in 5 days Optum Rx (UnitedHealthcare) — Weight-loss PA policy P 1114-22 adds Foundayo (orforglipron) to the covered drug list at 6 months initial authorization, footnoted as possibly excluded at launch on some plans See the changelog
WalletNoise

Ozempic® tablets (oral semaglutide) — 1.5 mg

Your cheapest verified route right now

verified price

$149 /month

NovoCare Pharmacy self-pay

Verified Aug 27, 2026 · novocare.com

Per year at 12 fills
$1,788
A plan exclusion is not the end. Under ACA rules you have 180 days to appeal, and secondary indications (sleep apnea for Zepbound, cardiovascular risk for Wegovy) run through different criteria. See your PBM's policy page.
Before your next appointment: at 4 mg your cheapest route (NovoCare Pharmacy self-pay) goes to $199/month — $50/month more than your current dose. WalletNoise shows the cost of a dose change, never whether to make one — that's your prescriber's call. Verified Aug 27, 2026 ·novocare.com
Plan the whole climb, not just this month Price every fill between any two doses, over 3 to 24 months, on the dates each one actually falls. Dated price changes are already in the arithmetic. Calculate ramp cost

Every route we can price

Verified prices outrank cheaper estimates. Reference rows inform, never win.

  1. Rank 1

    NovoCare Pharmacy self-pay

    $149/mo
    • Novo's direct channel. Free home delivery. Intro offers for new patients are time-limited.

    Verified Aug 27, 2026 · novocare.com

Share or post this breakdown

Posting in r/Zepbound, r/Mounjaro, or a patient group? Copy a formatted markdown comparison with verified source citations:

Markdown Summary

Not your situation?

The same dose, priced the other ways it can be paid for. Most people arrive unsure which of these they are in — and it changes the answer more than anything else on this page.

Paying cash — uninsured, or not using insuranceCommercial plan that covers itMedicareMedicaid

Fighting a denial instead?

Coverage criteria and appeal routes, from the payers' own documents:

Aetna (CVS Health)Blue Cross Blue Shield Federal Employee Program (FEP)CVS CaremarkElevance Health / Anthem (CarelonRx)Express Scripts (Evernorth / Cigna)HumanaKaiser PermanenteMedicaid (state-by-state)Medicare (Part D + GLP-1 Bridge)Optum Rx (UnitedHealthcare)