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The true cost of Ozempic might be higher than we thought
The delay in implementation of the BALANCE Model within Medicare Part D will not affect plans for implementation of the model within Medicaid beginning in 2026
The food mass can cause life-threatening blockages and obstructions
10.1016/j.bbr.2025.115742 29 HunterK.HlscherC
But when it reaches the market, here's what to expect based on the current GLP-1 insurance landscape: If Approved for Type 2 Diabetes Most commercial insurance plans will cover it, especially if it demonstrates A1C reduction comparable to or exceeding tirzepatide Prior authorization will likely be required Step therapy (try metformin first, then other agents) is standard Copays with manufacturer savings: potentially $25$50/month If Approved for Obesity/Weight Management Coverage remains highly variable, and many plans still exclude weight management medications Medicare Part D: Congress has been debating coverage of anti-obesity medications, but it remains excluded as of early 2026 Self-insured employers increasingly adding GLP-1 coverage, but it's employer-specific Expect significant prior authorization requirements (BMI thresholds, failed diet attempts) The practical reality: even when retatrutide is approved, many people will face the same insurance barriers that currently exist for Wegovy and Zepbound
