Key takeaways:
Glucagon-like peptide-1 (GLP-1) medications are not specialty drugs. Specialty medications treat complex health conditions, such as cancer. The cost of specialty medications is typically much higher than the average cost of GLP-1 medications.
Insurance plans may have similar restrictions for GLP-1s and specialty medications. For instance, your plan may require prior authorization or step therapy (trying other medications first) for both.
To find out if your insurance covers a GLP-1, look at your plan’s formulary (list of covered medications). This can help you determine which GLP-1s are covered and whether your plan requires prior authorization or step therapy.
Glucagon-like peptide-1 (GLP-1) medications, such as Wegovy (semaglutide), Ozempic (semaglutide), and Zepbound (tirzepatide), are a popular group of medications. They work well for Type 2 diabetes and weight management. But many people find accessing them difficult. This is primarily because many insurance plans have extra hoops to jump through before they’ll cover them. And others don’t cover GLP-1s at all.
Extra steps your insurance provider may require include prior authorization and step therapy. This is typical for medications that have a higher retail price. For example, insurance plans often require these steps if you’re getting a specialty medication. So it’s no surprise that many people wonder if GLP-1s are specialty drugs.
Despite similar insurance roadblocks, GLP-1 medications are not specialty medications. Here’s why not.
Are GLP-1 drugs considered specialty drugs?
No, GLP-1 medications are not considered specialty drugs. Specialty medications are those that treat rare or complex health conditions, such as cancers or autoimmune disorders. Type 2 diabetes and weight management don’t fall under this umbrella.
There isn’t a standard definition for specialty medications. But some qualities they typically have include:
High price: Specialty medications tend to have a high retail price. While GLP-1s may be costly, specialty medications often cost much more. The average annual cost of a specialty prescription is estimated to be more than $84,000 per year. By comparison, the average retail costs for GLP-1s ranges from about $7,400 to $9,200 per year.
Distribution: Typically, you can get specialty medications only from specialty pharmacies. GLP-1 prescriptions can be filled at community pharmacies.
Biologics: Most specialty medications are biologics (made from living sources such as proteins or DNA). Most GLP-1s are not biologic medications.
Monitoring: Your prescriber may need to monitor you closely for specialty medication side effects and reactions, such as an infusion reaction. Most GLP-1 side effects are mild and manageable from home. Serious reactions are rare.
Who determines if a medication is a specialty drug?
Insurance providers primarily determine if a medication is a specialty drug. Since there’s no standard definition for the term “specialty medication,” the decision process varies among plans. Medication cost is often a deciding factor.
It’s common for insurance providers to use a tier system when categorizing medications. The lowest tier (Tier 1) typically includes lower-cost generic medications, which have lower copays. The highest tier (usually Tier 4 or higher) is for specialty medications. These usually have higher copays. GLP-1s tend to fall into Tier 2 (preferred, brand-name medications) or Tier 3 (nonpreferred, brand-name medications).
Pharmaceutical manufacturers also play a role in determining if something is a specialty drug. Manufacturers may distribute medications only to certain pharmacies. This is called limited distribution. If a medication is a limited distribution drug, then it’s likely that an insurance plan will classify it as a specialty medication.
Do you need to get GLP-1s from a specialty pharmacy?
No, you don’t usually need to get GLP-1s from a specialty pharmacy. Many people can get GLP-1s from community pharmacies, such as CVS. Others may use online telehealth and home delivery services to access these medications.
Keep in mind that every insurance plan has different requirements. Some may require members to use a mail-order pharmacy when filling GLP-1 prescriptions. While this isn’t a specialty pharmacy, the process of receiving a GLP-1 by mail may be similar to how you’d receive a specialty prescription.
What is step therapy for GLP-1s?
Step therapy is a coverage limit used by insurance companies. In this process, your insurance provider may require you to try other medications that treat your condition before they’ll cover a GLP-1. Typically, the medications you’d be asked to try first have a generic available or cost less than your prescribed GLP-1. This is a common insurance requirement for many brand-name medications.
Your likelihood of having to complete step therapy may depend on why you’re using a GLP-1. For instance, it’s common for insurance providers to have more restrictions for GLP-1s when used for weight loss. If you’re using a GLP-1 to manage Type 2 diabetes, your plan may cover the medication with fewer limits.
If your plan requires step therapy, they may require you to try one or more non-GLP-1 medications first. In the case of step therapy for weight loss, other medications to try first could include:
How do you get GLP-1 prior authorizations approved?
