If you work in primary care, chances are you’re talking about GLP-1 prescriptions for weight loss multiple times a day. Maybe you're explaining why Wegovy isn’t covered, managing labs and titration schedules, or helping a patient understand why they regained weight after stopping. It's a challenging landscape, and we’re all trying to keep up.
It’s a fast-moving world out there — new FDA approvals, new insurance rules, and a steady stream of patient questions. We’ll break down what matters most in day-to-day GLP-1 prescribing, from indications to insurance pitfalls to what’s next on the horizon.
(This info is current at the time of publishing. Always double-check the most current FDA label or corporate press release — indications, titrations, and payer coverage are changing rapidly.)
Let’s start with a quick rundown of the major players — Ozempic, Wegovy, Mounjaro, and Zepbound —and what they’re actually approved to treat:
Ozempic (semaglutide injection)
Type 2 diabetes mellitus, adjunct to diet and exercise
To reduce major adverse cardiovascular events (MACE: Cardiovascular death, nonfatal myocardial infarction, stroke) in adults with Type 2 diabetes mellitus and established cardiovascular disease
Approved (Jan 2025) to reduce the risk of chronic kidney disease progression and cardiovascular death in Type 2 Diabetes mellitus and chronic kidney disease
Rybelsus (oral semaglutide)
Type 2 Diabetes mellitus, adjunct to diet and exercise
To reduce major adverse cardiovascular events (MACE: Cardiovascular death, nonfatal myocardial infarction, stroke) in patients with Type 2 Diabetes at high risk for MACE
Mounjaro (tirzepatide injection)
Type 2 Diabetes mellitus, adjunct to diet and exercise
No current FDA indication for weight loss or cardiovascular disease prevention (though trials are ongoing)
Wegovy (semaglutide injection, higher max dose for weight loss)
- Adults with obesity (BMI ≥30)
- Adults with overweight (BMI ≥27) plus at least one weight-related comorbidity
To reduce the risk of major adverse cardiovascular events in adults with obesity or overweight and established cardiovascular disease
Recently approved for noncirrhotic metabolic-associated steatohepatitis (with F2–F3 fibrosis) in adults
Zepbound (tirzepatide for weight loss)
Chronic weight management in adults with obesity or overweight, plus at least one comorbidity
Moderate-to-severe obstructive sleep apnea (OSA) in adults with obesity
Even when the indications are met, insurance coverage for GLP-1s isn’t guaranteed. Plans vary widely, even within the same insurer. A few practical tips to consider when navigating insurance coverage and prior authorizations.
Encourage patients to verify coverage before their visit. This saves time and frustration (for both the patient and the clinician).
Expect prior authorization requests. Most plans want documentation of prior weight loss attempts (diet apps, coaching, nutrition programs, etc.) and comorbidities
For CVD prevention (Wegovy): Document prior MI, stroke, PAD, or revascularization.
For MASH (Wegovy): Document F2–F3 liver fibrosis (imaging, biopsy, or scoring systems).
For OSA (Zepbound): Include a sleep study showing AHI, REI, or RDI >15, plus evidence that PAP isn’t working or tolerated.
Note that requirements differ by payer — always check the latest criteria for GLP-1 prior authorization to avoid delays.
If insurance doesn’t cover it, self-pay programs for GLP-1 meds may be an option. These are the current GLP-1 costs for the cheapest options.
Wegovy/Ozempic: $499/month via NovoCare or Costco
Zepbound: $499/month (2.5 mg dose is $349) via LillyDirect (vial form only)
Many patients are accessing GLP-1s through online programs that use compounded versions.
These are not FDA-approved and are not quality-controlled like commercial drugs.
Risks include inaccurate dosing, contamination, and poor storage.
Compounded meds should only be considered when there is a national drug shortage, and no approved product is available.
Wegovy
Start: 0.25 mg weekly, titrate every 4 weeks to 1.7 mg or 2.4 mg
For MASH: 2.4 mg weekly is the recommended dose; reduce to 1.7 mg if not tolerated
Zepbound
Start: 2.5 mg weekly for 4 weeks, then titrate to 5, 10, or 15 mg
Intermediate titration doses (7.5, 12.5 mg) are sometimes not covered beyond 4 weeks
Wegovy: If the next dose is >2 days away, take the missed dose ASAP; if <2 days, skip.
Zepbound: Take missed dose within 4 days; otherwise, skip and resume schedule.
Some patients space out doses (every 10–14 days) to cut costs. This is not guideline-based and may reduce efficacy.
We don’t have a definitive answer yet, but here’s what we do know:
Using GLP-1s for at least 12 months improves outcomes
Stopping often leads to weight regain. A 2022 trial showed patients regained two-thirds of their weight loss within one year of stopping semaglutide
Pre-op guidance:
Most patients should continue taking their glucagon-like peptide-1 (GLP-1) receptor agonists before elective surgery.
Risk of aspiration is higher during the escalation phase and while experiencing GI side effects; consider delaying elective surgery.
For high doses, a 24-hour liquid diet before surgery can reduce aspiration risk.
Patients are often advised to hold their GLP-1 meds for one week prior to a colonoscopy, since it can interfere with bowel prep. This is common practice, though there’s no official guidance yet from the American Gastroenterological Association.
Oral Contraceptives:
Tirzepatide (Zepbound/Mounjaro) may reduce efficacy due to slowed gastric emptying, especially during initiation and escalation.
Recommend switching to a non-oral contraceptive or adding a barrier method for 4 weeks after starting or increasing the dose.
Pregnancy:
Discontinue semaglutide or tirzepatide at least 2 months before a planned pregnancy.
If an unplanned pregnancy occurs, stop the medication immediately.
Recommended for everyone regardless of indication for use
Smaller, more frequent meals
Prioritize protein and fiber
Want to know more? Check out this blog on GLP1 medications and dietary counseling.
Orforglipron, Lilly’s oral GLP-1 (non-peptide), is in late-phase trials. One study showed an average weight loss of 27.3 lbs. Approval may be on the horizon.
Novo Nordisk is developing a high-dose oral form of semaglutide, but it hasn’t yet been FDA-approved. Keep an eye out in early 2026 as this is expected to debut soon.
These medications are transforming how we treat diabetes, obesity, and cardiovascular risk. But as frontline clinicians, we’re left to translate complex approvals and payer requirements into something workable for patients. We’re in the prior-authorization trenches with you, and we’ll keep updating you with what’s next.