Opinion: The U.S. needs a revolution to harness the potential of GLP-1s for weight loss

The introduction of the GLP-1 class of medications for weight loss has, to date, been one of the rockiest rollouts of a major medical advance in the United States. This is unfortunate, to say the least. Americans are among the most overweight people on the planet, and obesity leads to all manner of life-threatening ills — type 2 diabetes, serious cardiovascular events like heart attacks and strokes, numerous cancers, and sleep apnea, to name a few. And yet, there has been no national plan to facilitate the widespread and safe delivery to eligible Americans of GLP-1s like Novo Nordisk’s Wegovy (semaglutide) and Eli Lilly’s Zepbound (tirzepatide). Instead, it has been a dysfunctional mess, a tangled web spun by all major players in the U.S. health care industry: pharmaceutical companies, health insurance plans, national pharmacy chains, pharmacy benefit managers, and the federal government. Advertisement I’ve been caught in this web almost constantly since I started taking Zepbound last year. And that’s a very odd feeling for me. I’ve worked in health care communications for 30 years, helping to optimize the launch of many important medical advances. But this has been my first time seeking out one of these medical advances — and boy, what a struggle! As is the case for so many Americans, my insurance plan doesn’t cover the drug, so I have depended on a savings card from Lilly to reduce my out-of-pocket costs. Bizarrely, my savings card is contingent on the fact that I have a commercial health insurance plan that doesn’t cover the medication. With my “savings card,” I paid a whopping $7,500 for Zepbound in 2024, and my total will be nearly $8,500 in 2025. As of July, I can reduce this financial burden slightly by switching to Lilly’s newly-released single-dose vials — a bargain at just $500 per month through Lilly Direct. But these are much less convenient than the self-injector pens I am accustomed to. There is a simple four-step guide to using the pens. There is a rather intimidating 16-step guide for using the vials safely. I’m a klutz, and I dread filling my own syringes. Advertisement Cost has been just one of the barriers. Because Lilly (until recently) couldn’t get its supply chain together, I experienced frequent treatment interruptions. Not ideal for a drug that should be taken continuously, because the pounds pile back on quickly. I’m also on my third national pharmacy chain in a bid to maintain my Zepbound access. A pharmacist at my first pharmacy, Walgreens, told me after about six months that it no longer accepted the Lilly savings card. The company told STAT, “Walgreens accepts Lilly’s Zepbound discount card.” But that’s baffling to me, because I was told the opposite by two pharmacists at two different Walgreens locations. It highlights the confusion here. My second, Walmart, informed me after a few months that they were no longer a participating pharmacy in our health insurance plan. Let’s hope I have smoother sailing with CVS, but who knows? The whole experience has been farcical. But what could be dismissed as “first world problems” points to something bigger: Medical revolutions require accompanying revolutions across the health care system — and that is not happening with GLP-1s. How do we fix this? Here are the seven reforms that this patient would like to see: 1. A 180-degree turnaround in thinking There is a pernicious perception that GLP-1s are a way for the lazy and/or rich to “cheat” at weight loss. But millions of Americans struggle with varying degrees of obesity, and the causes are diverse — yo-yo dieting strategies, challenges accessing healthy food at an affordable price, individual biological and genetic factors, how our brains are wired, and widespread mental health and substance abuse issues. These are real barriers, and obesity is now recognized as a complex chronic disease that must be addressed on an individualized basis. 2. Tighter oversight of manufacturers’ pricing policies and the competitive environment It’s unseemly (polite word choice) that the CEO of Lilly, Dave Ricks, is able to rake in total compensation of $114 million in 2024 while at the same time acknowledging that the price his company charges for Zepbound is “too high.” Unseemly, because his payday was fueled by Lilly making more than $10 billion in profit from GLP-1s in 2024 alone. Against this backdrop, it’s a bit rich (pun intended) for Ricks to complain about telehealth/compounding pharmacies like Hims & Hers offering cheaper “backdoor generics” of GLP-1s. (Note to Congress: Rather than permitting the Food and Drug Administration to stop the work of compounding pharmacies on GLP-1s — a throttling that is now well underway — please devise a thoughtful generics strategy that prioritizes product availability, quality, patient safety, and an appropriate reward for innovator companies in equal measure.) Advertisement 3. Tighter oversight of promotional strategies. Novo Nordisk was permitted to bombard the American public with TV ads for Wegovy for nine months before the medication’s supply shortage was deemed resolved by the FDA. Why? Gaping regulatory loopholes allow a telehealth company like Ro to promote Lilly’s Zepbound, without being required to convey adequate patient safety and side-effect information. Why? (And those Wegovy ads — so irritating! Everyone stops working their respective jobs to join a street parade. When Europeans marvel at the kind of “shiny happy people having fun” pharma ads that are permitted to air on U.S. TV, this is exactly what they are referring to. My apologies to R.E.M.) Hims’ short-lived attempt to collaborate with Novo Nordisk on GLP-1s recently ended in disaster. But that had nothing to do with federal oversight — it appears to have been more about Novo concluding it could not control and expand its GLP-1 market via Hims. Again, why? Federal oversight of Big Pharma cozying up to telehealth companies needs to be far more robust; Right now, it’s practically nonexistent, though there is a group of senators who are doggedly working to change that. GLP-1s are serious medications with certain potential toxicities for