HDHP or PPO? Open Enrollment Math for Someone Taking a GLP-1 in 2027
If you take a GLP-1 every month, the HDHP-versus-PPO decision comes down to one comparison: total yearly cost, meaning your premiums plus the out-of-pocket spending you expect, minus any employer HSA money and tax savings. A monthly brand-name drug usually burns through an HDHP deductible early in the year, so the plan's out-of-pocket maximum matters more than its deductible. Before any of that math, confirm the drug is covered in both plans, because a plan that excludes it changes everything.
Key takeaways
- For 2027, the IRS sets HSA contribution limits at $4,500 (self-only) and $9,000 (family). HDHPs need a deductible of at least $1,750 or $3,500 and an out-of-pocket maximum no higher than $8,700 or $17,400.
- In an HDHP you usually pay the plan's full negotiated drug price until you meet the deductible. In a copay plan you may pay a flat amount per fill from the start.
- Novo Nordisk is cutting the monthly list price of Wegovy, Ozempic and Rybelsus to $675 starting January 1, 2027, a change it said is aimed at people in high-deductible and coinsurance plans.
- IRS rules let an HDHP cover "insulin and other glucose lowering agents" for diabetes before the deductible, but plans are not required to, and the list does not mention weight-loss drugs.
- Savings card caps (such as $100 a month) tend to help copay plans more than an HDHP in its deductible phase.
Figures recorded October 19, 2026. The worked example below uses hypothetical plan numbers, not any real employer's plan.
Step zero: Is the drug covered in each plan?
Employers often offer HDHP and PPO options that share the same pharmacy benefit manager and formulary, but not always. Check the 2027 formulary for each option you are considering. Look for your exact drug, its tier, and any prior authorization, step therapy or quantity limit.
If the drug is excluded in both, the plan choice no longer turns on the drug. You would compare plans on your other care, and price the GLP-1 separately through self-pay. If only one plan covers it, that plan often wins for you even with a higher premium.
Coverage also decides savings-card eligibility. Lilly's $25 Zepbound card is for commercially insured patients whose plan covers the drug, with savings capped at $100 per 1-month fill and $1,300 per calendar year under its 2026 terms (Lilly, Zepbound savings). Novo's Wegovy offer for covered patients is "as little as $25," capped at $100 a month (NovoCare, Wegovy). Both companies say current terms end or will be updated after December 31, 2026.
The diabetes exception for HDHPs
IRS Notice 2019-45 lets an HDHP cover certain drugs for chronic conditions before the deductible without losing HSA eligibility. The list includes "insulin and other glucose lowering agents" for people diagnosed with diabetes (IRS Notice 2019-45). The notice permits this coverage; it does not require it. It also does not mention obesity or weight-loss drugs. If you take Ozempic, Mounjaro or another GLP-1 for type 2 diabetes, ask whether your HDHP uses this option, because it can turn a deductible-phase cost into a copay.
The 2027 numbers that set the limits
| 2027 limit | Self-only | Family | Source |
|---|---|---|---|
| HSA contribution limit (yours plus employer's) | $4,500 | $9,000 | IRS Rev. Proc. 2026-24 |
| HSA catch-up, age 55 and older | +$1,000 | +$1,000 | IRS Pub. 969 |
| HDHP minimum deductible | $1,750 | $3,500 | IRS Rev. Proc. 2026-24 |
| HDHP maximum out-of-pocket | $8,700 | $17,400 | IRS Rev. Proc. 2026-24 |
| ACA out-of-pocket cap (any non-grandfathered plan, including PPOs) | $12,000 | $24,000 | CMS 2027 guidance |
Source: IRS Rev. Proc. 2026-24; IRS Publication 969; CMS 2027 payment parameters guidance (Jan. 29, 2026).
