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Commercial insurance coverage for GLP-1s still limited
Fewer insured people have coverage for GLP-1s, while more are beholden to prior authorization and step therapy before gaining access to the drugs.
Commercial insurance coverage for GLP-1s has gotten thinner for the 2025 plan year, with reductions in coverage and practices like prior authorizations and step therapy keeping people from the medications, according to a new analysis from GoodRx.
The report, which examined both GIP and GLP-1 receptor agonists, found lower overall unrestricted coverage for nearly all of the medications. Unrestricted coverage was defined as insurance coverage for the medication free from utilization management requirements, like prior authorizations and step therapy.
Perhaps most notable was the reduction in commercial insurance coverage for Eli Lilly's Zepbound. From 2024 to 2025, the number of people with no commercial insurance coverage for the weight loss drug increased by more than 14%. That shakes out to around 4.9 million people without insurance coverage for the medication.
Commercial insurance coverage for Ozempic also went down. The number of insured people with no coverage for Ozempic increased by 22% in 2025, meaning another 1.1 million people have no coverage. This is particularly salient because Ozempic is the most-filled GLP-1 receptor agonist, GoodRx said, citing one of its previous analyses.
The report also flagged sizeable drops in commercial insurance coverage for Saxenda and Victoza, precipitated perhaps by the introduction of generic liraglutide.
The number of people with no insurance coverage for Victoza increased by 92%, while that figure was 47% for Saxenda. Instead, 9.5 million people gained access to generic liraglutide, but that hardly offsets the number of people who lost coverage for its name-brand reference drugs.
The report had one bright spot: commercial insurance coverage did increase for Wegovy. The number of insured people without coverage decreased from 18.5% in 2024 to 14.8% in 2025.
Still, unrestricted coverage of Wegovy remained about the same year over year. In 2024, unrestricted coverage was at 14.2%, while in 2025, it is 14.6%.
All said, some 7 million people gained some type of commercial insurance coverage for Wegovy. However, utilization management practices, which became more common across most drugs in 2025, might create hurdles that can hamper patient access to care.
Commercial insurers increase utilization management
In addition to commercial insurance reducing coverage for some weight loss drugs, payers are also increasing utilization management strategies.
For example, 83% of commercially insured people must meet prior authorization requirements before accessing Zepbound. For Ozempic, the researchers observed a 15% increase in the number of people facing utilization management restrictions.
More people need to meet utilization management restrictions before accessing Wegovy and Liraglutide, too.
GoodRx said these restrictions lead beneficiaries to "jump through extra hoops" to obtain their medications, even when they have insurance. Indeed, most clinicians agree that utilization management, particularly prior authorizations, threatens patient care.
These findings come as demand for GLP-1 drugs bumps up against payer and employer coverage for them. According to October 2024 PwC data, 8-10% of people are taking a GLP-1, and 30-35% are interested in using them.
However, as evidenced by the GoodRx report, commercial insurance coverage is not keeping up. And although many employers acknowledge the value in coverage GLP-1 drugs, coverage still isn't common.
KFF says that 18% of firms with 200 or more workers cover the medication. Of those firms that cover, 24% require employees to meet with a professional, 8% require enrollment in a lifestyle or weight loss program before getting a GLP-1 and 26% have other conditions like prior authorizations.
This comes amid a murky Medicare coverage landscape, which most experts acknowledge sets the tone of payer coverage decisions nationwide. Toward the end of the Biden Administration, HHS proposed Medicare coverage for GLP-1s used for weight loss. It is unclear whether the Trump Administration will follow through on that proposal.
Sara Heath has covered news related to patient engagement and health equity since 2015.
