Oral GLP-1 Pricing Varies Widely Based on Coverage and Access: Eric Levin

Switching to an oral GLP-1 medication may offer modest cost savings for some patients, but it can also introduce new challenges, according to Eric Levin, CEO and cofounder of Scripta.

In an interview with The American Journal of Managed Care^®, Levin explained that for patients whose medications are covered by insurance, the cost difference between injectable and oral GLP-1s may be minimal. However, for those paying out of pocket, oral options can run a few hundred dollars less per month.

When formulary changes occur, such as when CVS Health dropped coverage of Zepbound in favor of Wegovy, patients often must adjust their dosing. In many cases, that means titrating down from one medication and slowly titrating back up on another. This process can disrupt treatment progress and may temporarily reintroduce side effects that patients had previously overcome,” Levin explained.

For patients trying to determine their GLP-1 coverage and costs, he recommends starting with their employer’s human resources department (HR) if they have employer-sponsored insurance. Because Medicare and Medicaid do not currently cover GLP-1 medications for weight loss, most coverage questions arise in the commercial insurance market. HR representatives or a pharmacy benefit manager (PBM) can typically clarify whether a medication is covered and what the out-of-pocket costs will be.

If a GLP-1 is not covered, patients may need to explore whether their employer offers an alternative benefit or consider paying cash. In those cases, Levin advises caution. Patients should obtain medications directly from a manufacturer or a well-established, reputable company rather than from unfamiliar online vendors or med spas, where quality and safety risks may be higher.