Access to Care for Obesity: Steps Forward and Back
There’s no denying it. More people are getting access to care for obesity than ever before. In part this is because health professionals have a range of tools for providing that care. GLP-1 agonists like semaglutide and tirzepatide are a big part of that.But those drugs carry a price tag that is blowing up pharmacy budgets. So following those steps forward in access to care for obesity, there’s an urge to pull back.
We’re seeing it in new reports on insurance coverage. It comes through in the front line experiences of health professionals. It shows up in headlines from public health programs.
A leading voice in obesity care, medical professor Caroline Apovian, sums it up:
“My patients are facing more roadblocks now. The prior authorization process was already bad enough. But now we are facing higher BMI cutoffs. If a patient has good results and their BMI drops, insurance uses that as an excuse to cut off coverage.
“I’m seeing more insurers demanding that patients enroll in a six-month diet and exercise program that the insurer runs. Often, the patient has to pay for it with a drain on both their money and time.”
Drops in Coverage
GoodRx crunched the numbers on what they see from patients who seek their help with prescription discounts. They report a 14% increase in patients with no coverage for Zepbound this year. For Ozempic, the gap in coverage has increased by 22%. And even though they’ve seen some increases in coverage for Wegovy, 83% of patients have to deal with restrictions like prior authorization and step therapy provisions.
Then there are the public programs, like Medicaid in Connecticut, that are pulling back on access to care for these advanced medicines if a patient has obesity. Sarah Makowicki is graduate student who has lived with obesity for her entire life. She has had metabolic surgery for severe obesity and went on to take tirzepatide to gain control over obesity and thus, the best health she enjoyed for some time.
But the Connecticut Medicaid program is threatening to take that from her. She says:
“I feel that it’s almost discriminatory. We have a medical bias against people who are overweight. And now, it’s like ‘Oh, we’ve finally found this tool,’ and they’re saying, ‘Oh no, you can’t have it because we don’t want to spend the money.’”
Something’s Gotta Give
Here’s the thing. As use of these meds grows exponentially, the price is coming down. From a list price at launch of more than $1,300 per month, net prices have already dropped below $500.
But the pricing isn’t transparent or uniform and patients find themselves caught in the middle between health plans, PBMs, and big pharma dickering over prices that are still too high.
The health of millions of people suffers while people in power fight about who gets to keep the most money. This is a stupid mess.
Click here for the analysis from GoodRx, here for reporting on it from Forbes, and here for reporting on the situation in Connecticut.
Steps, photograph by Ted Kyle / ConscienHealth
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March 24, 2025
