In 2023, the United States marked a major milestone in the battle against a longstanding public health crisis: adult obesity rates dropped for the first time in a decade.
Researchers pointed to GLP-1s as a potential contributing factor, alongside pandemic-related shifts in behaviors. And while these medications may be helping address the nation’s obesity epidemic, the reality is that high costs, limited insurance coverage for weight loss, unequal access across racial and socioeconomic groups, and low adherence rates are making them a tough solution to sustain across the healthcare ecosystem.
UnitedHealth Group, the largest healthcare company in the nation, with its vast reach through both the insurance sector and its expansive provider and pharmacy network via Optum, has a unique perspective on the challenges facing the industry. With control over one-third of all healthcare claims nationwide through Change Healthcare, the company is positioned to see trends that others might miss. In January, CEO Andrew Witty specifically mentioned GLP-1s to investors to explain one reason for why healthcare costs keep rising.
“Fundamentally, healthcare costs more in the U.S. because the price of a single procedure, visit, or prescription is higher here than it is in other countries,” he said. “Just look at GLP-1 prices. One drug, which costs $900 in the U.S., costs about a tenth of that in Europe.”
From an employer’s perspective, the high costs and low adherence rates of GLP-1s are making them a less effective tool in addressing obesity. A 2024 Mercer survey found that 44% of employers with 500 or more employees offer GLP-1 coverage for obesity.
“We see a very high rate of members that start these medications and don’t keep taking them,” Craig Kurtzweil, Chief Data and Analytics Officer for UnitedHealthcare’s Employer and Individual business, told Becker’s in February. “The economics and adherence rates just make the math really hard for GLP-1s in their current state to be an effective tool or solution for employers to combat this problem.”
Insurers and self-funded employers have been adjusting their GLP-1 coverage policies in recent years in response to the financial burden. The drugs have also been cited as contributing to financial losses for several Blue Cross Blue Shield plans in 2024.
A study published in March in JAMA Health Forum added weight to these concerns, suggesting that the blockbuster weight-loss drugs, Wegovy and Zepbound, despite their proven health benefits, are not cost-effective at their current prices. The University of Chicago researchers found that for these drugs to meet common cost standards, the price of Wegovy would need to fall by more than 80% to $127 per month, and Zepbound’s price would need to drop by nearly one-third to $361 per month. Currently, the average monthly prices are around $700 for Wegovy and $520 for Zepbound, making them financially unsustainable for many patients.
Despite the growing demand and expanded indications for GLP-1s, commercial insurance coverage has not kept pace because of the financial concerns. A March 2025 report from GoodRx showed that coverage for these drugs is increasingly restricted, with an estimated 6 million people losing access to GLP-1s from 2024 to 2025. Notably, the number of people without commercial coverage for Zepbound grew by more than 15% this year, while 1.1 million people lost coverage for Ozempic, which is primarily used for Type 2 diabetes. Still, an estimated 7 million people gained coverage for Wegovy, but 83% of those with coverage face restrictions such as prior authorization or step therapy.
Patient adherence to GLP-1 drugs has also been a major challenge. A cohort study published in January in JAMA Network Open found that more than half of patients discontinue GLP-1 therapy within the first year, with those without Type 2 diabetes showing the highest dropout rates. The JAMA study is consistent with findings from a Blue Cross Blue Shield Association study in May 2024, which showed that 30% of patients stopped using GLP-1 medications within the first month, and 58% discontinued before achieving any clinically meaningful health benefits.
Despite the clinical and financial challenges, several states have moved to address the need for broader coverage of the medications. Minnesota lawmakers proposed a bill in February that would require state-regulated health plans to cover GLP-1s for obesity, alongside other evidence-based treatments for obesity such as bariatric surgery and behavioral therapies. In January, North Dakota became the first state to cover weight-loss drugs under the ACA for both diabetes and obesity, allowing individual ACA plans and small-group employer plans to include GLP-1s and gastric inhibitory polypeptide drugs.
Medicare, which has seen a substantial rise in spending on diabetes medications, including GLP-1s, has faced its own set of challenges. A February report from the HHS Office of Inspector General showed that Part D spending on 10 common diabetes drugs, including GLP-1s, increased by 364% from 2019 to 2023, from $7.7 billion to $35.8 billion. The report noted that Medicare spending on the medications could surpass $106 billion by 2026.
