurance company’s website may also have a search option for checking medication coverage details.

If you’re still not sure whether your insurance covers GLP-1s, consider talking with your local pharmacist. Pharmacists deal directly with insurance companies every day and have a working knowledge of which plans offer certain levels of coverage or require out-of-pocket costs.

Expected costs

The costs of GLP-1s vary by brand and can change depending on the manufacturing landscape. A 2021 guide listed average costs of $706 to $1,161 for a 30-day supply of a GLP-1 for type 2 diabetes. More recent numbers suggest that the list price for GLP-1 medications can be more than $1300.

The amount you have to pay out of pocket (at the time of purchase) depends on factors such as your set copay or coinsurance rate. Copays and coinsurance are cost-sharing features of medical insurance in which you’re responsible for a certain amount of the cost of a service.

A cost evaluation from 2023 found that out-of-pocket costs for GLP-1s typically ranged from $25.08 to $118.43, depending on coverage plans and other variables, such as coexisting medical conditions.

Your insurance card usually lists your copay or coinsurance for common services such as prescriptions and doctor visits. If you’re unsure about your cost-sharing responsibilities, you can call your insurance company or ask your pharmacist. Some private plans might require you to cover the full cost of GLP-1s.

If you’re enrolled in Medicare, GLP-1s for type 2 diabetes are covered under Part D prescription coverage. But each Part D plan has its own formulary, and not every GLP-1 may be included on your plan’s list.

You can find out which GLP-1s are covered under your Part D insurance by visiting Medicare’s coverage search tool.

Tips for getting a prescription that meets insurance requirements

The way your doctor words your prescription can matter. For some people, this wording can make the difference between full coverage and no coverage at all for GLP-1s.

Here are some tips to ensure that your prescription is written in a way that optimizes your coverage:

  • Check to see whether certain drugs (such as semaglutide vs. exenatide) or formulations (such as extended-release vs. immediate release) are covered. Ask your doctor to stick to the medication criteria that are covered.
  • Verify whether your insurance has placed quantity limits that restrict coverage to a certain supply of the medication. (For example, you may have coverage for only a 30-day supply of a prescription drug, even if your doctor could write a prescription for a 90-day supply.)
  • Ask your doctor to write the prescription without “dispense as written” (DAW). A prescription without DAW can be filled with a generic version of the medication, which might be less expensive and more likely to be covered by insurance companies.
  • Have your doctor write down why your prescription is necessary in case your insurance provider requires prior authorization or justification for the medication.
  • Contact your insurance provider to see whether they have preferred pharmacy networks where coverage is higher and out-of-pocket costs are lower.

How to keep up with insurance changes

Aspects of your health insurance coverage can change. While your premiums, copays, and deductibles are set for the duration of the policy year, covered services and medications, provider networks, and prior authorization requirements can be adjusted during the time you have your policy.

Under the Affordable Care Act, your insurance provider is required to notify you of changes to your policy. Reading new documents they send to you during the policy year is an important way to stay on top of insurance changes.

You can also stay informed by:

  • regularly reviewing your Summary of Benefits and Coverage on the provider’s website
  • signing up for email or text alerts from your provider
  • calling customer service and asking about when the last updates were done
  • talking with your doctor about coverage changes they’ve encountered
  • taking the opportunity to review and compare your plan during open enrollment periods
  • contacting an insurance agent to help you understand any changes

Affording GLP-1s for type 2 diabetes can be a major barrier to treatment for many people. The latest KFF Tracking Poll, published in 2024, indicates that 54% of people who reported taking a GLP-1 had difficulty affording the medication.

If you’re looking for ways to manage the costs associated with GLP-1s, the following options might help:

  • searching for manufacturer discount programs, incentives, coupons, or copay cards
  • ordering from online pharmacies with more competitive pricing
  • seeking assistance from diabetes organizations or advocacy groups
  • talking with your doctor about alternative or generic medications
  • looking into pharmacy or state prescription discount programs
  • talking with your health insurance provider to make sure you’re enrolled in the best plan for your needs

Financial assistance options for GLP-1 medications

For more help affording GLP-1 medications, you may want to consider applying for a financial assistance program, such as:

Your doctor is on your side and can advocate for you when it comes to insurance. It’s important to talk about any insurance concerns you have that might affect the success of your treatment plan.

Your doctor would rather help you find an alternative treatment option you can afford than see you stop treatment completely because the costs become too high. It’s OK to ask for a more affordable GLP-1 medication or for other options that your insurance covers.

The following tips can help you have a productive conversation with your doctor about switching to a GLP-1 that’s covered by your plan:

  • Come prepared with a list of GLP-1s covered by your insurance and their coverage criteria.
  • Be able to explain your insurance coverage and out-of-pocket costs.
  • Express your concerns about staying consistent with your treatment plan due to costs.
  • Be honest about how much the cost will affect your finances.

Ask your doctor why they selected a specific GLP-1. They may be concerned about side effects, or a certain aspect of your medical history may warrant one medication over another. Understanding your doctor’s medication choice can help you both consider the pros and cons when selecting affordable options.

GLP-1s for type 2 diabetes help your body regulate your blood sugar levels by mimicking the action of the natural hormone GLP-1. Insurance coverage for these medications can vary significantly by insurance provider, and understanding your policy’s prescription plan is an important part of managing the costs.

To find additional ways to save on GLP-1s, consider discussing your insurance coverage with your doctor and applying for assistance programs through local pharmacies, advocacy organizations, or manufacturer websites.