Exploring payer coverage of anti-obesity medications

Shaila Yoshida: The inspiration for this research stems from the recognition that obesity is a chronic and complex disease with significant clinical and economic burdens. The CDC estimates that 40 percent of adults in the United States are affected by obesity, which can lead to severe health issues, including heart disease, type 2 diabetes, and certain cancers.^1,2 The economic impact is also substantial, with conditions related to overweight and obesity potentially costing U.S. businesses and employees billions annually.³ Despite the long history of attempts to address obesity with medications, it wasn't until 2014 that a new class of drugs, GLP-1 receptor agonists, began to show promising results. As of April 2025, there are 7 FDA-approved AOMs for the long-term treatment of obesity in the US.⁴

However, as demand rises for AOMs, U.S. payers are concerned about their associated budget impact, with coverage being uneven across commercial plans and state Medicaid agencies, while being completely excluded from Medicare Part D coverage. The Cencora team wanted to dig deeper with payers to understand how they are currently covering AOMs on their commercial formularies, what challenges they are facing, and the outlook for these drugs at their organizations.

Shaila Yoshida: Yes, our hypothesis that cost would be a major concern for payers was confirmed. The research showed that cost was indeed the primary reason identified by payers for not covering or planning AOMs on their commercial formularies. This aligns with our expectations, given the high prevalence of obesity and the potential budget impact of these new drugs to their organizations.

Shaila Yoshida: One surprising finding was that a majority of payers who track specific outcomes related to obesity are seeing positive impacts from AOMs. For instance, 96 percent of payers who track weight loss reported positive outcomes, and 93 percent saw a positive impact on body mass index. This indicates that the drugs are effective in real-world settings, which is promising for their continued use and coverage.

Shaila Yoshida: The healthcare landscape of AOMs is evolving every week, with new drugs being announced by several biopharmaceutical companies, and new clinical data being released on existing AOMs. A change in the administration will also open new opportunities to revisit existing regulation and consider new ones that impact AOMs. Future research will track all new developments in this space and analyze the impacts to the commercial, Medicare and Medicaid books of business of U.S. managed care organizations.