GLP-1 drugs on every 2026 Pennsylvania Part D plan
Pick a drug class, or type the drugs you want to check, and see which of the 12 stand-alone Part D plans in Pennsylvania cover each one, on what tier, and with what restrictions.
- Covered
- Covered, needs prior authorization (PA) or step therapy (ST)
- Not on the formulary
- QL 60/30d = quantity limit, 60 units per 30 days
12 plans, cheapest premium first. Scroll sideways for all of them →
| Drug | Humana Basic Rx Plan$6.60/moS5884-104 | Wellcare Value Script$8.20/moS4802-141 | Wellcare Classic$14.70/moS4802-080 | Humana Value Rx Plan$19.40/moS5884-185 | SilverScript Choice$22.70/moS5601-012 | AARP Medicare Rx Saver from UHC$43.50/moS5921-351 | HealthSpring Extra Rx$62.60/moS5617-356 | HealthSpring Assurance Rx$74.00/moS5617-215 | AARP Medicare Rx Preferred from UHC$121.90/moS5921-388 | Humana Premier Rx Plan$123.60/moS5884-152 | Blue Rx PDP Complete$164.80/moS5593-003 | Blue Rx PDP Plus$193.20/moS5593-002 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Ozempicsemaglutide injection | Tier 3PA25%QL 3/28d | Tier 6PA$11.00QL 3/28d | Tier 3PA25%QL 3/28d | Tier 3PA20%QL 3/28d | Tier 3PA19%QL 3/28d | Tier 3PA16%QL 3/28d | Tier 3PA17%QL 3/28d | Tier 3PA21%QL 3/28d | Tier 3PA16%QL 3/28d | Tier 3PA$45.00QL 3/28d | Tier 3PA25%QL 3/28d | Tier 3PA25%QL 3/28d |
| Mounjarotirzepatide injection | Tier 3PA25%QL 2/28d | Tier 6PA$11.00QL 2/28d | Tier 3PA25%QL 2/28d | Tier 3PA20%QL 2/28d | Tier 3PA19%QL 2/28d | Tier 3PA16%QL 2/28d | Tier 3PA17%QL 2/28d | Tier 3PA21%QL 2/28d | Tier 3PA16%QL 2/28d | Tier 3PA$45.00QL 2/28d | Tier 3PA25%QL 2/28d | Tier 3PA25%QL 2/28d |
| Trulicitydulaglutide injection | Not covered | Tier 6PA$11.00QL 2/28d | Tier 3PA25%QL 2/28d | Not covered | Tier 3PA19%QL 2/28d | Tier 3PA16%QL 2/28d | Tier 3PA17%QL 2/28d | Tier 3PA21%QL 2/28d | Tier 3PA16%QL 2/28d | Not covered | Tier 3PA25%QL 2/28d | Tier 3PA25%QL 2/28d |
| Ozempic tabletsoral semaglutide, formerly Rybelsus | Not covered | Tier 6PA$11.00QL 30/30d | Tier 3PA25%QL 30/30d | Not covered | Tier 3PA19%QL 30/30d | Tier 3PA16%QL 30/30d | Tier 3PA17%QL 30/30d | Tier 3PA21%QL 30/30d | Tier 3PA16%QL 30/30d | Not covered | Tier 3PA25%QL 31/31d | Tier 3PA25%QL 31/31d |
| Wegovysemaglutide, weight | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered |
| Zepboundtirzepatide, weight | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered |
| Victozaliraglutide | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered |
| liraglutidegeneric Victoza | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Tier 4PA25%QL 9/30d | Tier 4PA25%QL 9/30d |
| Saxendaliraglutide, weight | No 2026 Part D formulary lists this drug in the CMS files: it is too new, no longer sold, or excluded from Part D (as weight-loss-only drugs are). | |||||||||||
| Byettaexenatide | No 2026 Part D formulary lists this drug in the CMS files: it is too new, no longer sold, or excluded from Part D (as weight-loss-only drugs are). | |||||||||||
| Bydureon BCiseexenatide extended-release | No 2026 Part D formulary lists this drug in the CMS files: it is too new, no longer sold, or excluded from Part D (as weight-loss-only drugs are). | |||||||||||
| orforglipronoral GLP-1, approved 2026 | No 2026 Part D formulary lists this drug in the CMS files: it is too new, no longer sold, or excluded from Part D (as weight-loss-only drugs are). | |||||||||||
Where a plan covers several strengths or forms of a drug, the cell shows the least restricted one. Costs are the 30-day preferred-pharmacy cost-sharing in the initial coverage phase, from the CMS 2026 formulary files. Click a plan for its full drug list.