Foundayo Cost With Insurance in 2026: Plans, Savings Cards, Medicare

Foundayo (orforglipron) is Eli Lilly's once-daily pill for weight loss.¹ If your health plan covers it, you pay your plan's copay or coinsurance, and Lilly's Foundayo Savings Card can cut that to as little as $25 for a 30-, 60- or 90-day fill through December 31, 2026. The card takes off no more than $100 for each 30 days of tablets and $1,000 a year.² Every plan document we read that sets rules for Foundayo calls for prior authorization, meaning the plan must approve it for you before it pays (what they ask for).^{3, 4, 5, 6, 7, 8, 9, 10}

If your plan leaves Foundayo out, or you have no insurance, Lilly's cash price through LillyDirect is $149 to $299 for each 30-day supply, depending on the dose, as of October 4, 2026. The two highest doses cost $349 instead of $299 unless you buy each refill within 45 days of receiving the last one.^{2, 11}

By law, Medicare drug plans' basic benefit leaves out weight-loss drugs, though a plan with enhanced coverage can add them.^{12, 13} Medicare's temporary GLP-1 Bridge covers Foundayo for a $50 copay per monthly supply if you qualify.¹⁴ Medicaid coverage depends on your state.¹⁵

Go to your situation:

• My plan covers Foundayo
• My plan won't cover it, or I'm uninsured
• I have Medicare
• I have Medicaid
• I'm covered by the VA or TRICARE
• I have type 2 diabetes

Also on this page: Lilly's two cards, what six insurers and pharmacy benefit managers say, prior authorization rules, how the dose changes the price and label warnings. To compare Foundayo's cash price with other GLP-1 medicines, see our GLP-1 price comparison.

What you pay, situation by situation

Your plan covers Foundayo

With private insurance, such as a plan through work, your share depends on your plan: the tier (price level) it puts Foundayo on, its copay or coinsurance (a percentage of the price), and your deductible. Lilly's price page lists $649 for a 30-day supply, which is what Lilly charges wholesalers (the page dates the figure April 3, 2026), and says what you pay depends largely on your plan.¹⁶ We found no published average of what insured people actually pay.

Lilly's Foundayo Savings Card can lower your share to as little as $25 a fill, within limits explained in Lilly's two cards.² For prior authorization, your prescriber sends the plan records showing you meet its rules.³

LillyDirect, Lilly's pharmacy service, fills Foundayo for people using insurance as well as for people paying cash, with free home delivery or pickup at a retail pharmacy.¹¹ Lilly makes the drug; whether your plan pays for it is the plan's decision.

Your plan won't cover it, or you have no insurance

Whether weight-loss drugs are covered at all depends on how your plan is set up. Anthem's drug list marks Foundayo "BE," for benefit exclusion; UnitedHealthcare's weight-loss program applies only where an employer or other client chose to cover these drugs; and a Blue Cross and Blue Shield drug list warns that some plans exclude them.^{5, 6, 7}

Lilly's cash prices are $149 to $299 per 30-day supply, depending on the dose, as of October 4, 2026 (price table).^{2, 11} Which Lilly card you can use depends on your coverage:

• Commercial insurance that doesn't cover Foundayo: you can use the no-coverage price on the Foundayo Savings Card or the Self-Pay Savings Card, at the same prices. The Self-Pay card adds a promise not to seek reimbursement from any insurer or count the cost toward a deductible or out-of-pocket limit.²
• Medicare, Medicaid, the VA, TRICARE or no insurance: only the Self-Pay Savings Card is open to you, with the same prices and promise.²

Ask the pharmacy which card it applied, and read Lilly's full terms before you buy; the limits are in Lilly's two cards. The $25 price needs a plan that covers Foundayo.²

Foundayo needs a prescription. Ask your doctor to send it to LillyDirect Pharmacy; if you need help finding a doctor, LillyDirect says it can connect you with virtual and in-person care.¹¹ A seller that offers Foundayo without a prescription is a red flag: FDA's warning signs for online sellers include not requiring a screening and a prescription from a licensed doctor.¹⁷ Our guide shows how to check an online seller.

