Manufacturer direct-pay program
Both Lilly and Novo Nordisk run self-pay programs for people without coverage. Pricing tiers change frequently — check the official program page for current rates.
GLP-1 prior authorization
You are trying to work out what this will cost you per month.
Reference and calculator, not medical advice. This page explains how something works; it does not tell you what to take. Last reviewed August 2026.
Prior authorisation is your plan requiring approval before it will pay, and for GLP-1s it is close to standard rather than exceptional. It is not a judgement about you; it is a cost-control step applied to an expensive class.
The criteria are usually published by the plan, and knowing them before the request is submitted is the difference between one round and three. They commonly involve the documented indication, sometimes a BMI threshold for weight-management use, and occasionally a record of previously tried approaches — but the specifics belong to your plan and are worth reading directly rather than inferred from a page like this.
Where the price comes from
The routes people actually pay through, and what determines the number in each.
Through insurance (copay)
If your plan covers the drug for your indication, your cost is the plan copay. Coverage for weight-loss indications is far less common than for type 2 diabetes.
Telehealth platform (brand drug)
Online clinics bundle a prescriber visit with brand-name medication. Membership fee is usually separate from drug cost.
Compounded semaglutide / tirzepatide
Compounded versions are prepared by pharmacies rather than the original manufacturer. Availability and legality depend on FDA shortage status, which has changed several times — verify current status before relying on this route.
Retail pharmacy cash price
List price without insurance, sometimes reduced by discount cards.
Common questions
- Who submits it?
- Your prescriber’s office, using the plan’s form. Your part is making sure they have the documentation the criteria ask for.
- Does approval last?
- Usually for a defined period, after which reauthorisation is needed, sometimes with evidence of response. Worth knowing the expiry date rather than discovering it at the pharmacy.
- What is a formulary exception?
- A separate request asking the plan to cover something not on its list, or at a better tier. Different process from prior authorisation, and your plan documents describe both.
Common questions
- Why do quoted GLP-1 prices vary so much?
- Because the quotes are not measuring the same thing. A membership fee, a per-vial price, and a per-pen price all describe different quantities, and the dose you are on determines how long that quantity lasts. Converting everything to cost per milligram is the only way to compare them directly.
- Does insurance usually cover this?
- Coverage is far more common for type 2 diabetes indications than for weight management. Whether your specific plan covers your specific indication is something only your plan documents can answer.
Sources and last review
This page is general reference rather than a dosing table, so it quotes no figures from a label. Nothing here is reviewed by a clinician, and this site does not employ one — which is exactly why what I do publish stays traceable to its source.
- This page carries no product-specific dosing figures. The labels behind everything on this site are listed on the sources page, and the originals live on DailyMed.
Transcribed from the labels above and checked by me — Gavin, who builds this site, takes a GLP-1, and is not a clinician. Last reviewed August 2026. Found an error? [email protected] — I treat corrections as bugs. How this site is built and funded.
Also searched as: glp 1 prior authorization criteria · glp 1 formulary