GLP-1 and Your Annual Out-of-Pocket Maximum

GLP-1 and Your Annual Out-of-Pocket Maximum

The cost of semaglutide depends on whether you use the brand-name version or a compounded alternative through a telehealth provider. Brand-name semaglutide costs $1,349/mo, while compounded semaglutide through telehealth costs N/A.

With insurance coverage, your out-of-pocket cost for semaglutide could be as low as $25/mo after OOP max. However, insurance coverage for GLP-1 medications varies significantly by plan and often requires prior authorization.

Ways to Save on GLP-1 Medications

1. GLP-1 costs count toward your annual deductible and OOP max
2. Once you hit OOP max, GLP-1 may become $0 for the rest of the year
3. OOP max in 2026 for ACA plans caps at $9,450 individual / $18,900 family
4. Fill GLP-1 prescriptions after hitting OOP max to maximize savings
5. High-deductible plans pair well with HSA funding for GLP-1 costs

Is semaglutide Worth the Cost?

When evaluating the cost of semaglutide, consider the total value: clinical trials demonstrate significant weight loss results, and the associated health improvements often reduce costs for other medications and medical visits. Many patients find that the monthly cost of GLP-1 treatment is offset by reduced spending on blood pressure medications, diabetes management, and fewer doctor visits.