If your plan does cover weight-loss drugs but turned down your request, you can appeal; see what prior authorization asks for.

Medicare

By law, drugs used for weight loss are left out of Part D's basic benefit.¹² A plan that offers enhanced coverage can include them as an extra (supplemental) benefit, so look at your own plan's drug list.¹³ If a plan that covers Foundayo turns you down, the Medicare drug plan section of our appeals guide explains the steps. Foundayo's only FDA-approved use is weight reduction.¹

The other route is Medicare's GLP-1 Bridge, a temporary CMS program that runs outside the normal Part D benefit from July 1, 2026 through December 31, 2027. It covers Foundayo for weight reduction for a $50 copay per monthly supply, at every strength. You need Part D drug coverage, prior authorization and a body mass index (BMI) that meets the Bridge's criteria, and type 2 diabetes rules it out.^{14, 18} Our Medicare GLP-1 Bridge explainer has the eligibility rules and how approval works, and Medicare.gov's page on weight-loss drugs has CMS's summary.

If the Bridge isn't open to you, Lilly's Self-Pay Savings Card is: its terms don't exclude people with Medicare who pay cash and don't bill Medicare or count the cost toward Part D limits. The $25 Foundayo Savings Card isn't open to anyone with Medicare (see Lilly's two cards).²

Medicaid

Federal law lets each state Medicaid program exclude or limit drugs used for weight loss, so coverage depends on your state.¹⁵ In state documents taking effect October 1, 2026, for example, Wisconsin and North Carolina list Foundayo as a preferred weight-management drug (Wisconsin requires prior authorization for the class; North Carolina says clinical criteria apply), and Rhode Island stopped covering it when prescribed only for weight loss.^{19, 20, 21}

CMS's BALANCE model, which state Medicaid programs can join through January 1, 2027, includes Foundayo, but it doesn't guarantee coverage for anyone.²² CMS's model page named no participating state as of its September 29, 2026 update.²² Indiana's governor, though, directed the state's Medicaid agency on July 30, 2026 to take part, with eligibility rules and timing still to be announced.²³ Lilly's Foundayo Savings Card excludes Medicaid enrollees; the Self-Pay Savings Card's terms don't (see Lilly's two cards).²

If a Medicaid health plan turns down a request for a drug your state covers, you have 60 days from the date on its notice to appeal to the plan. If the plan keeps its decision, you can then ask your state for a fair hearing.²⁴ State-by-state detail is in our guide to Medicaid coverage of GLP-1s, including how appeals and fair hearings work.

VA or TRICARE

VA. The VA lists Foundayo as non-formulary, at copay tier 3, in formulary data last refreshed September 29, 2026.²⁵ Veterans in priority group 1 pay no copay for any medication; in groups 2 through 8 you may owe a copay for medicines that treat conditions not connected to your service, and VA's rate page lists $11 for a 30-day supply of a tier 3 brand-name medicine (page last updated December 29, 2025).²⁶ VA's May 2026 criteria for use ask for a lifestyle program within the past year and a BMI of 27 or more with a weight-related condition.²⁷

TRICARE. TRICARE's weight-loss FAQ, last updated August 6, 2026, names Wegovy, Saxenda and Zepbound as covered for weight management on certain plans, with prior authorization, and doesn't mention Foundayo.²⁸ TRICARE For Life, the TRICARE benefit that wraps around Medicare, doesn't cover weight-loss drugs.^{28, 29} We couldn't check TRICARE's formulary search tool, so confirm Foundayo's status with TRICARE before you count on coverage.

Lilly's Foundayo Savings Card excludes VA and TRICARE members; the Self-Pay Savings Card's terms don't (see Lilly's two cards).² More in our guide to TRICARE and VA coverage.

