Jun 8, 2026 at 7:09 AM#6
My A1C is 5.4, which is normal, not prediabetes. So that avenue doesn't work for me. I've looked into it thoroughly. My fasting glucose is 92, fasting insulin is 8. Metabolically I'm annoyingly healthy for someone with a BMI of 38. All my health issues are mechanical — joint pain, sleep apnea, back problems. But insurance doesn't care about those for GLP-1 coverage.
34 4tane_welly, Dr.PathRoch, mona_PHX and 31 others
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Jun 8, 2026 at 8:09 AM#7
I'm also on FEHB (federal employee plan). Important update for 2026: Several FEHB plans added Zepbound coverage for the new plan year. Check:
- GEHA Elevate Plus — added Zepbound, tier 4, $150 copay
- MHBP Standard — added Zepbound with PA, 30% coinsurance
- Kaiser Mid-Atlantic — covers Zepbound, $100 copay
FEHB open season is November 10 - December 8. You can switch plans. It might be worth doing the math on premium difference vs. Zepbound coverage.
33 3laura_annarbor, JenMemphis, pat_auckland and 30 others
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Jun 8, 2026 at 9:09 AM#8
Thank you for this. I'm going to look at GEHA Elevate Plus. If the premium increase is less than $1,059/month (current cash price), switching plans is a no-brainer. Even at $150 copay plus whatever premium increase, it should be dramatically cheaper.
Last edited: Jun 8, 2026 at 2:09 PM
32 2mona_PHX, andrew_nyc, Dr.EndoEP and 29 others
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Shop Reference StandardsJun 8, 2026 at 10:09 AM#9
The Zepbound vs Mounjaro coverage disparity is a huge policy issue right now. The CBO estimated that if Medicare covered anti-obesity medications (currently excluded by statute), it would cost $35 billion over 10 years. That's why private insurers are also hesitant — the cost exposure is enormous.
The Treat and Reduce Obesity Act has been reintroduced in Congress and would require Medicare Part D to cover FDA-approved anti-obesity drugs. If that passes, private insurers will likely follow within 2-3 years. But right now, weight management drugs are one of the last categories where insurers can legally just say no.
Last edited: Jun 8, 2026 at 11:09 AM
31 1Dr.BariatricHTX, LindaRN_retired, tommy_boulder and 28 others
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Jun 8, 2026 at 2:56 PM#10
I gave up fighting insurance entirely. I use Zepbound through Lilly's direct program at $550/month (they dropped the price for self-pay in late 2025). Is it ideal? No. But I was spending more time and mental energy fighting my insurance than I was spending on the medication itself. Sometimes the path of least resistance is worth the premium.
Last edited: Jun 8, 2026 at 7:56 PM
43 16Dr.EndoIndy, tom_AK, josh_phd_bmore and 40 others
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