GLP-1 costs push employers and states to rethink obesity drug coverage
Use of GLP-1 drugs is rising fast, forcing health plans to weigh short-term costs against potential gains in chronic disease care.
By Sofia Marchetti · World Affairs Correspondent
3 min read
Rising use of GLP-1 weight-loss drugs is putting new pressure on public programs and employers that pay for health coverage. The debate has sharpened as chronic disease remains widespread in the U.S. and spending on the drugs climbs quickly.
The Centers for Disease Control and Prevention says 76.4% of U.S. adults have at least one chronic condition, while 51.4% have two or more. FAIR Health reported that spending on GLP-1 treatments rose more than 500% from 2019 to 2024.
Demand is expected to keep growing. JPMorgan has projected that U.S. GLP-1 use could reach 25 million people by 2030, up from 10 million in 2025, according to figures cited in a Fortune commentary on the cost and coverage fight.
The Centers for Medicare and Medicaid Services’ Bridge program is also expected to expand access by covering GLP-1s for obesity with comorbidities under Medicare and Medicaid, according to CMS materials cited by the commentary. The authors described the program as an 18-month effort and warned that a longer-term successor has not been established.
Coverage limits are spreading
Some payers are already pulling back. MassHealth said in July that it would stop covering the medication, a decision expected to affect 22,000 Massachusetts residents and save the state about $15 million a year, according to the Fortune commentary.
Cigna also ended access for its employees in June, according to the commentary. The Business Group on Health found that 10% of companies currently covering GLP-1s for weight loss plan to discontinue that coverage by 2027.
The Fortune authors argued that health plans and employers should not treat the issue as a choice between broad access and no access. They said GLP-1s could reduce costs tied to diabetes, chronic kidney disease, liver disease and musculoskeletal conditions if coverage is aimed at patients most likely to benefit.
Authors call for targeted treatment
The commentary said obesity has been poorly captured in claims data because it was not treated as a disease until recently, leaving many physicians without enough training or infrastructure to prescribe the drugs effectively. The authors argued that health systems need more data to identify patients with the greatest need and match them with appropriate care.
That care, they wrote, should include more than GLP-1 prescriptions. The authors pointed to intensive behavioral therapy, non-GLP medications, GLP-1 drugs and bariatric surgery as possible parts of a broader treatment plan.
They also argued that obesity care should be multidisciplinary because obesity is associated with more than 200 conditions and can affect many systems in the body. In their view, treatment should combine medical care with support for nutrition, physical activity, behavioral change and social factors that affect health.
The authors said success should be measured beyond weight loss. They called for tracking biomarkers, heart, kidney and liver health, pain, physical activity, mental health and well-being.
Ilant, a startup founded by Elina, has observed improvements across several of those areas, including loneliness, according to the commentary. The authors said that data-driven coverage could help payers preserve access for higher-need patients while controlling costs.
This story draws on original reporting from Fortune.