MASSACHUSETTS — Twelve million people lost insurance coverage for the obesity drugs Zepbound and Wegovy over the past year, according to an analysis by GoodRx. The study relied on formulary data from health care analytics firm MMIT reflecting drug coverage for more than 190 million people.

Among people who retain coverage for GLP-1 drugs, 88% face some kind of restriction, the GoodRx analysis found. Those restrictions typically include a prior authorization requirement or a requirement that the patient's body mass index is 40 or higher, though clinical guidelines define obesity as having a body mass index of 30. Some people with coverage still pay hundreds of dollars a month because their plans cover only a small percentage of the drug's price.

"For many Americans, they can't afford that. That's the difference between for many people taking the medication that their doctor wants them to take and having to forgo it." said Amanda Nguyen, a senior health economist.

A survey by the International Foundation of Employee Benefit Plans found that the share of employers covering GLP-1 drugs for weight loss and type 2 diabetes grew from 34% in 2024 to 36% in 2025. The KFF Employer Health Benefits Survey found that the share of employers offering obesity drug coverage grew from 18% in 2024 to 19% in 2025, while the share not offering coverage increased from 52% to 57% over the same period.

CVS Caremark dropped Eli Lilly's Zepbound from its coverage in July. A CVS Caremark spokesperson said its formulary strategy uses competition to drive down costs, maintain clinically appropriate coverage, and enable greater access to GLP-1 drugs.

After CVS Caremark dropped coverage for Zepbound, Meghan Lena switched to Novo Nordisk's Wegovy. Her employer's health plan then dropped coverage for Wegovy in October, and her monthly health insurance premium increased by 20%. The school district's insurance trust attributed the premium increase to the cost of expensive GLP-1 drugs. Lena had been able to obtain Zepbound for a $30 monthly copay and lost 50 pounds in one year on the drug. She switched to a compounded medication prescribed by her doctor and now pays about $300 a month. Compounded drugs contain the same active ingredients as brand-name versions but are made by a specialized pharmacy rather than by a drug company, and they do not go through the Food and Drug Administration's approval process. The cash price for a dose of name-brand Zepbound is $450.

Dr. Catherine Varney, an obesity medicine director, has about 1,000 patients on obesity drugs, and around 60% of them pay out of pocket. "I feel like more of a financial planner these days than a physician, because we're crunching the numbers." Varney said.

"There are the lucky ones that have some form of coverage that is also affordable, but they are few and far between." said Tracy Zvenyach, vice president of advocacy and research. "Essentially every insurance carrier is just making it up, making up the policy, the limitation, the restriction on eligibility in the way that they want to, in a way that will kind of reduce the eligible population." she said.