some patients, including pancreatitis, thyroid cancer, and — very rarely, but now officially acknowledged in the case of Wegovy — blindness, caused by a condition called non-arteritic anterior ischemic optic neuropathy (NAION). Advertising for GLP-1s, therefore, should be carefully regulated and revised as needed, prior to airing across national media and social platforms. There is a bipartisan legislative effort in the Senate that could help address this one component of federal oversight; it remains to be seen how it will fare in the current Congress. Related Story Study of GLP-1 guidelines for teens points to potential for influence from drugmakers 4. Universal insurance plan coverage It’s not good enough that Medicare and Medicaid can’t (in the case of Medicare) or won’t (many state Medicaid programs) cover GLP-1s for weight loss. President Joe Biden waited until the dying days of his administration to propose a rule that would reverse a decades-long prohibition on federal coverage for weight loss drugs. This would have made an estimated 7 million Americans eligible for GLP-1s, according to the Centers for Medicare & Medicaid Services (CMS). Biden also waited until the last moment to recommend that Medicare be given price negotiating power for Wegovy starting in 2027. That 11th-hour timing proved to be a massive mistake. Unsurprisingly, since the new U.S. health secretary Robert F. Kennedy Jr. has called Americans “stupid” for flirting with GLP-1s, the new administration has wasted no time in reversing the Medicare/Medicaid coverage proposal. Kennedy might be open to improving federal coverage, but only “after [people] try other interventions” like glucose monitoring, improved diet, and exercise. In other words: a regimen of good food and fitness, which is (surprise!) perfectly aligned with RFK Jr.’s own lifestyle. But enforcing this traditional doctrine has already failed in the United States, which is why 50% of Americans are projected to become obese by 2030. Advertisement The advent of wearables won’t change that, as some would like to believe. Take me, for example. I’m highly educated, but my Apple Watch sits on its charger most of the time. Why? Life is less fun when you are being constantly bombarded by health notifications. There is no guarantee that the Medicare pricing negotiation proposal on Wegovy will survive, either. Even if it does, inexplicably, it doesn’t include Zepbound, which is now the U.S. market leader in the GLP-1 space. This strongly suggests that the Biden team was not up to speed on GLP-1s in the first place, and was instead myopically focused on “all things Ozempic” (the name frequently used in the media when referring to semaglutide for weight loss, though this is actually the drug’s brand name for its type 2 diabetes indication). Even if the Wegovy negotiation continues, it’s quite possible it may not cover its use for weight loss unless patients can show they have cardiovascular comorbidities. 5. Unqualified backing by the new administration Things are looking bleak on this front, given Kennedy’s antipathy, though perhaps the more progressive views on GLP-1s of Mehmet Oz, the recently confirmed CMS administrator, will help. But, in his nomination hearings, Oz failed to make any GLP-1 commitments, suggesting he may toe the line with Kennedy on any moves in this area. Kennedy has already insinuated that the use of GLP-1s in children could raise “the specter of unforeseen problems that interrupt, damage, or impair metabolism and growth development,” in his controversial MAHA Report. 6. No (more) backsliding by commercial insurance plans GoodRx reports that tightening criteria in employer-sponsored insurance plans has disqualified an additional 5 million Americans from Zepbound coverage in 2025 vs. 2024 — and that analysis was done before the recent CVS Caremark decision to drop coverage for the drug starting in July. The situation is improving a little for Wegovy patients — but 83% of patients with coverage still face barriers, including the Byzantine processes involved in securing prior authorizations and documenting compliance with step therapy requirements. Advertisement 7. A smarter approach by Congress Even well-intentioned senators like Bernie Sanders, Elizabeth Warren, and Dick Durbin — who are doing a good initial job of digging into GLP-1 policy — may not fully grasp the systemwide, “whole of government” approach that is needed to harness this medical revolution in a way that puts patients, and patient safety, first. It took until late September 2024 — just weeks before the presidential election — for Sanders, as the then-chairman of the Senate health committee, to call in Novo Nordisk’s CEO for a grilling on the “outrageously” high price of Wegovy. That shined a spotlight on only one part of the problem — but it also smacked of congressional grandstanding and belated recognition. (Wegovy was approved by the FDA in 2021.) We need Congress to play a far more robust role in developing a multifaceted GLP-1 access strategy for the nation. Medical revolutions can’t magically bring themselves to life. They need oxygen. And once they take root, they must be nurtured. The introduction of vaccines, the introduction of penicillin, the introduction of insulin for diabetes: All these medical revolutions needed system-wide support to reach their full potential. GLP-1s for weight loss are just as momentous. In fact, there is emerging evidence that they have the potential to cure a host of other ills beyond obesity, in part by catalyzing a patient-led paradigm where better health is less physician-guided, and more self-actualized. Although I don’t believe that “all Americans should be on GLP-1s,” the fact that this is a running joke among physicians points to a real concern that the potential of this class of medications may be seriously untapped. Let’s put a stop to these agonizing, piecemeal efforts to formulate a coherent policy on GLP-1s. We need a smart national strategy to bring this revolution to life. Gavin Hart has been working in health care public relations for 30 years, championing Big Pharma’s ability to advance innovation for patients while critiquing industry when it misses the mark. Advertisement