What GLP-1s Actually Cost
List prices, net costs after rebates, consumer self-pay, and Medicare negotiated prices — side by side for every drug. Includes PMPM trends over time, the PBM transparency problem, and an interactive cost calculator.
Last updated: April 14, 2026
Context
Why "what does a GLP-1 cost?" has no single answer
GLP-1 medications carry at least three different price tags, and the one that matters most to any given buyer depends on who is paying. Wholesale acquisition cost (WAC) — the list price pharmacies pay before rebates — ranges from $649 to $1,349 per month depending on the drug. Almost no one pays this price. It functions primarily as the starting point for rebate negotiations between manufacturers and pharmacy benefit managers (PBMs).
Employer net cost after PBM rebates is what ultimately hits plan budgets, but it varies enormously by contract and is often opaque even to the employer purchasing the benefit. The best published estimate — from EBRI's 2025 analysis of claims data — places employer net costs at $617 to $766 per month for obesity GLP-1s. Some PBMs claim they deliver net costs closer to direct-to-consumer (DTC) prices, but independent verification of these claims is limited.
Consumer self-pay prices of $149 to $449 per month through manufacturer programs (NovoCare, LillyDirect) have created a visible benchmark. Benefits consultants and employers are now comparing these prices to their own plan costs — and in some cases, discovering that their insured cost may exceed what employees could pay out of pocket. EBRI modeling suggests GLP-1 coverage could increase employer-sponsored premiums by 5.3% to 13.8%, depending on utilization and cost-sharing assumptions.
The data
Every drug, every payor
Click any column header to sort. Employer net costs are estimates derived from class-level discount rates (Hernandez & Sullivan, Obesity, 2024) applied to current WAC — not drug-specific negotiated prices. Actual employer costs vary by PBM contract.
| Drug ▼ | Indication ▼ | WAC/mo ▼ | Est. employer net/mo ▼ | Medicare price ▼ | Consumer self-pay/mo ▼ |
|---|---|---|---|---|---|
| Wegovy (injection) | Obesity, CV risk | $1,349 | ~$796 | $385 (IRA); $245 (MFN)³ | $199–$349 (NovoCare) |
| Wegovy (oral tablet) | Obesity | $1,349 | ~$796 | Not separately negotiated | $149–$299 (NovoCare) |
| Ozempic¹ | Type 2 diabetes, CKD | ~$1,027 | ~$421–$472 | $274 (IRA); $245 (MFN)³ | $199–$499 (NovoCare) |
| Rybelsus | Type 2 diabetes | ~$998–$1,028 | ~$422–$473 | $274 (IRA) | Not in DTC programs |
| Mounjaro | Type 2 diabetes | ~$1,069 | ~$438–$492 | $245 (MFN) | ~$995–$1,200 (no DTC vials) |
| Zepbound | Obesity, OSA | ~$1,086 | ~$641 | Not separately negotiated | $299–$449 (LillyDirect) |
| Foundayo² | Obesity | $649 | Unknown (new) | $50/mo copay (Bridge Demo, Jul '26) | $149–$349 (LillyDirect) |
IRA = Inflation Reduction Act negotiated price (effective Jan 2027). MFN = Most Favored Nation deal between the Trump administration and manufacturers (announced Nov 2025).
WAC sources: Managed Healthcare Executive (Apr 2026); Drugs.com; GoodRx; OptumRx/Asembia (Mar 2026); Fierce Pharma (Apr 2026). Employer net: Derived from Hernandez & Sullivan, Obesity, Mar 2024 (PubMed 38228492); ~41% discount for obesity GLP-1s, ~54–59% for diabetes GLP-1s. Medicare: CMS IRA Round 2 negotiated prices (Nov 25, 2025); Trump administration MFN deal (Nov 6, 2025). Consumer self-pay: NovoCare; LillyDirect; manufacturer press releases. Post-2027 projected pricing is covered in the regulatory timeline section below.
¹ Ozempic WAC note: Medfinder and KFF cite ~$935.77/month; Drugs.com and Ro.co cite ~$1,027–$1,028. The higher figure is more consistent with Novo Nordisk's stated 35% reduction to $675. The ~$936 figure may reflect an older database snapshot or specific NDC.
² Foundayo note: Only one source (Fierce Pharma citing Jefferies analyst note) provides the $649 WAC. Lilly's press materials emphasize self-pay pricing ($149+) but do not prominently display WAC. Not yet confirmed in a formal Lilly press release. Employer net cost is unknown — the drug launched April 9, 2026 and no rebate data exists. If obesity-class discounts (~41%) eventually apply, estimated net would be ~$383/month.
³ Medicare price conflict: The Trump administration's MFN deal with Novo Nordisk set a price of $245/month for Ozempic and Wegovy — lower than the IRA-negotiated $274/$385. How these two prices interact has not been clarified by CMS.
Want to model these costs for your specific plan?