Two rules from IRS Publication 969 matter here. Employer HSA contributions count toward the annual limit, and HSA money spent on qualified medical expenses comes out tax-free (IRS Pub. 969). Also note what does not count toward any out-of-pocket maximum: premiums, services the plan does not cover, and out-of-network care (HealthCare.gov glossary).
How each plan type charges you for a GLP-1
HDHP: Until you meet the deductible, you generally pay the plan's negotiated price for each fill. After that, you pay coinsurance (a percentage) or a copay until you hit the out-of-pocket maximum. For a drug filled every month, the first one to three fills of the year often satisfy most of the deductible.
PPO or copay plan: Drugs often have a flat copay by tier, sometimes with a separate pharmacy deductible or coinsurance for higher tiers. The plan's SBC lists the cost for each drug tier.
Because deductible-phase costs follow the drug's price, list prices matter more in an HDHP. Novo Nordisk said the list price (wholesale acquisition cost) of Wegovy, Ozempic and Rybelsus will drop to $675 a month on January 1, 2027, about 50% lower for Wegovy and 35% lower for Ozempic. Jamey Millar, Novo's head of US operations, said the cut is meant for patients "whose out-of-pocket costs are linked to list price," citing people in high-deductible health plans and coinsurance benefit designs (Novo Nordisk press release, Feb. 24, 2026). Your plan's negotiated price can differ from list price, so ask the plan or use its drug-price tool.
Drug not covered in either plan?
See what manufacturer and telehealth self-pay programs currently charge before you set your 2027 budget.
Paid links. We may earn a commission; it never changes what we write. See all options. Compounded medications are not FDA-approved.
The worksheet: fill this in for each plan
Pull these numbers from each plan's 2027 SBC, formulary and premium sheet. Use the same expected care for both plans.
| Line | What to enter | HDHP | PPO |
|---|---|---|---|
| A | Your annual premium share (per-paycheck amount × paychecks) | ____ | ____ |
| B | Expected annual drug cost to you (deductible phase, then copay or coinsurance) | ____ | ____ |
| C | Expected cost of your other care | ____ | ____ |
| D | Cap B + C at the plan's out-of-pocket maximum | ____ | ____ |
| E | Employer HSA (or HRA) contribution | ____ | n/a or ____ |
| F | Estimated tax savings on your own HSA or FSA contributions | ____ | ____ |
| Total | A + D − E − F | ____ | ____ |
Then run a worst case: A plus the full out-of-pocket maximum, minus E. That tells you the most each plan can cost in a bad year.
Illustrative example (hypothetical numbers)
This example is made up to show the method. It is not a real plan, and your plan's numbers will differ. Assume one person, self-only coverage, a covered GLP-1 filled 12 times, a plan-negotiated drug price of $675 a month (matching Novo's announced 2027 list price for illustration), and $1,000 of other in-network care.
| Line | Hypothetical HDHP | Hypothetical PPO |
|---|---|---|
| Plan design | $3,000 deductible, then 20% coinsurance; $6,000 out-of-pocket max | $500 medical deductible, 20% after; drug copay $100 per fill (no drug deductible); $4,000 out-of-pocket max |
| A. Premium share | $1,200 | $3,000 |
| B + C. Drug and other care | $8,100 drug + $1,000 other = $9,100 allowed. You pay $3,000 deductible + 20% of $6,100 = $4,220 | Drug: 12 × $100 = $1,200. Other: $500 + 20% of $500 = $600. Total $1,800 |
| D. Capped at out-of-pocket max | $4,220 (under $6,000) | $1,800 (under $4,000) |
| E. Employer HSA money | $750 | $0 |
| Total before tax savings | $1,200 + $4,220 − $750 = $4,670 | $3,000 + $1,800 = $4,800 |
| Worst case (A + max − E) | $6,450 | $7,000 |
All plan figures are hypothetical. The $675 price is used only as an illustration; your plan's negotiated price may be higher or lower.