You have type 2 diabetes

Foundayo is approved to help with weight reduction, together with diet and exercise; it is not approved to treat diabetes. Adults with type 2 diabetes who have obesity or overweight fit its approved use, and one of its two main trials enrolled them.¹ In June 2026, Lilly said it planned to ask FDA to approve Foundayo for type 2 diabetes; as of October 3, 2026, FDA's approval record shows no new use.^{30, 31}

Type 2 diabetes does count as a weight-related condition in plan rules; Caremark, Express Scripts and UnitedHealthcare all name it.^{3, 4, 5} Some plans add steps for people with diabetes. Centene's commercial policy, for example, asks members with type 2 diabetes to have tried Ozempic or Rybelsus, Trulicity, generic liraglutide and Mounjaro for at least 3 months each, unless they caused significant side effects or none can be used.¹⁰ That is at least a year on other drugs first.

With Medicare, type 2 diabetes rules out the Bridge, and Part D's basic benefit leaves out weight-loss use, so Medicare won't pay for Foundayo unless your plan has added weight-loss drugs as an extra benefit.^{12, 13, 18} You can still buy it with Lilly's Self-Pay Savings Card (see Lilly's two cards).² Your Part D plan may cover a GLP-1 that is approved for diabetes; whether one suits you, and what its own label warns, are questions for your prescriber.¹⁸ Foundayo's label also warns that low blood sugar is more likely with insulin or a sulfonylurea, a type of diabetes pill, and that diabetic eye disease can get worse (see the label section).¹

Lilly's two Foundayo cards are not the same

Which card you can use depends on your coverage, not your dose.

Foundayo Savings Card: for commercial insurance. One card with two price tracks, depending on whether your plan covers Foundayo.

• Who can use it: adults 18 or older in the US or Puerto Rico who have commercial drug insurance (private coverage, such as a plan through work) and a prescription for an FDA-approved use.²
• Who can't: anyone enrolled in a federal, state or other government-funded health program, including Medicare (Part D, Medicare Advantage and Medigap, which is extra insurance private companies sell to help pay your share of Original Medicare costs), Medicaid, TRICARE, the VA, the Department of Defense and state drug-assistance programs.^{2, 32}
• If your plan covers Foundayo: as little as $25 for a 30-, 60- or 90-day fill. The card takes off at most $100 on a 30-day fill, $200 on a 60-day fill or $300 on a 90-day fill, and $1,000 per calendar year.²
• If your plan does not cover Foundayo: as low as $149 for 0.8 or 2.5 mg, $199 for 5.5 mg and $299 for 9, 14.5 or 17.2 mg, per 30-day fill. Lilly caps the monthly savings at $520 for 0.8 and 2.5 mg, $470 for 5.5 mg and $370 for the three highest doses, and at 14.5 and 17.2 mg the $299 holds only with on-time refills (price table).²
• Limits on both tracks: up to 10 fills per calendar year. The card ends December 31, 2026, and Lilly can change or end it sooner.²

Foundayo Self-Pay Savings Card: cash, outside insurance.

• Who can use it: adults 18 or older in the US or Puerto Rico with a prescription for an FDA-approved use, who pay cash and promise not to seek reimbursement from any insurer or government program or count the cost toward a deductible or out-of-pocket limit. Its terms don't exclude people with Medicare, Medicaid or other government coverage.²
• What you pay: the same prices and savings caps as the no-coverage track, $149 to $299 per 30-day fill by dose (table).^{2, 11}
• Limits: up to 10 fills per calendar year, two short of a year of monthly fills (our price comparison covers what a full year costs). It ends December 31, 2026, and Lilly can change or end it sooner.²

On both cards, activation is required, and savings can't be combined with another discount or coupon. They may not be applied at the counter: if Lilly can't confirm at purchase that you refilled within 45 days, you may have to file a reimbursement claim in its patient portal or by mail, postmarked by March 31, 2027. The terms say "as little as" or "as low as," so confirm the price with the pharmacy before each fill.²

