The crisis over GLP-1 out-of-pocket costs deepens—it's time for health-care leaders to step up
Health-care professionals, eager to support their patients diagnosed with diabetes or obesity, are writing more prescriptions for these life-changing medications. In 2024 alone, prescription fills for FDA-approved weight loss medications Zepbound and Wegovy more than doubled. And with studies predicting staggering increases in the obesity rate by 2050, and the multiple conditions these drugs could help, interest in GLP-1s will continue to grow.
Unfortunately, cost is still prohibiting many Americans from accessing these medications. Despite the proven efficacy and external pressures, a new report from GoodRx Research found that commercial insurance coverage has not improved across the board in 2025. For example, the number of people without any commercial insurance coverage for Zepbound increased by over 14% in 2025. Even with increased coverage for Wegovy in 2025, 83% of people with coverage still face restrictions like prior authorization or step therapy, whether they're prescribed the medication for obesity, cardiovascular disease, or any other indication.
And employers, saddled with the impact of inflation and rising health-care costs, don't want to foot the bill. While there are long-term health benefits and related savings for people taking GLP-1s, most employers and health plans that paid for the upfront costs don't actually benefit when people change jobs every four years.
But the burden doesn't all fall on insurance plans and employers. Pharmaceutical manufacturers have set high list prices, citing among other things overwhelming demand, supply shortages, the cost of innovation, additional competitors joining the market, and anticipated price negotiations with the government as part of the Inflation Reduction Act (IRA). These prices have made it even more cost-prohibitive for insurance companies and employers to keep GIP and GLP-1 medications on their plans.
To alleviate the high costs affecting consumers, health-care leaders need to come to the table to address the friction preventing greater access and affordability. Everyone has a role to play.
Pharmaceutical manufacturers must reevaluate the list price and implement more affordability programs to help consumers prescribed GIP and GLP-1 medications for obesity. Eli Lilly took a step in the right direction recently by lowering the price of single-dose Zepbound vials by about $50. But there is still a greater need for more widely available cash price options at retail pharmacies across the country. These days, more consumers—frustrated with the friction and inefficiencies in the health-care system—opt for cash pay solutions so they can get the medications they need quickly and easily.
Manufacturers should also take the reins and spearhead industry-wide conversations on the long-term economic and clinical benefits of obesity treatment. The current perspective is too narrowly focused on short-term costs, overlooking the impact that improved population health has on patient outcomes and overall health-care spending.
Employers and health plans must then make better efforts to minimize restrictions on GIP and GLP-1 coverage. GoodRx Research shows restrictions limit over 82% of insurance coverage for Wegovy, Zepbound, and Saxenda when prescribed for weight loss. Even when GIP and GLP-1 agonists are prescribed for Type 2 diabetes, additional restrictions are usually placed on commercial insurance coverage—over 75% of the time for Mounjaro and over 83% of the time for Ozempic.
And the government needs to intervene, requiring Medicare to treat obesity as a chronic condition and initiating coverage for Part D enrollees who are prescribed a GIP or GLP-1 medication solely for the treatment of weight loss, rather than restricting coverage to those with diabetes or cardiovascular disease. A shift like this would trickle down to improvements in commercial insurance coverage, placing pressure on other payers and potentially stimulating a reevaluation of coverage and restrictions across the board.
It's time to come together to solve the GIP and GLP-1 challenge. As health-care leaders, it's our responsibility to step up and innovate to bridge access and affordability gaps. By making a commitment to affordability and opening the door to greater collaboration to reduce out-of-pocket medication spending, we can ensure that more people are able to reap the health benefits of these critical medications.
The opinions expressed in Fortune.com commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of Fortune.
Read more:
I'm an obesity medicine doctor and I've been on weight-loss drugs like Ozempic for a decade. Here's why I think they aren't a fad
Here's the real reason Ozempic-like weight-loss drugs are so popular
Ozempic and Wegovy are trimming waistlines—and showing how quickly U.S. health care can turn into a gold rush
This story was originally featured on Fortune.com
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