Preparation, responsiveness, and persistence are key when it comes to getting a GLP-1 prior authorization approved.
A prior authorization is an approval of coverage by your insurance company. Your insurance provider will ask your prescriber to provide more information about why you need a GLP-1. Similar to step therapy, your plan may be more likely to ask for a prior authorization if you’re using a GLP-1 for weight loss alone.
Your plan may ask your prescriber to include various details in a prior authorization request, including:
The reason why you’re being prescribed a GLP-1
Your body weight and body mass index (BMI)
Whether you have any weight-related health conditions, such as high blood pressure or obstructive sleep apnea
Your health history
If you’ve tried other medications before being prescribed a GLP-1
Proof of trying non-medication treatments for your condition, such as participation in a weight-loss program
Be sure to provide any documents your prescriber requests as quickly as you can. The sooner you respond, the faster your prescriber can submit the authorization request to your insurance provider.
If your insurance provider denies a prior authorization request, consider submitting an appeal. It’s common for insurance plans to approve a GLP-1 after a denial is appealed. So don’t give up, persistence often pays off.
Pharmacist tip: Before filling your prescription, check your plan’s formulary (list of covered medications) and summary of benefits and coverage. This can help you determine if your plan covers your prescribed GLP-1. It should also state whether a prescription requires step therapy or prior authorization. You can also call the member services number on your prescription insurance card for more details.
Frequently asked questions
Specialty medications are those that help manage rare or complex health conditions. Examples include treatments for autoimmune disorders, cancers, and blood clotting disorders such as hemophilia. Specialty medications also tend to be much more expensive than non-specialty medications.
Insurance coverage for GLP-1s varies among plans. In most cases, your employer needs to opt in for weight-loss coverage, or these medications won’t be covered. Your likelihood of coverage may also depend on why you’re using a GLP-1. For instance, if you’re living with Type 2 diabetes, it’s more likely a GLP-1 will be covered. But if you’re using a GLP-1 for weight loss only, coverage may be more limited.
You can find out if your insurance covers GLP-1s by checking your plan’s formulary and summary of benefits and coverage. These can help you determine whether a medication is covered and if your plan requires prior authorization or step therapy. You can usually find these documents online. But you can also call the member services number on your prescription insurance card.
Specialty medications are those that help manage rare or complex health conditions. Examples include treatments for autoimmune disorders, cancers, and blood clotting disorders such as hemophilia. Specialty medications also tend to be much more expensive than non-specialty medications.
Insurance coverage for GLP-1s varies among plans. In most cases, your employer needs to opt in for weight-loss coverage, or these medications won’t be covered. Your likelihood of coverage may also depend on why you’re using a GLP-1. For instance, if you’re living with Type 2 diabetes, it’s more likely a GLP-1 will be covered. But if you’re using a GLP-1 for weight loss only, coverage may be more limited.
You can find out if your insurance covers GLP-1s by checking your plan’s formulary and summary of benefits and coverage. These can help you determine whether a medication is covered and if your plan requires prior authorization or step therapy. You can usually find these documents online. But you can also call the member services number on your prescription insurance card.
The bottom line
Glucagon-like peptide-1 (GLP-1) medications are not specialty drugs. Specialty medications help manage rare or complex health conditions, such as cancer. The cost of specialty medications is typically much higher than the average cost of a GLP-1 medication.
There are similarities between how you access GLP-1s and specialty medications. You may need to use a certain pharmacy to fill your prescription. And it’s common for insurance plans to require prior authorization or step therapy (trying other medications first).
To find out if your insurance covers a GLP-1, look at your plan’s formulary (list of covered medications). This can help you determine which GLP-1s are covered and whether your plan requires prior authorization or step therapy.
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References
AMCP. (n.d.). Specialty pharmaceuticals.
BlueCross BlueShield of Illinois. (2025). New home delivery pharmacy service to fill members’ injectable GLP-1 prescriptions.
Hellems, S. S., et al. (2022). Association between health system specialty pharmacy use and health care costs among national sample of Medicare Advantage beneficiaries. Journal of Managed Care and Specialty Pharmacy.
National Association of Specialty Pharmacy. (n.d.). NASP definitions of specialty pharmacy and specialty medications.
Patient Advocate Foundation. (n.d.). Understanding drug tiers.
Pearson, S. D., et al. (2025). Affordable access to GLP-1 obesity medications: strategies to guide market action and policy solutions in the US. Journal of Comparative Effective Research.