On the covered-plan track, the $25 holds only when your share for a 30-day fill is $125 or less; above that, the card takes off $100 and you pay the rest. On 90-day fills it takes off up to $300 a fill, so three fills that each use the full $300 leave only $100 of the $1,000 yearly limit for a fourth. After 10 fills or $1,000 in savings in a calendar year, or after December 31, 2026, you pay your plan's full share.²

What six insurers and pharmacy benefit managers said about Foundayo, as of October 3, 2026

Your drug coverage may be run by a pharmacy benefit manager (PBM), a company that keeps the drug list (formulary) and reviews prior authorization requests for your plan. Check your insurance card or plan materials for its name. None of the documents below can tell you whether your employer added weight-loss coverage; each leaves that to your plan's design.

• CVS Caremark. On May 28, 2026, Caremark said that from June 1 it would lift its block on newly launched drugs for Foundayo on its most common commercial drug lists, "where approved for coverage by plans," and that employers using those lists can still change what they cover.³³ We did not find which tier Caremark puts Foundayo on.
• Express Scripts. Its weight-loss GLP-1 prior authorization policy added Foundayo on April 2, 2026.⁴ Its 2027 National Preferred Formulary drops Zepbound KwikPens and vials for weight loss and names Foundayo among the preferred alternatives, while warning that not every plan covers every listed drug.³⁴ We did not find its 2026 formulary status. Where an employer uses Evernorth's EncircleRx program, you must enroll in a lifestyle program before prior authorization can be completed, stay active in it (four weigh-ins and four app check-ins a month), and have a BMI of 32 or more, or 27 or more with two weight-related conditions.³⁵
• Optum Rx. Foundayo was put on Optum Rx's exclusion list for new drugs on April 3, 2026. On May 11, 2026 it came off that list and moved to tier 2 on Optum Rx's Select and Premium commercial formularies (on Select, tier 2 holds preferred brand-name drugs), with prior authorization and a quantity limit, a cap on how many tablets the plan pays for in a set period. Optum Rx notes that your plan's copay or coinsurance may differ.⁸
• UnitedHealthcare (UHC). Its weight-loss prior authorization program, effective October 1, 2026, includes Foundayo but is optional: it applies only where an employer or other client chose to cover weight-loss drugs, and state mandates can also apply. Foundayo isn't on UHC's standard commercial drug list dated September 1, 2026.^{5, 36} More in our UnitedHealthcare coverage guide.
• Anthem Blue Cross and Blue Shield. Its three-tier National Drug List, current as of August 1, 2026, puts Foundayo on tier 2 with prior authorization and a quantity limit, marked "BE" because it may not be covered, depending on your plan's design.⁶ More in our Anthem coverage guide.
• Blue Cross and Blue Shield, list prepared by Prime Therapeutics. The October 2026 Multi-Tier Basic Drug List, posted by Blue Cross and Blue Shield of Texas, Illinois and Montana, includes Foundayo on its list of preferred drugs, with prior authorization and quantity limits, and notes that some plans exclude weight-loss drugs.⁷ Prime's own weight-management criteria, effective July 1, 2026, are summarized in the next section; the document doesn't say which Blue plans use them.⁹

What prior authorization asks for

These rules come from each company's own documents. Your plan can differ, and your prescriber sends the request.

The documents: Caremark's criteria 7433-C, Express Scripts' policy as revised April 15, 2026, UnitedHealthcare's program effective October 1, 2026, Anthem's criteria dated September 16, 2026, and Prime's criteria effective July 1, 2026.^{3, 4, 5, 9, 37} Anthem's exceptions to the 6-month program include a BMI of 40 or more.³⁷

