A Call for Change: Ensuring Access and Insurance Coverage for People Living with Obesity
In recent months, abrupt changes to insurance coverage for obesity management medications have placed thousands of Americans living with obesity in an impossible situation. Many now find themselves forced to choose between discontinuing a clinically appropriate, effective treatment prescribed by their health care provider—or shouldering the entire financial burden out-of-pocket to continue their treatment.
This is a dilemma no one should ever be made to face. It not only undermines the doctor-patient relationship but also disregards the medical consensus that obesity is a chronic, complex disease requiring long-term, evidence-based management.
The landscape of obesity care in the United States is fraught with inconsistencies, delays, and discriminatory barriers. While the clinical understanding of obesity has evolved significantly over the past two decades—moving beyond outdated perceptions of the condition as a mere failure of willpower—coverage policies have not kept pace with this scientific progress. These abrupt and often opaque insurance decisions further widen the gap between what is medically appropriate and what is actually accessible.
The Consequences of Coverage Gaps in Obesity Care
The impacts of payer-driven treatment decisions are far-reaching. For patients currently undergoing treatment, these coverage changes can abruptly disrupt their progress. A therapy that has yielded measurable improvements in weight reduction, blood pressure, metabolic function, and overall well-being may suddenly be deemed no longer reimbursable—not because of a failure in efficacy or safety, but because of a change in formulary, cost-containment policies, or employer-based insurance decisions.
This means that individuals who have finally found a treatment that works for them may now face the devastating choice of stopping their medication entirely or paying hundreds, if not thousands, of dollars each month out-of-pocket to maintain their health.
It’s important to emphasize that these are not abstract concerns. Many of the individuals affected by these changes are managing not only obesity but also related conditions such as obstructive sleep apnea, Type 2 diabetes, hypertension, polycystic ovary syndrome (PCOS), and non-alcoholic fatty liver disease. For these patients, access to consistent obesity management is not simply a matter of aesthetics or convenience—it is critical to maintaining a stable quality of life and preventing further complications.
Unfortunately, these recent coverage decisions are not isolated events. They are symptomatic of a much broader systemic issue—one where insurance coverage, rather than clinical evidence, too often dictates which patients can access which treatments. Across the country, gaps in coverage for obesity medications are the norm rather than the exception.
Systemic Barriers to Obesity Care Access
At a national level, the disparities in access to obesity management medications are striking. Medicare, the largest health care payer in the United States, does not currently cover any prescription medications for obesity treatment, despite overwhelming evidence that these drugs can be effective in reducing long-term health costs and improving outcomes.
Medicaid, which provides insurance for low-income Americans, fares only slightly better. Only a small number of states include obesity medications in their formularies, meaning that access to these medications largely depends on where a person lives. In states without coverage, low-income individuals are often left with no viable treatment options, creating a stark disparity in care.
Even in the commercial insurance space, patients face unnecessary hurdles. When a pharmacy benefit manager (PBM) decides to include a specific obesity medication on its formulary, that decision only opens the door to access—it does not guarantee it. Employers must also actively opt in to provide that coverage, and many choose not to, whether out of cost concerns, stigma, or a lack of understanding about the value these medications offer.
This fragmented system creates a patchwork of access that leaves countless patients behind. It isn’t just about one medicine, one PBM, or one plan—it’s about an entire infrastructure that fails to recognize obesity as a chronic disease deserving of serious, sustained medical treatment.
Lilly’s Commitment to Expanding Access
At Lilly, our mission is to discover and deliver medicines that make life better for people around the world. We are proud to develop innovative treatments for obesity, and we are equally committed to ensuring that those treatments are accessible to the people who need them most.
However, no matter how effective a treatment may be, its benefits are irrelevant if patients cannot access it. That’s why we are actively working with insurance companies, PBMs, employers, and government leaders to broaden coverage and access for obesity medications.
Our position is clear:
- We advocate for open access to obesity management medications that are prescribed according to their FDA-approved indications. Every patient should have the opportunity to receive the most appropriate treatment for their condition, based on medical need, not insurance limitations.
- We believe coverage decisions should be rooted in scientific evidence, and treatment decisions should rest with health care providers and their patients—not insurance algorithms or cost-driven policies. These are decisions that require a deep understanding of a patient’s health history, co-morbidities, and treatment response—factors that no coverage document or PBM rulebook can fully account for.
- We support creative pricing and access strategies to help expand coverage for patients. We are actively offering innovative contracts, value-based arrangements, and tailored solutions that aim to reduce barriers and demonstrate the long-term value of obesity management to insurers and employers alike.
- We believe obesity should be treated like any other chronic condition—such as heart disease or diabetes—with access to evidence-based treatments reimbursed fairly and equitably. To do otherwise is to perpetuate stigma and deny the science that clearly defines obesity as a chronic, relapsing, and treatable medical condition.
A Shared Responsibility to Do Better
As much as we at Lilly are committed to advocating for expanded access, we know that meaningful, lasting change cannot be accomplished by one organization alone. We are calling on others across the health care landscape—insurers, PBMs, policymakers, employers, and advocacy groups—to join us in realigning obesity care with the science.
We must shift away from outdated narratives and discriminatory policies and toward a future where everyone living with obesity has access to the same standard of care afforded to those with other chronic conditions.
This includes passing legislation to allow Medicare to cover obesity medications, expanding Medicaid coverage at the state level, and encouraging employers to recognize the clinical and economic value of treating obesity effectively. It means investing in public education campaigns to reduce stigma and raise awareness of obesity as a medical condition. And it requires coordinated, cross-sector efforts to make coverage more consistent, transparent, and fair.
Aligning Policy with Progress
The science of obesity management has advanced significantly, offering hope and healing to millions of individuals who have long struggled without effective options. But science alone is not enough. If our health care system continues to deny access to these therapies through restrictive coverage policies, we are failing the very people these innovations are meant to help.
The time to act is now. We must align policy with progress and ensure that all patients—regardless of income, geography, or insurance plan—can access the medicines they need to live healthier, fuller lives.
At Lilly, we remain steadfast in our commitment to this goal. We will continue to fight for access, push for policy reform, and work alongside all stakeholders to build a system that delivers on the promise of modern obesity care.
Because no one should have to choose between their health and their financial stability.
