Open Enrollment 2027: A Plan-Picking Checklist for GLP-1 Patients

If you take a GLP-1 or plan to start one in 2027, the health plan you pick this fall can be the difference between a $25 copay and paying several hundred dollars a month out of pocket. The checklist below walks through what to confirm, in order, before the deadline: December 7, 2026 for Medicare, December 15 for a January 1 start on HealthCare.gov, and whatever date your employer set.

Step 1: Put your deadlines on the calendar

Missing the window usually means waiting a full year unless you have a qualifying life event.

Step 2: Write down exactly what you take and why

Formularies list drugs by name, and coverage rules often depend on the diagnosis. Before you compare plans, gather:

• The exact product and form: Wegovy pen, Wegovy pill, Zepbound KwikPen, Zepbound vial, Mounjaro, Ozempic, Foundayo or another
• Your current dose and the dose your prescriber expects you to reach
• The diagnosis on the prescription: type 2 diabetes, chronic weight management, obstructive sleep apnea, cardiovascular risk reduction, or MASH
• Your starting BMI and weight, plus any related conditions your prescriber has documented

This matters because the same molecule can be covered under one indication and excluded under another. A plan may cover Mounjaro for diabetes and still exclude Zepbound for weight loss.

Step 3: Read the 2027 formulary, not the 2026 one

Formularies change on January 1. A drug covered this year can be moved, restricted or dropped next year.

1. Find the right document. On HealthCare.gov, add your drugs in the plan comparison tool. For Medicare, use Medicare.gov's plan finder with your drug list. For employer coverage, ask HR or your pharmacy benefit manager for the 2027 formulary.
2. Search your drug by brand name. Check every form you might use. Some plans cover a pen but not a pill, or one brand but not another.
3. Note the tier. Lower tiers usually mean a flat copay. Specialty tiers often mean coinsurance, a percentage of the price, which can be expensive before you hit your out-of-pocket maximum.
4. Check for a weight-management exclusion. Look in the plan's exclusions section or the Summary of Benefits and Coverage. Some plans list GLP-1s but exclude "drugs for weight loss."

Step 4: Decode the restriction codes

Next to a covered drug you'll often see letters. They tell you what you'll have to do before the pharmacy can fill it.

If you're already on a GLP-1 and switching plans, ask whether the new plan offers a transition fill while prior authorization is pending. A gap of even a couple of weeks can mean restarting at a lower dose, which is a call your prescriber should make, not the pharmacy.

Step 5: If you have Medicare, check two things

Your Part D or Medicare Advantage drug coverage

Medicare drug plans generally don't cover GLP-1s for weight loss alone, but they may cover them for type 2 diabetes, sleep apnea or fatty liver disease. If that's your situation, compare plans with your exact drug in the Medicare plan finder.

The Medicare GLP-1 Bridge

For weight management, the temporary Medicare GLP-1 Bridge covers Wegovy (injection or pill), Zepbound KwikPen and Foundayo for a $50 copay per month supply. CMS says it has been extended through December 31, 2027. According to Medicare.gov, you must have Part D coverage through a standalone drug plan, an MA-PD plan, a Special Needs Plan, an employer group waiver plan or the LI NET program, and meet BMI-based criteria:

• BMI of 35 or higher, or
• BMI of 30 or higher with heart failure with preserved ejection fraction, uncontrolled high blood pressure, or stage 3a or later chronic kidney disease, or
• BMI of 27 or higher with prediabetes, a prior heart attack or stroke, or symptomatic peripheral artery disease

People with type 2 diabetes, moderate-to-severe sleep apnea or fatty liver disease aren't eligible for the Bridge, because their Part D plan may cover a GLP-1 for those conditions. The $50 copay doesn't count toward your Part D deductible or out-of-pocket limit and can't be lowered by Extra Help. Your prescriber completes the prior authorization, which Medicare says covers refills and dose changes through 2027 unless you switch drugs.

So the plan you pick still matters: you need some form of Part D coverage to use the Bridge at all.

Step 6: Price the full year, not just the copay

A plan with a lower premium and no GLP-1 coverage can still beat a richer plan once you count manufacturer self-pay prices. Run both numbers.

• Covered option: 12 months of premiums + drug cost until your deductible is met + copay or coinsurance after that.
• Self-pay option: 12 months of a cheaper plan's premiums + manufacturer self-pay.

For reference, Lilly's Zepbound savings page lists KwikPen self-pay at $299 (2.5 mg), $399 (5 mg), and $449 for 7.5 mg and up with its savings card if you refill within 45 days. Novo's Wegovy page lists the pill at $149 to $299 a month by dose, and the pen at $349 after a $199 introductory price that ends Dec. 31, 2026. Self-pay purchases don't count toward your deductible. Both companies' pages reference changes after December 31, 2026, so recheck in January.

Commercially insured patients whose plan covers Zepbound may qualify for Lilly's savings card, which can lower a pen fill to as little as $25, with caps of $100 off per month and $1,300 a year. Government-insured patients can't use manufacturer copay cards.

Step 7: Confirm your prescriber and pharmacy fit the plan

• Network: If you see an in-network doctor today, confirm they're in the new plan's network for 2027. If you use a telehealth prescriber, ask whether they bill insurance or are cash-only.
• Prior authorization help: Ask your prescriber's office whether they'll submit a PA for the new plan in early January and what records they need.
• Pharmacy: Check whether the plan requires mail-order or a specialty pharmacy, and whether that pharmacy ships refrigerated medication to your address.

Your printable checklist

1. Mark your deadline. Dec. 7 (Medicare), Dec. 15 or Jan. 15 (marketplace), or your employer's date.
2. List your drug, dose and diagnosis. Include your starting BMI.
3. Find each plan's 2027 formulary. Search your exact drug and form.
4. Record tier and codes. PA, ST, QL, specialty pharmacy.
5. Check exclusions. Look for "weight loss" or "anti-obesity" exclusions in plan documents.
6. Medicare: check Bridge eligibility. Call 1-800-MEDICARE if unsure.
7. Price 12 months both ways. Covered plan versus cheaper plan plus self-pay.
8. Confirm your prescriber and pharmacy. Network, PA support, cold-chain shipping.
9. Plan for January. Order your last 2026 refill early and ask about transition fills.

Changes in drug, dose or schedule because of coverage should go through your prescriber. If coverage falls through and you're thinking about pausing or switching, ask them how to restart safely rather than resuming at your old dose on your own.