Access to GLP-1s for Weight Loss Depends on Employer Choices | Asembia's AXS25 Summit

During the Asembia Specialty Pharmacy Summit in Las Vegas, Becky Davis, principal at Charles River Associates, addressed how insurance coverage for GLP-1 medications—used for obesity and diabetes—is evolving.

While some health plans, such as CMS and Point32Health, have moved to limit access, Davis noted that this does not yet represent a widespread pullback across the commercial market.

“I haven't found it to be a trend that payers are, in general, pulling gut coverage for commercial patients,” Davis said.

Access to GLP-1s for obesity is typically based on an opt-in model, where employers must actively choose to provide coverage.

Larger, self-funded companies are more likely to offer these benefits, especially in industries facing high labor demands.

However, this structure leaves many patients without access simply because their employer has not opted in.

Davis shared that the choice to opt in typically depends on how employers view the return on investment.

Since employees may not stay long-term, some companies hesitate to invest in treatments like GLP-1s that could yield health benefits over a longer timeframe, she said.

As a result, the broader potential of these drugs to reduce comorbidities and improve population health may be underappreciated, she added.

The long-term value of treating obesity is growing, as well, given its link to numerous chronic conditions.

Davis stressed that as the list of GLP-1 indications grows, it will become less common to treat obesity in isolation. This could shift how both payers and employers think about coverage.