• BMI (body mass index). For adults, all five ask for a BMI of 30 or more, or 27 or more with a weight-related condition such as high blood pressure, type 2 diabetes or abnormal cholesterol.^{3, 4, 5, 9, 37} Prime also accepts a BMI of 25 or more for people of South Asian, Southeast Asian or East Asian descent, and EncircleRx asks for 32, or 27 with two conditions.^{9, 35} Plans want the numbers documented; Anthem wants a BMI recorded within 90 days of the request.^{3, 37}
• Renewal. All five use a test of losing at least 5% of your starting weight (or, in some, keeping that loss off); Prime also renews someone with less than 52 weeks on the highest dose they tolerate.^{3, 4, 5, 9, 37} Rules tied to your dose are in the next section.
• Quantity limits. Caremark allows 30 tablets per 25 days at every strength, or 90 per 75 days, timed to let refills process. Prime and the Blue Cross list limit the 0.8 and 2.5 mg starting strengths to 60 tablets per 180 days.^{3, 7, 9}
• One GLP-1 at a time. Express Scripts doesn't recommend coverage alongside another GLP-1 drug, and Anthem lists the combination as a reason a request may not be approved.^{4, 37}

If a request is denied, the plan must tell you why in writing. HealthCare.gov says to file an internal appeal within 180 days of receiving the denial notice and, if the plan still says no, to ask for an outside review.³⁸ Check the denial letter for your own plan's deadline and steps. Our prior authorization guide, written for Zepbound, walks through appeals step by step.

How the dose changes what you pay

Foundayo is one tablet a day, sold in bottles of 30, in six strengths. Its label starts everyone at 0.8 mg, then 2.5 mg, then 5.5 mg, each for at least 30 days, and allows 9, 14.5 or 17.2 mg after that depending on how you respond and tolerate it.¹ Your prescriber sets your dose; the steps matter here only because cash prices follow them.

The 2.5 and 5.5 mg prices are temporary reductions through December 31, 2026. "On-time" means each refill is bought within 45 days of the date the last one was delivered or received, and your first purchase of 14.5 or 17.2 mg is automatically $299. Taxes and fees may be added.^{2, 11} Whatever you pay, go over the label warnings in the next section before you buy.

• The first fills cost least. Both $149 prices belong to the label's first two steps, so don't budget a year at $149.^{1, 11} Three 30-day fills at 0.8, 2.5 and 5.5 mg bought by December 31, 2026 cost $149 + $149 + $199 = $497; at Lilly's regular prices they come to $647 (our arithmetic).^{2, 11} Our price comparison shows what a full year costs.
• What stays the same. The $25 price and the Bridge's $50 copay don't vary by strength.^{2, 14, 18} With insurance, your share follows your plan's tier and deductible rather than Lilly's cash steps, so ask your plan whether its charge differs by strength.
• Plan limits on starting strengths. Prime's criteria limit each starting strength to 60 tablets per 180 days, which is two 30-day bottles (our arithmetic).⁹ A long break can send you back to them: after 7 or more missed doses in a row, the label has your prescriber restart the step-up at a lower dose, so call your prescriber before restarting.¹
• Renewals check your dose. Caremark renews after 3 months at a stable maintenance dose, UnitedHealthcare gives one extra 6-month approval to someone still stepping up to a maintenance dose, and Centene's commercial policy renews only if you can stay on at least 5.5 mg a day after the step-up period.^{3, 5, 10}

What Foundayo's FDA label warns about

Two label rules bear on the dose steps, and so on price: a 9 mg cap with some medicines, and backup birth control after each dose increase for people on the pill. This is a summary of what matters before you buy, not the full label.¹

What it's approved for. Foundayo is FDA-approved, with a reduced-calorie diet and more physical activity, to help adults with obesity, or with overweight and a weight-related condition, lose excess weight and keep it off. Its safety and effectiveness in children haven't been established, so use under 18, or beyond that approved use, is off-label.¹ If the approved use doesn't describe you, start with your own doctor; our guide to GLP-1s for people who aren't obese or overweight explains what to ask.

