Last Updated on March 2, 2026 by Chicago Policy Review Staff
Technological innovations often face backlash or skepticism at first before finding a place in everyday life. Famously, many believed the printing press would diminish human intellect, as the written word would replace memorization. Luddites opposed innovations during the Industrial Revolution in England, fearing that their businesses would be displaced by creative destruction. Artificial intelligence is a modern, developing example – on the one hand, it may bring about unprecedented levels of prosperity, while on the other, some fear human obsolescence or even catastrophe. In the healthcare realm, innovations are often met with even greater scrutiny, and for obvious reasons – what are we without our health?
Today, glucagon-like peptide-1 receptor agonists, colloquially known as GLP-1s, face backlash for addressing what has historically been viewed as a lifestyle consequence: obesity. The negative reception is not novel – past transformative medical therapies have been met with public backlash and over-medication fears, as with statins, and cost concerns, as with Hepatitis C therapies. As the effects of obesity weigh on society and the obesity rate continues to rise, a medical solution to this problem is one that would yield enormous benefits both to individuals dealing with the disease and to society through reduced downstream healthcare expenditure. Yet a fundamental problem in the healthcare system remains: GLP-1s are expensive and inconsistently covered by insurance. For the potentially transformative medical therapy to be a factor in medicine’s shift toward preventive care, the healthcare system must allow equitable access to GLP-1s, and the emergence of value-based care can support that ambition.
GLP-1s were initially developed to treat type 2 diabetes, but in recent years, they have demonstrated substantial benefits in treating obesity and reducing cardiovascular risk. Obesity heightens risks for additional diseases, including type 2 diabetes, cardiovascular disease, cancer, dementia, and depression. With nearly one in three Americans living with obesity, these follow-on diseases become more prevalent, and the system must dedicate resources toward their treatment. With the emergence of GLP-1, obesity treatment can now be viewed through a medical lens, and patients can take preventive measures against comorbidities. Patients facing obesity due to genetic and socioeconomic factors now have a treatment option to address conditions that cannot be resolved by simple lifestyle changes. In the long term, the resulting reduction in chronic disease will yield downstream cost savings and ease the burden on the U.S. healthcare system.
However, GLP-1s’ meteoric rise has drawn detractors, with concerns centered on cosmetic motivations and the risk of overmedication. Obesity is still viewed negatively as a byproduct of poor lifestyle factors. Perhaps the most significant skepticism that GLP-1 treatment for obesity is a necessary medical therapy is among insurance providers. While GLP-1s are covered for their original purpose of treating diabetes, coverage for obesity treatment has not gained a foothold. For patients paying out of pocket, the therapies typically cost around $1,000 per month. Lack of insurance coverage, which rarely covers treatment for obesity, has left patients to fend for GLP-1s in the cash pay world, thereby limiting access to individuals who can afford to pay for the therapies out of pocket. This results in inequitable access. With inconsistent coverage from state and commercial plans, lower-income individuals have limited access to these therapies, despite being the most in need; the obesity rate trends higher as income lowers. But current public perception and historical tendency of insurance providers to withhold coverage for preventive treatment are only part of the explanation for why GLP-1s for obesity remain unaddressed in most healthcare plans.
Budget constraints present a significant hurdle. As GLP-1s are expensive for patients, they are also costly for insurers. Recent evidence suggests that GLP-1s require long-term treatment rather than a short-term intervention, and most state and commercial coverage plans lack the budget to immediately add $1,000 per month of treatment coverage for up to a third of their coverage universe (roughly the U.S. obesity rate), even if there are downstream savings. Simply “switching on” coverage is not feasible financially, especially when studies suggest minimal short-term cost savings associated with GLP-1 prescriptions. A more creative approach is needed.
There is an emerging healthcare payment framework focused on clinical outcomes that aligns well with GLP-1 coverage: value-based care, an alternative to the traditional fee-for-service payment model that emphasizes clinical outcomes. By tying the reimbursement model to outcome metrics, this approach would ensure that GLP-1s are delivered to patients most in need – i.e., those with genetic contributors to obesity that cannot be treated by lifestyle factors alone, and those with the highest risk comorbidities. Because the value-based care model emphasizes clinical outcomes, the impact of treatment will be closely monitored to ensure positive patient outcomes and a return on investment for insurers. By targeting high-risk patients who are most likely to benefit, budgets would be spared a surge in demand, and insurers could achieve maximum short- and long-term cost savings by reducing the prevalence of chronic disease. Coverage should become increasingly feasible as more affordable versions of the treatment enter the market, either as pills or in generic form. For a transformative therapy aimed at improving preventive care, a payment model centered on clinical outcomes would help the highest-risk patients gain access to treatment and incentivize insurers to cover GLP-1s for obesity.
Based on lessons learned from previous transformational medical therapies, obesity must be recognized as a chronic disease deserving of pharmacologic treatment, and GLP-1 coverage should be phased in sooner rather than later – the Center for Medicare & Medicaid Services’ recent BALANCE model announcement is a step in the right direction. From there, coverage decisions should align with public health needs, which would be optimized under a value-based care model that prioritizes sustainable budgeting for insurers while reaching patients most in need. The long-term population health benefits would outweigh the short-term budgetary constraints associated with funding the therapies. All of this would enable GLP-1s to fulfill their potential and incorporate into the broader metabolic disease prevention strategy, while continuing to direct healthcare coverage toward preventive care that improves overall public health.