Commercial Insurance Coverage for GLP-1s Faces Cutbacks and Increased Obstacles
By Sara Heath, Executive Editor
Published: 04 Mar 2025
Commercial insurance coverage for GLP-1 medications, a class of drugs that includes popular weight loss treatments, has become more restrictive for the 2025 plan year. A new analysis by GoodRx highlights reductions in coverage, coupled with a rise in practices like prior authorizations and step therapy, that are making it harder for people to access these medications. The report examined both GIP and GLP-1 receptor agonists, finding lower overall unrestricted coverage for many of the medications.
Unrestricted coverage, in this context, is defined as insurance coverage for the medication free from utilization management requirements such as prior authorizations and step therapy.
Perhaps the most significant finding was the drop in commercial insurance coverage for Eli Lilly’s Zepbound. Between 2024 and 2025, the number of individuals with no commercial insurance coverage for the weight-loss drug surged by more than 14%, translating to roughly 4.9 million people without coverage for the medication.
Coverage for Ozempic also decreased. The number of insured individuals without coverage for Ozempic climbed by 22% in 2025, meaning an additional 1.1 million people lost access. GoodRx noted that Ozempic is the most commonly prescribed GLP-1 receptor agonist, citing previous analyses.
Other drugs affected include Saxenda and Victoza, which saw substantial drops in commercial insurance coverage. The report suggests this may be due to the introduction of generic liraglutide. The number of people without coverage for Victoza soared by 92%, while the figure for Saxenda fell by 47%. Simultaneously, approximately 9.5 million people gained access to generic liraglutide, but this does not fully offset the loss of coverage for the name-brand versions.
The report did identify a positive trend: an increase in commercial insurance coverage for Wegovy. The number of insured individuals without coverage fell from 18.5% in 2024 to 14.8% in 2025. However, unrestricted coverage for Wegovy remained essentially unchanged year-over-year, from 14.2% in 2024 to 14.6% in 2025. In total, about 7 million people gained some form of commercial insurance coverage for Wegovy, but the positive impact may be lessened by the adoption of utilization management practices, which increased overall in 2025.
The insurance changes and utilization management are creating hurdles that may hamper patient access to care.
Commercial Insurers Increase Utilization Management
In addition to coverage reductions, commercial insurers are increasingly implementing utilization management strategies. For instance, 83% of commercially insured individuals now must meet prior authorization requirements before getting access to Zepbound. Compared to the previous year, the researchers found a 15% increase in the number of people facing utilization management restrictions for Ozempic. Restrictions are also increasing for Wegovy and Liraglutide.
These restrictions require people to “jump through extra hoops” to obtain their medications, even when covered by insurance.
GoodRx stated that these practices force people to “jump through extra hoops” to get their medications, even when they have insurance coverage. Many clinicians agree that utilization management, especially prior authorizations, threatens patient care as it can delay or prevent patients from getting the medications they need.
These findings come as demand for GLP-1 drugs increases, while coverage is not keeping up with the needs of patients. According to October 2024 PwC data, approximately 8-10% of people are taking a GLP-1 medication, and 30-35% are interested in using them. The GoodRx report confirms that commercial insurance coverage isn’t keeping pace with the demand.
Although many employers acknowledge the advantages of covering GLP-1 drugs, this coverage remains uncommon. KFF reports that only 18% of firms with 200 or more employees cover the medication. Among those firms, 24% require employees to meet with a professional, 8% require enrollment in a lifestyle or weight loss program before accessing a GLP-1, and 26% have other conditions, such as prior authorizations.
This trend arises against the backdrop of uncertainty surrounding Medicare coverage, which many experts believe sets the tone for payer decisions nationwide. Towards the end of the Biden Administration, HHS proposed Medicare coverage for GLP-1s intended for weight loss, though it is not certain whether the Trump Administration will pursue the proposal.
