The GLP-1 paradox: too expensive to cover, too effective to cut

The U.S. healthcare system is at a critical juncture with rising obesity and chronic disease coupled with skyrocketing GLP-1 costs. Three in four (76.4%) U.S. adults have at least one chronic condition, and over half (51.4%) have two or more.

At the same time, spending on GLP-1 treatments has surged by more than 500% between 2019 and 2024. Growth is expected to continue, especially with the introduction of the Bridge program, which offers GLP-1 access for obesity with comorbidities under Medicare and Medicaid. Experts predict the number of people in the U.S. using GLP-1s could reach 25 million by 2030 (rising from 10 million in 2025). 

While the health need is great, the near-term financial pressure feels unsustainable. Plans across government and employers are pulling back support. This month, MassHealth announced it would cease covering the medication, a move that will impact 22,000 Massachusetts residents but save the state an expected $15 million per year. Last month, Cigna became the latest organization to cease access for its employees. More may follow – research from the Business Group on Health found 10% of companies that now cover GLP-1s for weight-loss plan to drop them by 2027. 

Too many states and employers are viewing this through a binary lens between those who want unfettered access and those that reject coverage.  We need to get off this roller coaster, where access and affordability are pitted against each other, and move toward a financially sustainable treatment approach that actually enables progress on chronic disease. GLP-1s can make a significant dent in the obesity epidemic and reduce downstream costs of treating diabetes, chronic kidney disease, liver disease, musculoskeletal conditions, and more. The answer isn’t to reach for a hammer and eliminate GLP-1 coverage entirely. It’s to use a smart scalpel to target the right population at the........

© Fortune