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U.S. insurers restrict coverage for GLP-1 medications

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Pricy drugs Wegovy and Zepbound are weekly injections

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U.S. insurer list prices for them top $1,000 per month

By Deena Beasley

Aug 13 (Reuters) - Doctors advise most patients on GLP-1

obesity drugs such as Wegovy and Zepbound to stay on them to

keep the weight off, but as more U.S. insurers restrict coverage

people are trimming costs by stretching doses or forgoing

expenditures like vacations to pay for the medication out of

pocket.

A half dozen doctors who spoke with Reuters said insurance

coverage has tightened in 2025 as many employers drop it for the

expensive GLP-1 drugs. While patients on these medications are

counseled on proper diet and exercise, clinical trials show that

people who stop taking these drugs are apt to regain weight.

Novo Nordisk's Wegovy and Eli Lilly's ( LLY )

Zepbound are weekly injections with U.S. insurer list prices of

more than $1,000 a month. For customers willing to pay cash,

both drugmakers will ship directly for $499 a month if refills

are purchased at fixed intervals.

"A significant number of my patients now pay cash," said Dr.

Nidhi Kansal, an obesity specialist at Northwestern Medicine in

Chicago. "People find a way to scrounge up $6,000 a year, which

sucks, because that's a vacation or two."

More than a billion people worldwide are obese, according to the

U.N. World Health Organization, which has said the GLP-1 drugs

could help end the obesity pandemic.

'A KIND OF PURGATORY'

A tech industry job change for Yelena Kibasova, a

40-year-old who lives in the Minneapolis area, meant loss of

coverage for her Zepbound prescription that helped her achieve

and maintain a 150-pound (68-kg) weight loss.

"My new company does not cover GLP-1s, so now I am in a kind

of purgatory," Kibasova said. "I stopped doing my nails. I

stopped doing my hair. Those things are not as important as me

staying at a healthy weight."

The doctors interviewed by Reuters said patients once leery

about long-term obesity treatment are now more comfortable

staying on a drug. The doctors said that conversations about

temporary use happen only when a patient is trying to lose a

certain amount of weight for issues such as fertility treatment

or an organ transplant.

These obesity specialists said they are hopeful that

competition will help bring down prices as new weight-loss

options emerge, including new oral drugs that may be available

next year.

Lilly last week announced trial results for its

easier-to-manufacture pill, which was shown to cut patient

weight by 12.4%, a few percentage points less than injected

drugs. The company hopes to launch it in August 2026.

Kenneth Custer, Lilly's head of cardiometabolic health, told

Reuters the pill is being tested in several settings, including

as a maintenance therapy. Custer declined to comment on how it

might be priced.

MEDICATION FOR MAINTENANCE

Dr. Anne Peters, an endocrinologist at Keck Medicine USC in

Los Angeles, said it is important that patients who reach their

weight-loss goal not stop a prescription "cold turkey," so the

dose can be tapered down over several months. Peters said about

a third of her patients are able to reduce their dose and

maintain weight loss, while the rest need to stay on the

medication.

An analysis of U.S. pharmacy insurance claims found that nearly

two-thirds of patients who started on Wegovy or Zepbound in 2024

were still on the medications a year later.

Peters said she uses "every technique in the book" to secure

insurance coverage for patients, but noted that a growing number

of plans no longer pay for the treatments, and patients have to

pay out-of-pocket.

U.S. pharmacies supply self-injection pens pre-loaded with

doses of Wegovy or Zepbound. Lilly's direct-to-consumer service

also offers vials.

"Some patients can stretch out the vials longer. Get 15 mg,

and then give a 10 mg dose for instance," Dr. Peters said,

noting that the drug's instructions advise that such an approach

should not be taken. Doses of 5 mg, 10 mg and 15 mg are

recommended for weight-loss maintenance.

Patients also are turning to lower-cost compounded versions of

the GLP-1 drugs, or are even mixing them at home with raw

ingredients, both of which Peters and other doctors advise

against due to safety concerns.

Dr. Angela Fitch, former president of the Centennial,

Colorado-based Obesity Medicine Association and chief medical

officer at online primary care provider Knownwell, said nobody

wants to be on a medication, but patients who respond to a GLP-1

drug "really don't want to go off of it when they recognize that

it has such a value to them."

Both Wegovy and Zepbound were first launched, under the brand

names Ozempic and Mounjaro, as diabetes treatments. The class

has been linked to a range of benefits, including improved heart

health and less sleep apnea.

Fitch said the most common reason for her patients to stop

taking a GLP-1 drug is loss of insurance coverage. She said her

experience is that about 10% of patients are able to reach a

target weight and maintain it without further treatment.

"We are in a dip where people are dropping coverage," Fitch

said, adding that the direct-to-consumer options are an

"upper-ish middle-class thing."