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ForumsInsurance & Access2026 payer coverage update — GLP-1 formulary changes by insurer Page 4

2026 payer coverage update — GLP-1 formulary changes by insurer

InsuranceTom Mon, Feb 26, 2024 at 4:00 PM 132 replies 48,422 viewsPage 4 of 20
pam_columbus
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Feb 26, 2024 at 9:40 PM#16

Congrats sarah_TO!! You should be so proud of yourself. 🎉

Last edited: Feb 27, 2024 at 3:40 AM
36 20kevin_tulsa, Dr.PainCLE, mike_mealprep and 33 others
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PharmHunterJen
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Illinois
Feb 26, 2024 at 9:57 PM#17

Clinical perspective on 2026 payer coverage update GLP-1:

I have managed roughly 300 patients on GLP-1 therapy and this topic comes up frequently. What the data shows — and what I see in practice — is that the medication works best as part of a comprehensive approach.

For this specific question, I would recommend: getting comprehensive baseline labs first.

1 22alex_tucson
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JessicaH_TX
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Feb 26, 2024 at 10:14 PM#18
pam_columbus said:
You should be so proud of yourself

I respect pam_columbus perspective but I think this oversimplifies things a bit. Re: 2026 payer coverage update — the subgroup analyses show meaningful heterogeneity.

I am not saying pam_columbus wrong entirely — just that the picture is more nuanced than a blanket statement. The STEP data specifically shows dose-dependent variation.

32 1kim_atl_prep, sarah_TO, wendy_avl and 29 others
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Dr.ObesityMed
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Feb 26, 2024 at 10:31 PM#19

Exactly this. My pharmacist said the same thing about 2026 payer coverage.

36 7PeptideChemSF, A1cHero_PHX, Dr.RenalNash and 33 others
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TinaHashiRN
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Raleigh, NC
Feb 26, 2024 at 10:48 PM#20

Want to share my personal experience related to 2026 payer coverage update since I think it might help others in a similar situation.

I started my GLP-1 journey in March 2025 at 286 lbs with metabolic syndrome. My telehealth provider prescribed semaglutide 0.25mg to start.

Now, 18 months later: I am down 51 lbs, my labs have normalized, and my sleep apnea has improved dramatically. The 2026 payer coverage aspect specifically was something that made a big difference in my journey.

This forum was my go-to resource throughout.

Last edited: Feb 27, 2024 at 4:48 AM
3 0MikeNYC_runner
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