Open Enrollment 2027: Switch to Brand-Name GLP-1 or Stay Compounded?

If you're paying cash for compounded semaglutide or tirzepatide, open enrollment is the one window each year when you can pick a plan that might cover brand-name Wegovy or Zepbound instead. For plan year 2027, the federal marketplace window is November 1, 2026 through January 15, 2027, and Medicare's is October 15 through December 7, 2026. Whether switching makes sense comes down to three numbers: your compounded cost, the brand cost under a plan you can actually get, and the brand self-pay price if no plan covers it.

The 2027 enrollment calendar

HealthCare.gov's dates come from its own deadlines page. If your state runs its own exchange, its window may differ, so confirm on your state's site. Employer windows are often only two or three weeks long, which is the easiest deadline to miss.

What brand-name actually costs now, with or without coverage

The case for compounded GLP-1s used to be simple: brand list prices were over $1,000 a month. That's no longer the comparison. Both manufacturers now sell self-pay at much lower prices, and those prices set a ceiling on what switching would cost you even if no plan covers the drug.

Zepbound (tirzepatide), from Lilly's savings page

• KwikPen self-pay: $299 (2.5 mg), $399 (5 mg), $499 (7.5 mg), $699 (10–15 mg)
• With Lilly's self-pay savings card: $449 for 7.5 mg and higher, if you refill within 45 days of your last delivery
• With commercial insurance that covers Zepbound: the savings card can bring a single-dose pen fill as low as $25, up to $100 off per month and $1,300 a year
• Lilly says all its savings cards expire December 31, 2026, and can change without notice. Government-insured patients can't use them.

Wegovy (semaglutide), from Novo Nordisk's savings page

• Wegovy pill: $149 (1.5 mg), $199 (4 mg), $299 (9 mg and 25 mg) per month
• Wegovy pen: $199 intro price for 0.25 mg and 0.5 mg for two fills through Dec. 31, 2026; $349 after that
• Wegovy HD 7.2 mg: $399 per month
• Novo says self-pay purchases don't count toward your deductible or out-of-pocket maximum, and pricing will be updated after Dec. 31, 2026.

Compounded, for comparison

In our monthly price checks, bundled compounded semaglutide plans started around $99 a month and compounded tirzepatide around $133 to $200 a month as of late October 2026, with higher-dose tiers costing more at some providers.

How to check whether a 2027 plan covers Wegovy or Zepbound

Plan brochures rarely say "weight loss drugs covered." You have to look it up drug by drug.

1. Find the plan's 2027 formulary. On HealthCare.gov, use the plan comparison tool and add your drugs. For employer plans, ask HR or the pharmacy benefit manager for the 2027 drug list, not the 2026 one.
2. Search the exact product. Look up "Wegovy" and "Zepbound" by name. Mounjaro and Ozempic are often covered for type 2 diabetes only, which won't help if your prescription is for weight management.
3. Note the tier. Tier tells you whether you'll pay a flat copay or a percentage. A 30 to 50 percent coinsurance on a drug with a high list price can cost more than self-pay.
4. Read the restrictions column. PA means prior authorization. ST means step therapy, which may require trying another drug first. QL means quantity limits.
5. Check the weight-loss exclusion. Some plans list the drug but exclude coverage "for weight loss." If the formulary is unclear, call the plan and ask directly.
6. Estimate your real yearly cost. Add 12 months of premiums plus the drug cost under that plan's deductible and copay. Compare that to self-pay plus a cheaper plan.

Prior authorization: plan for it

Most plans that cover Wegovy or Zepbound require prior authorization, typically with BMI and diagnosis documentation from your prescriber. Plans usually want recent records. Ask your prescriber now whether they'll submit the PA in January, and whether your compounded treatment history counts as a starting weight. Many plans want the baseline weight from before you started any GLP-1, so keep your earliest records handy.

Questions to ask before you enroll

When the formulary isn't clear, call the plan's member services line or your HR benefits contact and ask these, in this order. Write down the date, the rep's name and the answer.

• Is Wegovy (or Zepbound) on the 2027 formulary for chronic weight management, not only for diabetes or sleep apnea?
• What tier is it, and is the cost a flat copay or coinsurance after the deductible?
• What does prior authorization require, and how long is an approval valid before renewal?
• Is there step therapy, and would prior use of a compounded GLP-1 count?
• Must I use a specific specialty or mail-order pharmacy?

A yes on coverage with a reasonable copay is the green light. A vague answer is a reason to price the plan as if it won't cover the drug.

If you're on Medicare

Medicare Part D generally doesn't cover drugs for weight loss alone. The temporary Medicare GLP-1 Bridge is the exception. Per Medicare.gov, it covers Wegovy (injection or pill), Zepbound KwikPen and Foundayo for a $50 copay per month for eligible Part D enrollees, and CMS says it has been extended through December 31, 2027 because the BALANCE model isn't launching in Part D in 2027.

Eligibility starts with a BMI of 35 or higher, or lower BMIs with specific conditions such as heart failure with preserved ejection fraction, uncontrolled high blood pressure, stage 3a or later kidney disease, prediabetes, a prior heart attack or stroke, or symptomatic peripheral artery disease. People whose Part D plan already covers a GLP-1 aren't eligible. The $50 copay doesn't count toward your Part D out-of-pocket limit.

For most eligible Medicare patients, $50 a month for a brand drug beats any compounded price. Note that manufacturer savings cards exclude government-insured patients, though Novo says Medicare patients can use its self-pay offer if they pay outside insurance.

Reasons to stay compounded in 2027

Switching isn't always the right move. Staying compounded makes sense when:

• No plan you can get covers Wegovy or Zepbound for weight management, and your compounded price is meaningfully below brand self-pay at your dose.
• Your prescriber has a documented clinical reason for a compounded formulation, such as an allergy to an inactive ingredient. That's the use case the 503A pathway is meant for.
• You're near the end of planned treatment and don't want to restart prior authorization and titration.

Keep in mind that compounded GLP-1s are not FDA-approved, FDA has proposed keeping semaglutide and tirzepatide off the 503B bulks list, and access depends on providers continuing to operate within the 503A rules. Have a backup plan if your provider or pharmacy changes.

Decision guide: brand or compounded for 2027

Switching products, even between compounded and brand versions of the same ingredient, is a clinical decision. Your prescriber should set the starting dose, because compounded concentrations and brand dosing don't always line up. Don't stretch or skip doses to bridge a gap in coverage without talking to them first.