Boxed warning and who must not take it. The boxed warning concerns thyroid C-cell tumors. Related drugs caused them in rats and mice; orforglipron isn't active at the rodent receptor, so those studies couldn't test it, but it is active at the human one, and the label says the risk to people hasn't been determined. Foundayo is not for anyone with a personal or family history of medullary thyroid carcinoma (MTC), a thyroid cancer, or with multiple endocrine neoplasia syndrome type 2 (MEN 2), an inherited condition that involves tumors in hormone-producing glands, or with a serious allergy to orforglipron or its ingredients. It isn't recommended with severe gastroparesis (very slow stomach emptying) or severe liver impairment.^{1, 39}

Pregnancy, breastfeeding and birth control. Foundayo may harm an unborn baby, so the label says to stop it once a pregnancy is recognized and advises effective birth control during treatment; it isn't recommended while breastfeeding. Because it slows stomach emptying, birth-control pills may not work as well, and the label advises a non-pill method, or a barrier method added to the pill, for 30 days after you start and after each dose increase.¹

Other medicines. Foundayo's Medication Guide says it should not be used with other GLP-1 receptor agonist medicines, and Anthem's criteria list semaglutide and tirzepatide products among them, so tell your prescriber if you take either, compounded or brand-name.^{1, 37} The label caps Foundayo at 9 mg with strong blockers of CYP3A4, a liver enzyme that breaks it down, says to avoid some of them (ritonavir is its example) and strong inducers, and limits simvastatin, a cholesterol drug, to 20 mg a day. Foundayo also slows stomach emptying, which can change how other pills are absorbed.¹

Other serious risks. The label also lists pancreatitis (some cases with GLP-1 drugs have been fatal), gallbladder disease, severe stomach and bowel problems, serious allergic reactions, worsening diabetic eye disease, kidney injury, mostly after dehydration from nausea, vomiting or diarrhea, and low blood sugar, which is more likely with insulin or a sulfonylurea (a type of diabetes pill). Rarely, people taking GLP-1 drugs have gotten food or liquid into their lungs during anesthesia or deep sedation, so tell every provider you take Foundayo before a procedure. The most common side effects are nausea, constipation, diarrhea and vomiting.¹

Warning signs. Stop taking Foundayo and call your prescriber right away for severe stomach-area pain that won't go away. Stop and get medical help right away for signs of a serious allergic reaction, such as swelling of the face, lips, tongue or throat, or trouble breathing or swallowing.¹ Read the full Foundayo label and Medication Guide for every warning, sign and side effect.

Costs beyond the tablets

• Taxes and fees. Lilly says these may be added to its self-pay prices.¹¹
• Prescriber and program fees. Some online services that prescribe Foundayo charge a fee on top of the medicine. Three examples, from each company's own site on October 3, 2026:
  • Ro: a Ro Body membership, as low as $74 a month when you prepay for a year, in addition to the medicine.⁴⁰
  • WeightWatchers: a WW Med+ membership, $25 for the first month as an introductory offer, then $74 a month on a 12-month plan or $84 a month on a 6-month plan, renewing automatically; the medicine is bought separately through LillyDirect.⁴¹
  • Optum Perks Online Care: $39 per visit, with no membership, plus the medicine. Optum Perks, LLC, which also offers a prescription discount card, is an RVO Health company, not the Optum Rx plan manager described above.⁴²
  Before you pay any program, read its renewal and cancellation terms (what to look for).
• HSA or FSA. LillyDirect lists Foundayo as HSA and FSA eligible and adds that eligibility may vary by plan; see paying with an HSA or FSA.¹¹
• Free-medicine programs. Lilly Cares, Lilly's free-medicine foundation, did not list Foundayo as of October 3, 2026.⁴³

Gaps we could not fill, and five questions for your plan

Besides the TRICARE, Caremark and Express Scripts gaps noted above, we could not confirm:

• FEP Blue, the Blue Cross and Blue Shield plan for federal employees: we found no Foundayo coverage rules to report.
• Plans we did not check, including Cigna and Aetna: the questions below work for any plan.
• What plans pay Lilly for Foundayo: these negotiated prices are not public.
• Lilly's prices and card terms for 2027: none were published as of October 4, 2026.

