Kristi Turner experienced significant health improvements after losing 108 pounds on Zepbound. Her mobility and blood sugar levels improved, she slept better, and had more energy for activities like Pilates and pickleball. However, in January 2025, her insurance coverage for the medication was unexpectedly terminated.

Coverage Loss Due to Lack of Diabetes Diagnosis

According to documents reviewed by Business Insider, Turner’s insurer cited her lack of a diabetes diagnosis as the reason for ending coverage. She was informed that the only way to potentially restore coverage was to complete a six-month program encompassing diet counseling, physical therapy, mental health check-ins, and lab tests – with no guarantee of success.

Financial Burden of Self-Pay

Turner declined the extensive program due to the time commitment and uncertainty. She now pays approximately $500 per month out-of-pocket to continue her Zepbound treatment. Her husband, Keith, who uses Mounjaro for type 2 diabetes, continues to receive coverage with a $25 monthly copay.

A Disparity in Coverage for Obesity and Related Conditions

Turner believes her insurance readily covers obesity-related conditions like diabetes but not obesity itself. “We have the same disease. We’re just at different points,” she stated. She acknowledges the financial strain but emphasizes that the medication has been “life-changing” for her.

Rising Costs and Restrictive Coverage for GLP-1s

The increasing popularity of GLP-1 medications like Wegovy and Zepbound has prompted insurers to tighten eligibility requirements, add administrative hurdles, or eliminate coverage altogether. A GoodRx analysis revealed that insurance coverage for Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound became “more restrictive” in 2026.

Increased Uninsured Rates

The number of individuals without commercial insurance coverage for Wegovy increased by 42% from 2025 to 2026, while those without Zepbound coverage rose by 12% during the same period. Over 16 million people with private insurance now lack coverage for these drugs when prescribed for weight loss.

A Broader Trend of Coverage Restrictions

Patients, doctors, and researchers have reported instances of coverage being unexpectedly scaled back or cut off entirely, not just for GLP-1s, but also for treatments like immunotherapy, mental healthcare, and IVF. Amanda Nguyen, GoodRx’s senior health economist, describes this as “coverage with a catch.”

Exploring Alternatives and Direct-to-Consumer Options

Nguyen notes that more consumers are exploring cash options, bypassing insurance, and shopping for the best prices. “Just because they have health insurance doesn’t mean the medication they need will be covered by their plan,” she says.

The Financial Strain on Healthcare Systems

GLP-1s, initially developed for type 2 diabetes, have shown potential benefits for conditions like sleep apnea, arthritis, heart disease, and addiction. KFF estimates that 36 million people with employer-sponsored insurance could qualify for GLP-1s based on their body mass index. Matt Rae, associate director of KFF’s Health Care Marketplace Program, explains that the sheer number of potential users translates to “an astronomical sum of money.”

Rising Premiums and Employer Strategies

America’s Health Insurance Plans attributes rising costs to “the exorbitant prices drugmakers set.” Novo Nordisk and Eli Lilly offer direct, self-pay options, with prices decreasing in some cases. Employers are increasingly passing costs onto employees, with private insurance premiums jumping nearly 9% between 2025 and 2026.

Direct-to-Consumer and Compounding Pharmacies

Eli Lilly and Novo Nordisk have partnered with pharmacies like Walmart, Amazon, Ro, WeightWatchers, and Hims & Hers to offer savings programs and self-pay options. Compounding pharmacies are also emerging as alternatives for patients facing coverage issues. Novo Nordisk emphasizes that self-pay platforms are intended to fill coverage gaps, not replace insurance-based access.

Navigating Insurance and Seeking Alternative Solutions

Healthcare providers are spending significant time navigating insurance denials and seeking alternative prescribing strategies to ensure patients receive necessary treatments. Chrissy Glenn, a psychiatrist, often prescribes GLP-1s based on conditions like sleep apnea to increase the likelihood of coverage. Gianna Beasley, who lost coverage for Mounjaro, turned to direct-to-consumer options after exhausting other medications for her polycystic ovarian syndrome.