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SAMBA GLP-1 coverage in 2027: 50% of the plan allowance instead of the normal drug copay

Read November 2, 2026 on opm.gov

From January 1, 2027, SAMBA covers GLP-1s for weight loss at 50% of the plan allowance. Until now they cost the same as any other covered prescription. The prior authorization and the Omada program stay in place.

If 50% or the program is too much: cash now

Two cash programs to check.

No insurance needed.

  1. Collective logoCollective$76 a month, with $199 yearly membershipcompounded semaglutide
    Check price →
  2. SnagRx logoSnagRx$99 a monthBilled monthly. The 12-month plan is $69 a month, billed as $828 up front.compounded semaglutide
    Check price →SnagRx's homepage shows its 12-month prepaid prices first

What the SAMBA brochure says

Covered GLP-1 weight loss medications are now covered at 50% of the Plan allowance. Previously, benefits were paid at the same per prescription copayment or coinsurance as any other covered prescription drug. All existing prior authorization requirements and participation in the Plan's lifestyle management program remain in effect.

Source: SAMBA Health Benefit Plan 2027 brochure, Changes section, on opm.gov, read November 2, 2026.

  • SAMBA's weight program is EncircleRx, which pairs the drug with Omada, a virtual lifestyle program.
  • The brochure asks your prescriber for documentation and a BMI of 32 or more, or 27 with related conditions.
  • Only the price rule changes for 2027.

The brochure gives Express Scripts at 800-753-2851 for coverage reviews.

What cash costs today

The brochure states a share of the plan allowance. Ask the plan for your drug's allowance, then compare it with these.

Compounded semaglutide and tirzepatide are pharmacy-made versions that are not FDA-approved and are not Wegovy, Ozempic, Zepbound or Mounjaro.

Cash routeMonthly priceChecked
Compounded semaglutideFrom $79November 2, 2026
Compounded tirzepatideFrom $129November 2, 2026
Wegovy pill from NovoCareFrom $149 at the starter doseNovember 2, 2026
Zepbound vial from LillyDirectFrom $299 at 2.5mgNovember 2, 2026

All federal plans also sit under OPM's 2027 rule on GLP-1 coverage.

Frequently asked questions

What changes for GLP-1s on SAMBA in 2027?
From January 1, 2027, SAMBA covers GLP-1s for weight loss at 50% of the plan allowance. Until now they cost the same as any other covered prescription. The prior authorization and the Omada program stay in place. The brochure says: "Covered GLP-1 weight loss medications are now covered at 50% of the Plan allowance. Previously, benefits were paid at the same per prescription copayment or coinsurance as any other covered prescription drug. All existing prior authorization requirements and participation in the Plan's lifestyle management program remain in effect."
Does this apply to diabetes?
This brochure line is about anti-obesity use. Check Section 5(f) of your brochure for a GLP-1 prescribed for type 2 diabetes.
When can I change plans?
Open Season for 2027 plans runs November 9 to December 14, 2026, according to OPM. A plan you choose then starts January 1, 2027.

Cash does not go through your plan and does not count toward its deductible. 2027 open enrollment dates.

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