GLP-1 Out-of-Pocket Cost Calculator

Understanding Your GLP-1 Out-of-Pocket Costs

GLP-1 medications like Ozempic, Wegovy, Mounjaro, and Zepbound carry list prices between $499 and $1,640 per month — but most commercially insured patients pay far less. Your actual out-of-pocket cost is determined by three separate insurance benefit phases that this calculator models: the deductible phase, the coinsurance phase, and the out-of-pocket maximum phase. Understanding how each phase works is essential to knowing what you will actually pay.

During the deductible phase, you pay the full list price (or your plan's allowed amount) until you have met your annual deductible. For a $1,500 deductible and a $1,000/month GLP-1, you would exhaust your deductible after about one and a half months of treatment. After the deductible, you enter the coinsurance phase — typically paying 20–30% of the drug cost. Once your total out-of-pocket spending hits your plan's annual maximum (often $5,000–$9,450 for ACA plans), the insurer covers 100% for the rest of the year.

How Deductibles Affect GLP-1 Costs

The timing of when you start GLP-1 therapy within the plan year dramatically affects your first-year cost. If you start in January and your deductible has not been met, you will pay the highest amounts in the first few months and then see costs drop sharply. If you start in November after meeting your deductible through other medical expenses, you may pay only coinsurance for the remainder of the year.

High-deductible health plans (HDHPs) paired with HSAs present a different calculation. HDHP deductibles are often $1,500–$3,000 for individual coverage, meaning you will be in the full-cost phase longer. However, you can use tax-advantaged HSA funds to pay those out-of-pocket costs, effectively reducing your real cost by your marginal tax rate. GLP-1 medications qualify as eligible HSA and FSA expenses regardless of whether they are prescribed for diabetes or weight loss.

Copay accumulators and copay maximizers are plan features that affect how manufacturer savings card payments count toward your deductible. If your plan uses a copay accumulator, the $0–$25/month you pay with a manufacturer savings card may not count toward your deductible — meaning you could face higher costs once the savings card runs out. Check your plan documents or call your insurer to determine whether copay accumulator rules apply.

Ways to Reduce Your Out-of-Pocket GLP-1 Costs

• Manufacturer savings cards: Novo Nordisk (Ozempic, Wegovy) and Eli Lilly (Mounjaro, Zepbound) offer savings programs that can reduce monthly costs to $25–$50 for commercially insured patients. Not eligible if you have Medicare, Medicaid, or government-funded insurance.
• Appeal a coverage denial: If your plan covers GLP-1s but denied your specific claim, file an internal appeal. Provide clinical documentation of BMI and comorbidities. Approval rates on first appeals are meaningful.
• Compounded alternatives: Compounded semaglutide and tirzepatide from licensed 503B facilities have offered significantly lower prices ($200–$400/month). The regulatory environment for compounding changes — verify current availability.
• Patient assistance programs: Novo Nordisk and Eli Lilly both have patient assistance programs for uninsured or underinsured patients who meet income thresholds. These programs can provide medications at no cost.
• Use HSA and FSA funds: Pay out-of-pocket GLP-1 costs with pre-tax HSA or FSA funds to reduce your effective cost by your marginal tax rate.

Frequently Asked Questions