In this made-up case, the plans land within $130 of each other before taxes. The HDHP pulls ahead once you add tax savings on your own HSA contributions, which depend on your tax bracket and how much you put in. Small changes flip the answer:
- If a $25 savings card applies to the PPO copay, the PPO drug cost could fall from $1,200 to $300 a year, because a $100 copay is within a $100 monthly savings cap. In the HDHP's deductible phase, the same cap covers only $100 of a $675 fill. (2027 card terms are not yet published.)
- If your HDHP covers diabetes GLP-1s before the deductible under Notice 2019-45, the HDHP drug cost can drop sharply.
- If you start the drug mid-year, fewer fills fall in the HDHP year, and the deductible weighs more heavily per fill.
- If your plan runs a copay accumulator, card payments may not count toward your deductible at all. Read the plan's pharmacy terms.
Questions to ask before you pick
- Is my drug on both plans' 2027 formularies, at what tier, and with what prior authorization rules?
- In the HDHP, what is the plan's negotiated price for my drug and dose?
- Does the HDHP cover glucose-lowering drugs before the deductible for people with diabetes?
- Does either plan use a copay accumulator or maximizer program?
- How much will the employer put into my HSA, and when (lump sum or per paycheck)?
What to do this open enrollment
- Confirm coverage of your drug in each plan option, in writing.
- Fill in the worksheet for each plan, including the worst-case line.
- If you choose the HDHP, set HSA contributions so that you, plus your employer, stay within $4,500 (self-only) or $9,000 (family) for 2027.
- If you choose the PPO, consider whether an FSA election makes sense for predictable drug copays.
- Check manufacturer savings terms again in January, since the 2026 cards state a December 31, 2026 end date.
Compare care options before choosing a program
If neither plan covers your GLP-1, compare current self-pay options as your fallback.
Paid links. We may earn a commission; it never changes what we write. See all options. Compounded medications are not FDA-approved.
Frequently asked questions
What are the 2027 HSA contribution limits?
IRS Rev. Proc. 2026-24 sets 2027 HSA limits at $4,500 for self-only coverage and $9,000 for family coverage. People 55 and older can add $1,000, and employer contributions count toward the limit.
Can an HDHP cover my GLP-1 before the deductible?
For diabetes, possibly. IRS Notice 2019-45 allows HDHPs to cover insulin and other glucose lowering agents for people with diabetes before the deductible, but plans are not required to. The notice does not mention weight-loss drugs.
Is an HDHP or PPO cheaper if I take a GLP-1 every month?
It depends on premiums, the drug's negotiated price, copays, the out-of-pocket maximum and employer HSA money. Compare total yearly cost (premiums plus expected out-of-pocket minus employer HSA money and tax savings) for each plan, plus each plan's worst case.
Does the Wegovy list price cut affect HDHP members?
Novo Nordisk said the monthly list price of Wegovy, Ozempic and Rybelsus drops to $675 on January 1, 2027, and that the cut is aimed at patients whose out-of-pocket costs are linked to list price, such as people in high-deductible and coinsurance plans. Your plan's negotiated price may differ.
Sources
- IRS Rev. Proc. 2026-24: 2027 HSA and HDHP Limits
- IRS Notice 2019-45: Preventive Care for Chronic Conditions
- IRS Publication 969: Health Savings Accounts
- CMS: 2027 Premium Adjustment Percentage and Maximum Cost Sharing Guidance
- HealthCare.gov Glossary: Out-of-Pocket Maximum
- Eli Lilly: Zepbound Coverage and Savings
- NovoCare: Wegovy Savings Offer
- Novo Nordisk press release: Significant reduction in US list price for Wegovy, Ozempic and Rybelsus (Feb. 24, 2026, via BioSpace)
Medical disclaimer: This article is general information, not medical advice, and does not replace a licensed clinician who knows your history. Approvals, labels, coverage and prices change; check the linked sources and talk with your prescriber or pharmacist before making decisions about any medication.