Cost & Insurance

Open Enrollment 2027: Does Your Plan Cover the Wegovy Pill or Foundayo?

Two documents, one phone call, and a December 15 deadline decide whether next year’s plan pays for a daily GLP-1 pill.

October 31, 2026 · 8 min read · Last checked: October 31, 2026

Whether a 2027 health plan covers the Wegovy pill or Foundayo comes down to two things: whether the plan pays for weight-loss drugs at all, and how each pill sits on its drug list. On HealthCare.gov, Open Enrollment for 2027 runs November 1 through January 15, and you must pick a plan by December 15 for coverage that starts January 1. Check both answers before you choose.

This guide shows where to look, what to ask, and what the manufacturers charge if your plan says no. Every price below comes from an official manufacturer page checked on October 31, 2026.

The deadlines that matter

Different kinds of coverage have different enrollment windows. Find your row, then work backward from its deadline.

If your state runs its own marketplace instead of HealthCare.gov, confirm the dates on your state’s site. Medicare follows separate rules, including a temporary federal program for weight-management GLP-1s; the section on your options if a plan says no covers it briefly.

What you are checking coverage for

Two daily pills are FDA-approved for chronic weight management. Plans may treat them differently, so search for each by name.

Wegovy tablets (the “Wegovy pill”)

The Wegovy pill is oral semaglutide from Novo Nordisk. Its current FDA label, revised June 2026, covers both Wegovy tablets and Wegovy injection. The tablets step up from 1.5 mg to 4 mg, 9 mg, and a 25 mg maintenance dose.

That shared label matters for coverage. A drug list that says “Wegovy” may refer to the pen, the tablet, or both. Ask the plan which form and strengths it means.

Foundayo (orforglipron)

According to Eli Lilly, the FDA approved Foundayo on April 1, 2026. It is taken once daily, with or without food. Doses range from a 0.8 mg starting dose up to a 17.2 mg maximum.

Because Foundayo is newer, some formularies may not list it yet. Ask directly rather than assuming silence means a no. For a side-by-side look at the two pills, see our Foundayo vs oral Wegovy comparison.

How to read a formulary in five steps

A formulary is a plan’s list of covered prescription drugs, also called a drug list. You can usually find it on the plan’s website or in its enrollment materials. Use the version for the 2027 plan year, not this year’s.

1. Find the 2027 drug list. Open the plan’s formulary document or drug search tool. Confirm the plan year printed on it.
2. Search both brand and generic names. Try “Wegovy,” “semaglutide,” “Foundayo,” and “orforglipron.” Note whether each entry says tablet, pen, or both.
3. Record the tier. The tier sets your share of the cost. A drug on a high or specialty tier can cost far more than one on a preferred tier.
4. Read the codes next to the drug. Most lists use abbreviations such as PA (prior authorization), ST (step therapy), and QL (quantity limit). The key is usually on the first pages.
5. Check the exclusions section. A drug can appear on a list and still be excluded for a specific use, such as weight loss. Read the next section before you count a listing as a yes.

Weight-loss drug exclusions: the bigger hurdle

Many people get stuck here, not on the formulary. HealthCare.gov defines excluded services as care that a plan does not pay for or cover. Some plans list weight-loss medication as an excluded service, which can block coverage even when the drug appears on the formulary for another use.

Look in two documents. The Summary of Benefits and Coverage (SBC) is a short, standard comparison sheet you get when you shop for, renew, or change coverage. The full plan document, often called the evidence or certificate of coverage, has the complete exclusion list.

Words to search for

• “Weight loss,” “weight management,” “obesity,” or “anti-obesity”
• “Excluded services” or “services your plan generally does not cover”
• “Rider” or “optional benefit,” which can mean coverage is available only if an employer added it

With an employer plan, the employer often decides whether weight-loss drugs are included. HR or the benefits portal can tell you whether the 2027 plan includes them. Ask for the answer in writing.

Prior authorization and other rules

Prior authorization means the plan must approve the drug before it will pay. A covered drug with a PA code still needs paperwork from your prescriber, and approval is not automatic.

Plans set their own criteria and renewal periods. The only reliable way to know them is to ask the plan. Use this checklist on the phone or in the member chat, and write down the date and the representative’s name.

If a drug is not on the formulary, plans generally have an exception process your prescriber can start. An exception is a different question from a benefit exclusion, so ask whether an exception can apply when weight-loss drugs are excluded.

Manufacturer self-pay prices, checked today

Both manufacturers publish cash prices for people paying without insurance. These figures come from NovoCare and LillyDirect, checked October 31, 2026. A month means 30 tablets.

*Lilly says its 2.5 mg and 5.5 mg prices are temporarily reduced through December 31, 2026. For the 14.5 mg and 17.2 mg doses, regular prices apply if you don’t refill within 45 days. Lilly notes that taxes and fees may apply and that it can change or end the offer.

Savings cards for commercial insurance

If your commercial plan covers the drug, both companies offer savings cards. NovoCare says eligible patients may pay as little as $25, with savings capped at $100 a month. Lilly says eligible commercially insured patients may pay as little as $25 a month for Foundayo.

Both programs say government beneficiaries are excluded, which generally means people whose drugs are paid through programs such as Medicare or Medicaid. Read the full terms, which either company can change. For more on whether the cash price makes sense, read our analysis of oral Wegovy at $149 a month.

If your plan says no

A no during enrollment still leaves options. Weigh them in this order.

1. Compare another plan. If you are shopping on the Marketplace, a different 2027 plan may cover weight-management drugs. Check its formulary and exclusions the same way before December 15.
2. Ask about an exception. If the drug is simply off the formulary, your prescriber can ask the plan for one. Expect a slower path if weight-loss drugs are excluded entirely.
3. Use the manufacturer’s self-pay price. The table above shows the official cash prices. You still need a valid prescription.
4. If you have Medicare, Medicare.gov says a temporary Medicare GLP-1 Bridge program covers Foundayo and Wegovy (tablet or injection) for eligible people with Part D, with a $50 monthly copay. Eligibility rules are strict, and Medicare’s own site has the details.

Compounded versions also exist, but they are a different category. Compounded medications are not FDA-approved. Our guide to compounded vs FDA-approved oral GLP-1s explains the difference.

Commercial pages may contain paid referral links.