Costco has struck a deal with drugmaker Novo Nordisk to sell the popular GLP-1 medications Ozempic and Wegovy for about half their usual price — $499 a month. The discount still requires a doctor’s prescription, medical supervision, and careful consideration of coverage and cost.
The partnership also comes as some of Massachusetts’ largest health insurance plans will stop or change how they cover the shots next year. Local health experts say that while the move could make the sought-after drugs more accessible, it may also leave behind those who need them most.
Here’s what you need to know:
1. Yes, you still need a prescription.
Even with Costco’s new deal, these drugs are not available over the counter.
A prescription from a licensed provider is needed for Costco’s pharmacy. Costco works with online health-care service provider Sesame, which can prescribe GLP-1 medications for eligible patients, but a medical screening and a fee are required.
There are seven Costcos in Massachusetts: In Avon, Everett, Danvers, Dedham, Sharon, Waltham, and West Springfield. There are six in Connecticut, one in New Hampshire, and none in Rhode Island, which could lead some patients to travel for the drugs.
2. GLP-1s are still expensive.
The $499 monthly price tag is discounted from the drugs’ typical out-of-pocket cost, which can be more than $1,000. Most health plans do not cover the drugs unless you have a prescription and meet specific criteria.
“It’s good news, but many patients will still not be able to afford it,” said Dr. Amin Sabet, an endocrinologist at UMass Memorial Medical Center. “Obesity disproportionately impacts individuals with the fewest financial resources.”
Novo Nordisk also offers these medications directly from its manufacturer’s pharmacy at the same price. Still, it can be difficult for providers to connect patients to a manufacturer’s mail-order pharmacy, Dr. Sabet said. “So bringing that same reduced price to places where patients already shop or pharmacies they already use does increase access to the lower cash price.”
The same discount price without insurance is available at most major pharmacies, including CVS, Walgreens, Wegmans, Walmart, Target, Star Market, Stop & Shop, and online at GoodRx.
3. Fewer insurers are covering GLP-1s
GLP-1 coverage varies by insurer and whether the drug is prescribed for diabetes or weight management.
Most Massachusetts private plans, such as Blue Cross Blue Shield, cover Ozempic for Type 2 diabetes, but not Wegovy or other GLP-1s prescribed solely for weight loss.
Starting Jan. 1, Blue Cross Blue Shield and Point32Health, the owner of Harvard Pilgrim Health Care and Tufts Health Plan, said they will scale back their coverage of GLP-1s due to their increased popularity. Blue Cross Blue Shield is offering employers the option to decide whether to continue covering GLP-1s for weight loss at an additional cost for their employees. “We are seeing some employers choosing this option... And we will continue to cover GLP-1s for Type 2 diabetes for all members,” a Blue Cross spokesperson said.
Similarly, for weight management at Point32Health, large employers will have the option of paying extra to cover only Zepbound. All existing prior authorizations for weight-loss treatments will be canceled, though coverage for GLP-1 medications prescribed for Type 2 diabetes will continue. For patients who are insured by a smaller employer or who purchase their plans through the state’s marketplace, Point32Health is ending coverage for weight loss altogether.
MassHealth covers Zepbound for patients with obesity and Mounjaro for those with diabetes. Starting Jan. 1, the program will not cover Wegovy or Saxenda for weight treatment, but they could be covered for other indications.
Massachusetts saw a 255 percent surge in obesity-related GLP-1 prescriptions in 2024 — one of the highest increases in the country — while Point32Health reported a $382 million loss last year and has begun layoffs amid mounting costs.
“Insurance companies are really making it very difficult for patients to get access to these drugs,” said Dr. Apovian.
Dr. Sabet argued Costco’s offer is a positive development, “but we are in dire need of improved insurance coverage for these treatments, so that the patients who need them the most can access them.”
4. You still need to diet and exercise.
Doctors underscored that obesity is a disease, and while GLP-1s can help in many cases, they’re not a quick fix.
Many patients stop taking the GLP-1s after six to nine months because they’re not seeing progress, said Dr. Caroline Apovian, director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital.
“To make it work, they have to understand that it’s dosed slowly and low to mitigate the side effects, and that you really do have to be on a high-protein, low-calorie diet, you have to eat healthy, and you have to exercise,” Apovian said. “If you don’t, and you just get a prescription to try it, it’s not going to work. It’s about recognizing you have a disease, you need to diet, exercise, take medications, and consider surgery.”
And the drugs are not for everyone. Doctors say they’re most appropriate for people with Type 2 diabetes, and adults with a BMI over 30 or 27 with a condition, including people who’ve had a heart attack or stroke, peripheral vascular disease, and for sleep apnea, Apovian said.
They are not recommended for people with certain thyroid conditions, hypertension, a history of pancreatitis, or those who are pregnant or planning to become pregnant.
“Obesity is a disease with biological causes that disrupts the body’s ability to regulate weight, often leading to serious health conditions,” said Dr. Sabet.
5. Watch out for copycats
The popularity of GLP-1s has shifted from diabetes treatment to lifestyle management, creating shortages and ethical questions about access. Doctors warn of online compounding pharmacies advertising similar, but not FDA-approved, shots and supplements.
“Many patients who are unable to access these evidence-based, FDA-approved treatments turn to either compounded pharmacy solutions, which have both safety and efficacy concerns, or to a wide host of unproven supplements, which don’t have proven benefit and can cause harm,” Dr. Sabet said.
Doctors also worry that Costco’s deal could blur the lines between health care and retail.
“The caveat to this is that we need more specialists in obesity medicine in this country to be able to use these medications the way they’re supposed to be used. That’s not going to happen at Costco,” Apovian said.
Sarah Rahal can be reached at sarah.rahal@globe.com. Follow her on X @SarahRahal_ or Instagram @sarah.rahal.