A recent survey of US health care payers found that, despite growing demand for US Food and Drug Administration (FDA)-approved anti-obesity medications (AOMs), commercial coverage remains limited, driven primarily by cost concerns and the need for long-term evidence.

The web-based survey, conducted by Cencora in October 2024, included responses from 48 payers representing health plans, integrated delivery networks, and pharmacy benefit managers. Respondents reported that, on average, only 31% of their commercial members currently have coverage for AOMs.
Among payers who offer AOM coverage, 52% preferred semaglutide (Wegovy) and 44% preferred tirzepatide (Zepbound). Utilization management strategies are common, with quantity limits, supplemental care programs, and prior authorization frequently employed to manage access and cost. For payers that do not currently cover AOMs or do not plan to cover them in 2025, 64% cited cost as the primary barrier. Other key challenges included high budget impact (92%) and limited long-term data on sustained weight loss (79%).

Despite concerns, payers tracking obesity outcomes reported seeing measurable clinical benefits. Among these organizations, 93% observed improvements in body mass index, and 96% reported patient weight loss. “Payers who track obesity outcomes are seeing positive impacts of AOMs on body mass index and weight loss,” the study stated.

To guide future formulary decisions, 81% of payers indicated interest in medical cost offsets, and 73% sought real-world evidence. These data points are considered critical for evaluating the long-term value of AOMs.

Looking ahead, three-quarters of payers expect to cover Wegovy and Zepbound on their commercial formularies in 2025. Among those offering opt-in rider policies for employer clients, 56% anticipate moving AOMs to standard formulary coverage.

The authors concluded, “On average, less than one-third of commercial members currently have coverage for AOMs,” noting that utilization controls remain central to cost management.

Reference 
Yoshida S, Liu E, Friedman M. Payer coverage trends of anti-obesity medications (AOMs) on commercial formularies. Presented at: AMCP 2025; March 31-April 3; Houston, TX.