Millions lose GLP‑1 coverage

Millions of Americans lost insurance coverage last year for Wegovy and Zepbound, two of the most widely used prescription weight-loss drugs. (npr.org) NPR reported analysts estimated about 12 million people lost coverage for Zepbound in 2025 and another 12 million lost coverage for Wegovy as insurers and employers tightened benefits. (npr.org) These drugs work by copying gut hormones that curb appetite and slow digestion, and both are sold as weekly injections. Wegovy is Novo Nordisk’s semaglutide, and Zepbound is Eli Lilly’s tirzepatide. (icer.org) Coverage has narrowed as employers and insurers confront high demand and high prices. KFF reported in October 2025 that many employers were considering scaling back GLP-1 coverage for weight loss or adding stricter requirements. (kff.org) Business Group on Health said GLP-1 medicines were among the top drivers of employers’ health cost increases, and 52% of employers said they would either implement or strongly consider reducing coverage. (businessgrouphealth.org) Medicare still generally does not cover drugs when they are prescribed only for obesity, because anti-obesity medicines remain excluded under the Part D drug benefit unless they are used for another approved condition. (cms.gov) That exception has become more important as the Food and Drug Administration has added other approved uses. In March 2024, the FDA approved Wegovy to reduce the risk of heart attack, stroke, and cardiovascular death in some adults with cardiovascular disease and overweight or obesity. (fda.gov) In December 2024, the FDA approved Zepbound as the first medication for moderate to severe obstructive sleep apnea in adults with obesity, opening another path to coverage for some patients. (fda.gov) The Biden administration had proposed in November 2024 to reinterpret Medicare and Medicaid rules so anti-obesity drugs would be covered more broadly, but that rule did not take effect. (cms.gov) Instead, the Centers for Medicare & Medicaid Services now says a temporary “Medicare GLP-1 Bridge” will begin July 1, 2026 and run through December 31, 2027 for eligible Part D enrollees. CMS said it will release more details on who qualifies in spring 2026. (cms.gov) For patients who do not meet those narrower rules, access still depends on whether an employer, marketplace plan, Medicaid program, or Medicare drug plan will pay. KFF said coverage in Medicaid, Affordable Care Act marketplace plans, and most large employer plans remains limited because of cost. (kff.org)