Millions of Americans are finding that new weight-loss drugs, like Ozempic and Wegovy, are out of reach despite recent price cuts. Insurance coverage is shrinking rapidly: roughly 6 million people have lost access since 2025, and fewer than 20% of employer plans now cover these medications for weight loss. The FDA has also cracked down on compounding pharmacies, eliminating a cheaper alternative, leaving many desperate patients with few options.
This isn’t just a matter of convenience. The rising cost and restricted access to GLP-1 drugs highlights a widening gap in healthcare, where effective treatments are increasingly available only to those who can afford them. The issue raises critical questions about the future of obesity care and whether it will remain a privilege rather than a standard treatment.
Navigating the System When Coverage Fails
The first step for those denied coverage is persistent appeal. Insurance companies often require multiple attempts and sometimes contradictory requests before approving treatment. Bridget Roberts, a Pennsylvania resident, secured coverage for Zepbound only after repeatedly calling and requesting a new prior authorization, even though she already had one. Her story demonstrates that navigating insurance requires tenacity, as companies often operate with opaque rules.
Switching diagnoses is another strategy. Many GLP-1 drugs are FDA-approved for conditions beyond weight loss, including diabetes, heart disease, and sleep apnea. Supriya Rao, a gastroenterologist, suggests that obtaining a prescription for one of these conditions can bypass weight-loss restrictions. However, insurers may still deny coverage even when FDA guidelines are met.
Risky Alternatives: Compounding and Beyond
For those who can’t afford brand-name drugs, compounding pharmacies offered a cheaper alternative. However, the FDA has banned copies of GLP-1 weight loss drugs, driving many patients to unregulated sources. The market is now rife with counterfeit medications and unverified formulations, including pills and mixed compounds. Experts strongly advise against these alternatives, as they haven’t undergone rigorous testing and may pose safety risks.
Megan Wyatt, a North Carolina resident, turned to compounded semaglutide after her insurance dropped coverage. She eventually found a provider she could afford but only by taking on an extra job. The delays caused her to lose progress, illustrating the instability of this approach.
Other Options: Surgery, Older Drugs, and Lifestyle Changes
If GLP-1 drugs are inaccessible, weight loss surgery remains the most effective long-term solution. Bariatric surgery is covered by many insurers and may even be more cost-effective than indefinite medication use. However, it is invasive and requires significant recovery time.
Older prescription weight loss drugs, such as liraglutide (Saxenda), orlistat (Xenical, Alli), and phentermine, are available but less effective than semaglutide or tirzepatide. Diet and exercise remain a fundamental part of weight management, though often insufficient on their own. Experts emphasize that obesity is a chronic disease requiring medical attention, not a failure of willpower.
Ultimately, the GLP-1 access crisis underscores the need for systemic change in healthcare pricing and insurance coverage. Without broader reforms, effective obesity treatments will remain out of reach for millions, exacerbating health disparities and leaving patients with few viable options.
