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Glucagon-like peptide-1 (GLP-1) medications for weight management and diabetes have become one of the most closely watched cost drivers in employer-sponsored health plans. As plan sponsors weigh whether and how to cover these drugs, a separate market has developed alongside the traditional benefit structure.

Employees are increasingly obtaining GLP-1s through direct-to-consumer (DTC) channels that operate entirely outside their group health plan, whether or not their employer offers coverage. Industry reports show that major employers are pulling back on weight-loss drug coverage even as direct-to-patient prices for two GLP-1 medications now start at $149 per month, although this cost is still a meaningful expense for many patients. This dynamic means that the coverage decision an employer makes is no longer the only factor determining whether an employee can access these medications. It is one input into a landscape that also includes manufacturer pricing programs, a new federal pricing platform, and DTC telehealth services.

This article explores GLP-1 self-pay options and ways employers can support employees, regardless of their plan’s coverage status.

The Rise of the Self-pay Market

Health plans cover prescription drugs through a formulary, which is the list of medications the plan will pay for. Historically, a drug excluded from a formulary was simply unavailable to most employees unless they paid full retail price, which for GLP-1 medications has commonly exceeded $1,000 per month. However, that reality is changing as manufacturers have introduced DTC pharmacy programs, the federal government has launched a cash-price platform, and telehealth companies have built businesses around prescribing and fulfilling GLP-1 prescriptions outside insurance entirely. Employees who are told a medication is not covered or who face a high deductible before coverage applies now have several options to pursue the medication on their own. Employers who understand these channels are better positioned to guide employees toward the safest and most cost-effective ones, regardless of the plan’s formulary coverage.

Self-paying for GLP-1s

Employees pursuing GLP-1 medications without relying on employer coverage generally use one or more of the following channels.

Manufacturer DTC Pharmacies

Eli Lilly operates LillyDirect, and Novo Nordisk operates NovoCare Pharmacy, both of which sell select medications directly to self-pay patients at reduced cash prices. Through the Zepbound Self Pay Journey Program, Lilly prices single-dose vials starting at $299 per month for the 2.5 milligram (mg) dose, $399 for the 5 mg dose and $449 per month for higher doses, provided the patient refills within 45 days of the previous shipment.

For its newer oral medication Foundayo, Lilly’s self-pay price starts at $149 per month for the lowest doses, with certain doses temporarily reduced through the end of 2026. Novo Nordisk prices self-pay Wegovy tablets at $149 to $299 per month, depending on the dose, and Wegovy pens at an introductory $199 per month for new patients, increasing to $349 or $399 per month. These programs require a valid prescription but operate independently of insurance.

Manufacturer Savings Cards for Commercially Insured Patients

Separate from the self-pay programs, both manufacturers offer copay cards that reduce out-of-pocket costs for patients with commercial insurance, regardless of whether that insurance covers the specific GLP-1 medication.

Lilly’s Foundayo Savings Card can lower the monthly cost for patients whose plan covers the drug, subject to monthly and annual maximums, while patients with commercial insurance that does not cover Foundayo can use the same program structure to access the self-pay pricing. These cards uniformly exclude patients enrolled in Medicare, Medicaid and other government-funded health programs.

TrumpRx and Most-Favored-Nation Pricing

In 2026, the federal government launched TrumpRx, a website that lists cash prices for a limited set of brand-name medications negotiated under Most-Favored-Nation pricing agreements with manufacturers. The platform lists Wegovy tablets at $149 per month, the Wegovy pen at $199, Ozempic at $199 and Zepbound at $299, each substantially below list price. Savings across the roughly 40 listed drugs range from 33% to 90% off list prices.

TrumpRx does not accept insurance, so purchases made through the platform do not count toward a plan’s deductible or out-of-pocket maximum, and enrollees in Medicare, Medicaid, TRICARE, Veterans Affairs or other government-funded programs are not eligible to use it. Because the discounts are measured against manufacturer list prices rather than negotiated insurer rates, the displayed savings do not necessarily reflect what an insured employee would already pay through the health plan.

