GLP-1 Therapy Insurance Cost Estimator

Estimate your out-of-pocket cost for GLP-1 medications such as Ozempic, Wegovy, or Mounjaro after insurance. Provide the monthly list price, coinsurance rate, remaining deductible, copay card support, and any pharmacy fees to surface the first-fill amount, post-deductible monthly cost, projected annual spend, savings card impact, and whether the deductible clears during your planning window.

Retail price billed by the pharmacy for a four-week box or pen pack.
Percentage of the drug price you owe once the deductible has been satisfied.
Amount of your medical or pharmacy deductible remaining this plan year.
Manufacturer copay card or patient assistance applied to each fill.
Defaults to $0. Add flat dispensing or delivery fees that apply to every fill.
Defaults to 12 months to report annual out-of-pocket cost.

Medication coverage varies by insurer and plan. Confirm costs with your pharmacy benefits manager before ordering.

Examples

  • $1,350 list price, 25% coinsurance, $1,450 deductible left, $450 savings card, $15 fee ⇒ Month 1 out-of-pocket: $915.00 after insurance, savings support, and fees • Post-deductible monthly cost: $112.50 • Projected spend across 12 months: $2,347.50 • First 12 months out-of-pocket: $2,347.50 • Savings card applied over the horizon: $5,400.00 • Deductible dollars covered during projection: $1,450.00 • The deductible is cleared in month 2.
  • $950 list price, 30% coinsurance, $0 deductible left, $200 savings card, no fee ⇒ Month 1 out-of-pocket: $85.00 after insurance, savings support, and fees • Post-deductible monthly cost: $85.00 • Projected spend across 12 months: $1,020.00 • First 12 months out-of-pocket: $1,020.00 • Savings card applied over the horizon: $2,400.00 • Deductible dollars covered during projection: $0.00 • The deductible was already satisfied before this fill.
  • $1,025 list price, 35% coinsurance, $3,200 deductible left, $150 savings card, no fee, 6-month projection ⇒ Month 1 out-of-pocket: $1,025.00 after insurance, savings support, and fees • Post-deductible monthly cost: $211.25 • Projected spend across 6 months: $3,938.75 • First 6 months out-of-pocket: $3,938.75 • Savings card applied over the horizon: $900.00 • Deductible dollars covered during projection: $3,200.00 • The deductible is cleared in month 4.

FAQ

Can I model a high-deductible health plan?

Yes. Enter your remaining deductible and the calculator will apply it before coinsurance just like a HDHP. Adjust the projection months to mirror how long it takes to satisfy the deductible each plan year.

What if my plan has a copay instead of coinsurance?

Set the coinsurance rate to 0% and enter your fixed copay under dispensing fee. The calculator then treats every fill as the same out-of-pocket cost after any savings card.

Do manufacturer cards cover Medicare or Medicaid plans?

Most manufacturer programs exclude government insurance. Leave the savings card field at $0 if you are ineligible so the estimate reflects the true amount you will pay.

How do I account for manufacturer card maximums?

If your savings card has a monthly cap, enter the portion that actually applies each month. Rerun the calculation with a lower value once the benefit steps down or expires so the forecast reflects the new support level.

Can I compare different fill intervals such as 28-day versus 56-day supplies?

Yes. Adjust the list price to reflect the supply length you pick up each time and set the projection months to match how often you refill so the totals map to your specific regimen.

Additional Information

  • Savings cards reduce what you owe after the plan applies deductible and coinsurance rules, then pharmacy or delivery fees are added on top.
  • If you project fewer than 12 months, annual cost reflects only the months requested so partial-year budgets stay accurate.
  • Dispensing fees are treated as flat additions owed every time you pick up the medication, whether or not the savings card applies.
  • Deductible dollars covered shows how much of your remaining deductible is satisfied over the projection window.
  • Savings card totals help you anticipate when manufacturer support is exhausted or when a maximum benefit may be reached.

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