Supplies of Wegovy, a GLP-1 weight-loss drug, are shown. While use of such injectable drugs has soared in recent years, many people face steep costs for the treatment, putting them out of reach.
Photo by James Manning, courtesy PA Images/Getty Images
For nearly seven years, Chika Anekwe, MD, MPH, has been on the front lines of obesity care at Massachusetts General Hospital Weight Center.
In addition to prescribing her patients healthy diets with behavioral and lifestyle counseling, she has witnessed first-hand the transformative impact of a new class of medications for weight loss: GLP-1 receptor agonists.
“It’s way more effective,” Anekwe told The Nation’s Health, noting that her patients achieved significantly greater weight loss with GLP-1 medications compared to diet and lifestyle changes alone.
More than 40% of adults in the U.S. have obesity, defined as a body mass index over 30. However, unlike some of the patients Anekwe treats in Massachusetts — where Medicaid covers the medications — most adults across the country face steep out-of-pocket costs for treatments.
Glucagon-like peptide-1 receptor agonists, aka GLP-1 drugs, were originally approved and used for treatment of Type 2 diabetes, with the first product debuting in 2005.
The first use of a GLP-1 drug for weight management was not approved by the U.S. Food and Drug Administration until 2014. Approvals later followed for semaglutide and tirzepatide, which are sold under brand names such as Wegovy. Ozempic, a popular GLP-1 drug for Type 2 diabetes, is not FDA-approved for weight loss, but is often used off-label.
As of May 2024, about 22% of adults who had been told by a doctor that they are overweight or obese said they had ever taken a GLP-1 drug, according to a KFF poll.
Strong consumer demand and lack of competition has kept prices high, with out-of-pocket costs reaching over $1,000 per month before insurance, rebates and discounts. People with employer-based insurance have had the easiest path to using the medications. About half of large employers in the U.S. covered the drugs in 2024, according to a 2024 survey from Mercer.
But Americans with low incomes or who lack comprehensive employer health insurance coverage often struggle to obtain the medications. While 13 state Medicaid programs offer coverage of GLP-1 drugs for weight loss, most do not. Although the Biden administration proposed a rule last year that would have extended coverage to all Medicaid and Medicare users, the Trump administration said in April that it would not finalize it.
The proposal would have likely improved health outcomes for millions of people. But the fiscal cost on state Medicaid budgets would have been substantial, Jack Rollins, MPH, director of federal policy at the National Association of Medicaid Directors told The Nation’s Health.
Under Biden’s proposal, Medicare spending would have increased by $25 billion and Medicaid spending by $15 billion over 10 years, the Centers for Medicare and Medicaid estimated. Because Medicaid is jointly financed by the states and the federal government, CMS estimated the federal government would pay $11 billion of that total.
The decision to scrap the plan by the budget-slashing Trump administration could make things much harder for millions of people with obesity, however. A 2023 study in the Journal of the American Medical Association found that only 10% of people with a BMI over 25 manage to lose just 5% of their body weight. In general, the higher the BMI, the harder it is to take off weight and keep it off.
Long-term use of GLP-1 drugs has shown substantially larger results for many people, Anekwe said. The medications work by suppressing appetite and slowing stomach emptying, helping people feel full longer.
“Compared to the 3-5% body weight reduction for behavior and lifestyle, you can get upward of 15-20% body weight reduction with the newer GLP medications,” Anekwe said.
High costs serve as barrier to care
High out-of-pocket costs for people without insurance coverage remain a key factor in determining who can benefit from GLP-1 medications and who cannot, said Tracy Svenyach, PhD, director of policy strategy and alliance at the Obesity Action Coalition.
“Affordability is the leading barrier to accessing care.”
— Tracy Svenyach
“Affordability is the leading barrier to accessing care,” Svenyach told The Nation’s Health.
As of 2023, most adults earning below 200% of the federal poverty level lacked employer-sponsored insurance, leaving out-of-pocket payment as the only option for accessing the medications — unless they were a Medicaid user living in a state where the program covered the drugs.
Yet low-income communities often face higher obesity rates. Counties with minimum wages above $9 generally have lower obesity rates than those with lower wages, an October study in the Journal of Racial and Ethnic Health Disparities reported. The study also linked higher obesity rates to greater income inequality, limited access to healthy foods and higher racial and ethnic segregation.
While U.S. Black, Hispanic, American Indian and Alaska Native, and Native Hawaiian and Pacific Islander adults have higher per capita obesity rates than white adults, they are less likely to have health insurance and more likely to have lower incomes, according to a 2023 analysis from KFF.
Those factors could be contributing to the fact that people of color in the U.S. are less likely to use the drugs than white people, a 2024 study in the Journal of Racial and Ethnic Health Disparities found.
If left untreated, obesity can lead to a range of serious health conditions, including Type 2 diabetes, high blood pressure and cholesterol, heart disease, sleep apnea, osteoarthritis, and cancer. Adults with obesity also face significantly higher medical expenses — averaging nearly $1,900 more per year compared to those at a healthy weight, according to the Centers for Disease Control and Prevention.
A man holds a syringe containing semaglutide in Germany. Use of the medication for weight loss is growing in the U.S.
Photo by Roberto Pfeil, courtesy Picture Alliance/Getty Images
Beyond weight loss and diabetes management, recent studies suggest GLP-1 drugs may offer other health benefits, too —from treating addiction to lowering the risk of dementia. An April study in The Lancet eClinical- Medicine suggested GLP-1 medications may cut some cancer risks in half.
Until greater competition emerges among GLP-1 manufacturers, the cost of covering the medications may pose a financially unfeasible burden for federal and state governments, said David Kim, PhD, assistant professor of medicine and public health sciences at the University of Chicago.
“Highly effective treatment may not be cost-effective,” Kim told The Nation’s Health.
A more efficient care model could reduce financial pressure on both public and private insurers, Kim said. The approach could begin by prioritizing treatment for patients most likely to benefit from GLP-1 drugs to reach specific weight loss targets. After achieving their goals, patients could shift to less costly weight loss medications, complemented by behavioral therapy and nutrition education.
“We need to think about creative alternative weight maintenance strategies to provide a whole obesity chronic care model,” Kim said.
For more on GLP-1 drugs, visit www.fda.gov. For more on coverage of the drugs, visit www.kff.org/policy-watch.
This article was corrected post publication.
- Copyright The Nation’s Health, American Public Health Association