Use the interactive cost calculator ↓Trend data
GLP-1 per-member-per-month cost over time
After estimated rebates and discounts. PMPM cost is the GLP-1 spend divided across all plan members, not just those taking the drug. From 2019 to 2024, this figure grew at a 77% annualized rate — though the pace has moderated as the base has grown larger (Q1 2025 vs. 2024 represents roughly 13% growth).
| Year | GLP-1 PMPM (after rebates) | Source |
|---|---|---|
| 2019 | ~$1.50 | WTW Rx Collaborative; AssuredPartners |
| 2022 | $4.34 | WTW Rx Collaborative |
| 2023 | $11.00 | WTW Rx Collaborative |
| 2024 | >$24.00 | WTW Rx Collaborative; AssuredPartners |
| Q1 2025 | $27.23 | WTW Rx Collaborative |
Source: WTW, "GLP-1 Drugs in 2025: Cost, access and future of obesity treatment," Apr 11, 2025 (wtwco.com); Atria Insurance/AssuredPartners, Aug 2025.
Pricing transparency
PBM transparency and the employer cost gap
The gap between what employers think they pay for GLP-1s and what they actually pay remains poorly documented — in part because PBM contracts have historically made this difficult to determine. Below are the published data points that shed light on this dynamic.
For context: PBMs argue that rebates subsidize premiums for the entire plan population — not just GLP-1 users — and that pass-through pricing models often carry higher administrative fees that can offset rebate savings. These are legitimate structural considerations. The data above does not resolve whether current PBM arrangements are net positive or negative for any individual employer; it documents the transparency gaps that make that determination difficult.
Use of alternative PBMs increased approximately 19% from 2024 to 2025, while reliance on the Big 3 PBMs decreased approximately 11%. Among large employers, 75% have or will put their PBM out to bid, and 49% already use transparent/pass-through contracts (with another 22% planning to adopt them).
Sources: Mintz PBM Policy Update, Nov 2025; WTW 2025 Best Practices Survey.
What's changing
Announced price changes and regulatory timeline
Several converging forces — WAC reductions, new lower-priced entrants, FTC enforcement, and legislated PBM reform — will reshape GLP-1 economics between now and 2029. Here is the confirmed timeline.
Value assessment
Cost-effectiveness at current and future prices
The most comprehensive published cost-effectiveness analysis of GLP-1s for obesity was conducted by Hwang et al. and published in JAMA Health Forum in March 2025.
Hwang et al., JAMA Health Forum (2025)
Using SSR Health manufacturer discount data, the authors modeled a population of 126 million eligible U.S. adults based on 2017–2020 NHANES clinical trial criteria. Net prices used were approximately $520/month for tirzepatide and $701/month for semaglutide. The analysis assumed a lifetime time horizon, with weight loss in the first two years and first-year discontinuation from adverse events, measured in 2023 U.S. dollars.
To reach the $100,000/QALY cost-effectiveness threshold, tirzepatide would need to reach approximately $4,334/year (~$361/month) — an additional 30.5% discount beyond current net prices. Semaglutide would need to reach approximately $1,522/year (~$127/month) — an additional 81.9% discount. Notably, naltrexone-bupropion was found to be cost-saving, with an 89.1% probability of cost-effectiveness at $100,000/QALY due to its far lower cost.
At Novo Nordisk's announced $675/month WAC (effective January 2027), applying the same ~41% obesity rebate yields an estimated employer net of ~$398/month (~$4,781/year). This is still above the tirzepatide cost-effectiveness threshold of $4,334/year and far above semaglutide's $1,522/year threshold. Even with the WAC reduction, GLP-1s for obesity may not reach standard cost-effectiveness benchmarks without additional competitive pressure from pipeline drugs or further price reductions.
Source: Hwang JH, Laiteerapong N, Huang ES, Kim DD. JAMA Health Forum. 2025;6(3):e245586. DOI: 10.1001/jamahealthforum.2024.5586
Model it
What would GLP-1s cost your plan?
Adjust the inputs below to estimate GLP-1 plan costs under different pricing scenarios. All outputs update in real time.
GLP-1 plan cost estimator
Select a drug, adjust discount assumptions, and model total plan impact.
Employer net costs are estimates derived from published discount rates (Hernandez & Sullivan, Obesity, 2024). They do not reflect any individual employer's actual PBM contract. Actual costs may be higher or lower. Self-pay comparison uses representative midpoint values from manufacturer DTC programs — actual self-pay ranges vary by dose and program (see pricing table above). "Annual cost per treated member" reflects the months-on-treatment input, not a full 12-month rate. Months-on-treatment default based on Prime Therapeutics persistence data for H1 2024 initiation cohorts. This calculator does not incorporate PBM administrative fees or member cost-sharing offsets.
Methodology
How this page was built
All data on this page is drawn from publicly available sources: peer-reviewed studies, government filings, manufacturer press releases, industry surveys, and reports from research organizations. Where sources conflict — as with the Ozempic WAC or the Medicare IRA vs. MFN pricing — both figures are presented with the conflict noted. Employer net cost estimates are derived from class-level manufacturer discount rates published in Hernandez & Sullivan (Obesity, 2024) and are clearly labeled as estimates, not observed plan-level data. No data points have been inferred or extrapolated beyond what the source material supports; gaps are noted as gaps. This page is reviewed and updated as new data becomes available. Corrections and updates can be submitted via the contact page.
References
Sources
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