DTC Telehealth Platforms

Telehealth providers, such as Hims and Hers Health and Ro, combine an independent telehealth evaluation with prescription fulfillment, charging a membership fee separate from the cost of medication. Hims prices its ongoing membership at $149 per month following a discounted first month, with GLP-1 medications billed separately starting at $149 per month for lower-dose oral options and $299 per month for Zepbound. Ro follows a similar structure, with membership starting at $74 per month on an annual plan and medication pricing that the company states matches the cash prices available through LillyDirect, NovoCare and TrumpRx.

These platforms provide a prescriber and pharmacy fulfillment in a single online transaction, which appeals to employees who don’t have easy access to a prescribing physician or who prefer not to involve their employer-sponsored plan at all.

Using HSAs and FSAs for GLP-1s

A GLP-1 medication does not need to be covered by the health plan to be eligible for payment through a health savings account (HSA) or flexible spending account (FSA). The determining factor is not insurance coverage but the reason the medication was prescribed. The IRS treats amounts paid for weight-loss treatment as a qualified medical expense when the treatment addresses a specific disease diagnosed by a physician (e.g., obesity, high blood pressure and heart disease). The same standard applies when the purpose of the weight loss is to treat a specific disease diagnosed by a physician rather than to improve appearance, general health, or sense of well-being. Since GLP-1s require a prescription and obesity and Type 2 diabetes are diagnosable conditions, purchases made through any of the self-pay channels described above are generally eligible for HSA or FSA reimbursement when documentation links the prescription to a diagnosed condition, regardless of whether the plan itself covers the drug.

Manufacturers acknowledge this distinction on their own consumer sites. Lilly marks both the commercial and self-pay Foundayo pricing tiers as HSA- and FSA-eligible, noting that eligibility may vary by plan and directing patients to confirm with their benefits administrator. Telehealth platforms draw a narrower line: Hims notes that the medication fee itself is FSA- and HSA-eligible, but the separate membership fee is not, and an FSA or HSA card generally cannot be used as the payment method on file, requiring the employee to pay with a standard card and submit the medication portion for reimbursement afterward. TrumpRx sits differently again, since its coupons generally cannot be combined with insurance, though the site for at least one manufacturer notes separately that the underlying expense may still be eligible for HSA reimbursement.

Employees navigating any of these programs should keep an itemized receipt showing the medication, dose and prescribing clinician, and should confirm reimbursement rules with their plan administrator before assuming an expense qualifies.

How Employers Can Support Employee GLP-1 Use Without Adding a Formulary Benefit

An employer’s decision not to add GLP-1 medications to the formulary does not have to mean the organization has no role to play. Several forms of support are available without expanding drug coverage. Consider the following actions:

• Clarify HSA and FSA eligibility for employees. Because eligibility depends on diagnosis rather than plan coverage, employers can help employees understand that a letter of medical necessity from a prescriber, tied to a diagnosis (e.g., obesity and Type 2 diabetes), is typically what determines whether a self-pay purchase qualifies for reimbursement.
• Point employees toward manufacturer and federal resources. Many employees may be unaware that LillyDirect, NovoCare Pharmacy and TrumpRx exist or that a savings card may apply even when a specific drug is excluded from the formulary. Including this information in open enrollment materials or a benefits FAQ can help employees find lower-cost options rather than paying full list price or turning to unverified sources.
• Explain how self-pay purchases interact with the health plan. Employees should understand that amounts paid through TrumpRx, LillyDirect, NovoCare or a telehealth platform typically do not count toward the plan’s deductible or out-of-pocket maximum, since those purchases are not processed through insurance.
• Review how the organization’s account-based plans are structured. Employers offering an HSA, FSA or health reimbursement arrangement should confirm with their administrator how documentation for GLP-1 reimbursement claims is handled, since dual-purpose medications prescribed for weight management can require more substantiation than a standard prescription claim.
• Coordinate with existing wellness and telehealth vendors. If the organization already offers a telehealth benefit or wellness program, employers can clarify for employees how that benefit relates to or differs from consumer platforms like Hims, Hers and Ro, so employees understand which resources are already included in their benefits package.