To get your own answer, call the number on your insurance card and ask:

1. Does my plan cover weight-loss drugs?
2. Is Foundayo on my drug list, and on which tier?
3. What does prior authorization require, and is there a quantity limit or a required program such as EncircleRx?
4. What will I pay for a 30-day fill and a 90-day fill, before and after my deductible?
5. If I'm turned down, how do I appeal, and by when?

PlexusDx and Foundayo

Foundayo is not part of PlexusDx's GLP-1 programs, which are built on compounded semaglutide and compounded tirzepatide when a clinician prescribes them. Both drugs, including in the Microdose GLP-1 plan, are available as weekly injections and as orally disintegrating tablets (ODT) taken daily, and PlexusDx's published price list charges the same for a tablet as for an injection. No tirzepatide tablet is FDA-approved, and FDA has not approved any compounded semaglutide tablet. PlexusDx is self-pay and does not bill health insurance (see its Terms of Service), so the insurance rules, savings cards and Medicare routes above don't apply to its programs.

Compounded drugs are not FDA-approved: FDA does not review their safety, effectiveness or quality before they are sold.⁴⁴ More on how compounding rules work.

Lone Star Virtual Health supplies the U.S.-licensed clinicians for those programs, and they, not PlexusDx, decide whether to prescribe. PlexusDx itself handles technology, payment, support and care coordination, and licensed partner pharmacies fill the prescriptions. PlexusDx does not sell or ship brand-name medications. If you would prefer a brand-name, FDA-approved medication, your provider may write a prescription you can fill at the pharmacy of your choice.

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How we made this page

FDA approved Foundayo in April 2026, and what it costs with insurance is spread across dozens of documents that each answer one piece of the question. For this page, AI tools read those documents: Lilly's Foundayo price page, card terms, list-price disclosure, news release and free-medicine list; FDA's approval record and the Foundayo label and Medication Guide; coverage documents from CVS Caremark, Express Scripts and Evernorth, Optum Rx, UnitedHealthcare, Anthem, a Blue Cross and Blue Shield list, Prime Therapeutics and Centene; Medicare.gov, CMS, HealthCare.gov, two federal statutes and two federal rules, on enhanced Part D coverage and on Medicaid health plan appeals; three state Medicaid documents and Indiana's BALANCE announcement; the VA's formulary data, criteria and copay rates; TRICARE's FAQ and its Q&A on TRICARE For Life; FDA's pages on compounded and unapproved GLP-1 drugs; MedlinePlus's page on MEN 2; and the fee pages of the three services, among the top results we read, that state a fee for prescribing Foundayo. The wording came from AI tools working only from those documents. What the page says about PlexusDx is our own statement, based on PlexusDx's Terms of Service and website, so it carries no citation.

Most documents were read on October 3, 2026. An AI review of an earlier draft found mistakes, including a North Carolina Medicaid drug list read in the wrong column and a track of Lilly's commercial savings card that we had left out; after correcting them we reopened Lilly's card terms and prices, the label and the Medicare, state Medicaid, VA, TRICARE and Anthem documents on October 4, 2026. Each source below shows its own date. For the prices, plan rules and label warnings above, a script checked nearly every supporting passage we had recorded against the text we saved when we read each document, and it recomputed the savings-card table and the starting-dose cost example. These checks are not a medical or legal review, and none of them can say whether your own plan will cover Foundayo. For this page we did not use or test any company's service. The older PlexusDx post at this address put PlexusDx prices beside Foundayo's and said people on government coverage could use neither Lilly card, which is wrong for the self-pay card; we reused nothing from it.

Jay Hastings reviewed and approved this version on October 19, 2026. Dr. Asad K. Niazi, MD, MPH, reviewed the medical content on October 17, 2026. He is co-founder and CEO of Lone Star Virtual Health, the company that provides PlexusDx's prescribing clinicians, so he has a business relationship with PlexusDx. PlexusDx sells compounded GLP-1 treatment, supplement packs and at-home blood tests, so we have a financial interest in this topic. See our editorial policy.