Insurance companies grapple with exorbitant costs of GLP-1 drugs, spurring efforts to gradually discontinue patient prescriptions

The use of GLP-1 drugs for weight loss is gaining popularity, but several factors are putting pressure on public and private payers to limit or restrict coverage.

In the United States, the University of Michigan has set a two-year cap on GLP-1 drug coverage for weight loss. This decision comes as steep spending cuts in the budget reconciliation package signed into law by President Donald Trump put pressure on all state Medicaid programs. The high costs of these medications, such as the injectable Zepbound with list prices of roughly $1,000 a month, are a significant concern.

As a result, some payers are eliminating or restricting coverage for GLP-1 weight loss drugs. For instance, North Carolina Medicaid plans to end GLP-1 coverage for weight loss on Oct. 1, 2025. This trend is causing concern for individuals like Lily, who lost almost 80 pounds on Wegovy but had to quit due to insurance issues, worrying about potential weight regain and future health problems.

The concept of deliberate "deprescription," which aims to taper some patients off their medication after a certain amount of time or weight loss, is being explored by researchers, payers, and providers. Research suggests that slowly tapering off GLP-1 medications may help maintain weight loss. For example, a Virta-funded study assessed 154 people with Type 2 diabetes who stopped using GLP-1 medications but continued following Virta's nutrition-focused weight management program, concluding that their weight did not significantly increase after a year.

However, there's no standard of care for weaning off GLP-1 medications. Allison Adams, an obesity and internal medicine doctor, acknowledges this gap. On the other hand, Michelle Gourdine, chief medical officer for CVS Caremark, explains that time-limited coverage is appealing to payers struggling with GLP-1 prescription costs.

In an effort to maximise savings, plans could see real savings if they covered GLP-1s for initial weight loss and then moved people to cheaper options. However, the need for potentially lifelong treatment and the high costs have led to many patients, often paying out-of-pocket, discontinuing use within a year, reflecting challenges in sustained insurance coverage for these expensive therapies.

In response, some states like Pennsylvania are planning to limit Medicaid coverage for GLP-1 weight loss drugs to beneficiaries at the highest risk of complications from obesity. Pennsylvania projects it will spend $1.3 billion on GLP-1 drugs this year.

A. Mark Fendrick, who directs the Center for Value-Based Insurance Design at the University of Michigan, argues that if some people using GLP-1s to lose weight were eventually transitioned off, more people could take advantage of them. The U.K.'s National Institute for Health and Care Excellence also recommends two-year limits on the use of some weight loss medications, such as Wegovy.

As the demand for GLP-1 weight loss drugs continues to grow, public and private payers are struggling to keep up. Virta Health advertises its nutrition-focused weight management program as a proven approach for deprescribing GLP-1s when clinically appropriate, offering an alternative for those who can no longer afford or access these expensive medications.

In conclusion, while GLP-1 drugs for weight loss show promise, their high costs and the need for potentially lifelong treatment pose significant challenges for public and private payers. Efforts to explore deprescription and alternative weight management programs are underway, aiming to make these treatments more accessible and sustainable for those who need them.

Insurance companies grapple with exorbitant costs of GLP-1 drugs, spurring efforts to gradually discontinue patient prescriptions