Fall 2026
Who Gets to Benefits from GLP-1s?
By Shelby Crosier
Illustration by Josie Portillo
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GLP-1 agonist medications have revolutionized health care in the past five years, but costs carry health equity concerns.
Who Gets to Benefit from GLP-1s?
Imagine this: Two patients, Mrs. A and Mrs. B, both saw the same doctor at the same clinic. Both had diabetes and high BMIs, and both had struggled for years to control their A1C (blood sugar levels) through lifestyle changes or medicine. The only difference between these two women was their health insurance provider.
Mrs. A had private insurance through her job that approved coverage for a GLP-1 agonist medication. After starting the medication, she lost 60 pounds, brought her A1C down from 12.9 to 6.9, and drastically reduced her insulin use within a few months. She was able to control her diabetes and live a much healthier life.
Mrs. B, on the other hand, was an hourly employee with less comprehensive health insurance. Despite her doctor’s efforts, her insurance provider did not consider her to be enough of a high-risk patient to cover a GLP-1 prescription, and she could not afford it on her own. Eventually, she developed a foot ulcer from her diabetes and had to undergo a toe amputation. Only after that procedure was she eligible for the medication she needed.
These are the stories of two real, anonymized patients of Mohammed K. Ali, MD, a practicing physician and William H. Foege Distinguished Professor of Global Health at Emory University’s Rollins School of Public Health. Mrs. B is not the only patient he has seen get denied GLP-1 medication when it may have saved them from poor health outcomes.
“It’s a system where the people with lower incomes and the marginalized have to get very unhealthy for coverage to really kick in,” says Ali.
The Cost of Weight Loss is Heavier for Some
Early GLP-1 agonist medications entered the market for diabetes management more than a decade ago, but they exploded in popularity and use in 2021 when the Food and Drug Administration approved semaglutide for weight loss. Since then, many drugmakers have put out their own formulations of medications that mimic the GLP-1 hormone or mimic two to three hormones simultaneously (like GLP-1, GIP, or glucagon).
But, as the stories of Mrs. A and Mrs. B demonstrate, the people who need GLP-1 medications the most are not always the ones who get them. Public insurance, for example, does not always cover the drugs for people who could benefit from them. Of those enrolled in Medicaid or the Children’s Health Insurance Program, 37.8% are categorized as having obesity, but there are only 13 state Medicaid programs that cover GLP-1s to treat obesity. Medicare Part D plans do not cover weight loss medications, including GLP-1s, despite 45.4% of Medicare beneficiaries having obesity.
“We have an extremely perverse health system where the combination of insurers, social determinants of health, and health care have left a whole lot of people out.”
Mohammed K, Ali, MD
William H. Foege Distinguished Professor of Global Health
“We have an extremely perverse health system where the combination of insurers, social determinants of health, and health care have left a whole lot of people out,” says Ali.
Hui Shao, MD, a health economist and associate professor of global health at Rollins, agrees.
“Historically, new technologies are often accompanied by higher costs when they are first introduced, making them more accessible to people with greater financial resources,” says Shao. “However, this unequal access raises a more contentious issue. People with fewer economic resources may have a greater need for these treatments due to poorer underlying health conditions and greater overall health needs, yet they often face the greatest barriers to accessing them. We have seen this not only with GLP-1s, but with many medical treatments over the years.”
GLP-1s have become slightly more affordable as less expensive injectables, oral pills, and compounding pharmacies create more options for patients. But over half of GLP-1 users report that it is still difficult for them to pay for this medication, and 14% of people who stopped using their GLP-1 medication did so because of cost.
How to Prioritize Access to GLP-1s
The cost of GLP-1s is not just a barrier for individual people—it is also prohibitive for insurance providers.
“A large population could benefit substantially from GLP-1s due to their broad and still-expanding indications, including obesity, and no single payer can afford to cover all of them at this scale,” says Shao. “With the price of these medications, insurers cannot afford to cover them for everyone who can benefit from them. So, we're facing a resource prioritization issue.”
The problem goes beyond public insurers. About one in five U.S. companies with 200 or more workers who provide health insurance to their employees have plans that cover GLP-1s for weight loss. Many of those companies say that GLP-1 use among their employees was higher than expected and significantly impacted their prescription drug budget. These costs are leading employers to implement restrictions on who has GLP-1 coverage based on health conditions or BMI, make employees go through lifestyle coaching first, or drop GLP-1 coverage all together.
“We need to prioritize coverage for those who need these medications the most, an approach often referred to as precision public health policy,” says Shao. “But we need stronger evidence to identify who would benefit the most so that we can reduce access barriers for these populations first.”
Another key factor may be determining how much money insurers could save thanks to the health gains patients see on GLP-1 medications.
“If there is a way to really estimate whether using medications like these can keep people with diabetes or people with other comorbidities out of the hospital, then the upfront cost and investment might be worthwhile for the insurance company,” says Ali. “That might be the type of analysis that we need to move the needle on this, as opposed to waiting for people to get so unhealthy that their kidneys are not good, their heart is failing, they are getting peripheral arterial disease (which can lead to amputations),and then we finally give them the drug.”
Access and Support for Life
Maintaining access and affordability is also important. Nearly half of patients without diabetes and two-thirds of patients with diabetes stop using GLP-1 medications within one year. Most people who stop using these medications rapidly regain weight and lose health benefits.
“The problem is that if patients lose access, they will often gain more weight than where they originally started,” says Ali. He adds that improving lifestyle is also still important in tandem with these medications.
“With some of these compounds, people are losing muscle mass as they lose weight. So, if we can help them learn to do muscle strengthening exercises, eat better, and eat more fiber, it is amazing how it can change some people's lives.”
GLP-1s are typically meant to be taken across a lifetime. This raises more financial questions. Namely, how much the drugs would cost an insurer over years or decades, and if that cost is worth it.
“From a payer perspective, we have to think about how we would finance lifetime use of an expensive drug like this,” says Shao. “If patients lose much of the benefit after discontinuing treatment, it raises a fundamental question: Is the initial investment in coverage worthwhile for insurers?”
In five or 10 years, we could reach a point where GLP-1s are accessible even to people without comprehensive insurance coverage. But getting there will require coordinated efforts from drug developers, payers, policymakers, health care providers, and other stakeholders across the health care system.
Hui Shao, MD
Associate Professor of Global Health
But Shao is hopeful that, as more competitor products get approved and generic versions eventually become available, GLP-1 access across a lifetime will become more realistic.
“As more GLP-1 products enter the market and demonstrate their effectiveness, we will see greater competition with the two companies that currently dominate the market, and I expect that competition to substantially lower prices,” says Shao. “I am optimistic about where pricing will be in the next few years. In five or 10 years, we could reach a point where GLP-1s are accessible even to people without comprehensive insurance coverage. But getting there will require coordinated efforts from drug developers, payers, policymakers, health care providers, and other stakeholders across the health care system. We are not there yet.”
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Rollins Magazine is published twice a year by the Rollins School of Public Health, a component of the Woodruff Health Sciences Center of Emory University, for alumni and friends of the school.