Current Market Access to GLP-1s — and What’s Next
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Apr 17, 2025
President Donald Trump’s administration on April 4 abandoned a proposal from Joe Biden’s administration that would have expanded Medicare and Medicaid beneficiaries’ access to obesity drugs, including the popular but costly GLP-1 medications.
Data from MMIT Analytics shows that fewer than 4% of Medicare enrollees have plans that put Wegovy (semaglutide) and Zepbound (tirzepatide) — GLP-1s that were approved for weight loss — under the preferred/preferred (prior authorization and/or step therapy) tier and covered/covered (PA/ST) tiers, as of April 2025 (AIS Health is a division of MMIT.) While Medicare Part D plans are barred by statute from covering weight-loss medications, they can cover them when they are approved for other indications, like reducing the risk of stroke or heart attack in patients with obesity.
Meanwhile, another two GLP-1s — Ozempic (semaglutide) and Mounjaro (tirzepatide) — are available for almost all Medicare enrollees for the treatment of diabetes. (It is likely, per news reports, that a substantial amount of diabetes-coded utilization of GLP-1s is actually off-label weight loss utilization.)
Across Medicaid plans, over 50% of beneficiaries nationwide currently have access to Wegovy and Zepbound with utilization management restrictions (such as prior authorization and/or step therapy), MMIT data shows. At least 14 states already cover GLP-1s to treat obesity for patients on Medicaid, while a half-dozen other states floated bills this year to require the same coverage, according to an Associated Press analysis.
Currently, the obesity GLP-1 market is dominated by Novo Nordisk’s Wegovy and Eli Lilly and Co.’s Zepbound. With many companies racing to develop rival versions of semaglutide in cheaper and easier-to-take forms, several drugs in clinical trials are expected to be reviewed by the FDA over the next few years. In addition, studies have shown that semaglutide can provide benefits other than weight loss, such as a reduction in dementia risk. In December 2024, the FDA approved Zepbound as the first and only prescription drug for treating moderate to severe obstructive sleep apnea in adults with obesity. Earlier that year, the FDA also approved Novo Nordisk’s Wegovy for reducing the risk of cardiovascular events in adults with established cardiovascular disease who are also obese or overweight.
According to a white paper published by the Pharmaceutical Strategies Group (PSG), Novo Nordisk and Eli Lilly are leading the near-term drug pipeline, with pursuit of both additional expanded indications for Wegovy and Zepbound and approval of new drug candidates in the pipeline.
Across commercial health plans, data from MMIT Analytics shows that over 80% of enrollees have access to Wegovy or Zepbound with utilization management restrictions, an increase of more than 10% compared to last April. A 2024 survey from PSG found that 33% of health plans and employers provide coverage of GLP-1s for obesity and 91% cover them for Type 2 diabetes.
This infographic was reprinted from AIS Health’s biweekly publication Radar on Drug Benefits.
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