Innovative Payment Models, Holistic Medicaid Approaches Could Improve GLP-1 Access, Outcomes

Access to glucagon-like peptide-1 (GLP-1) receptor agonists for obesity treatment could be expanded through innovative payment models, while associated outcomes could be improved through a more holistic Medicaid approach, experts said during a session at the Academy of Managed Care Pharmacy (AMCP) Nexus 2025 meeting in National Harbor, Maryland.1

Jane F. Barlow, MD, MPH, MBA, of Real Endpoints; Gail Ryan, PharmD, an independent consultant; and Joshua Moore, PharmD, of the Missouri HealthNet Division, helped attendees better understand the evolving GLP-1 landscape during the Wednesday morning session, “Improving Outcomes for Patients With Obesity: Impediments and Solutions for Sustainable Access to Anti-Obesity Medications.”

Innovative payer approaches and holistic support could help expand GLP-1 use and improve obesity care outcomes. | Image Credit: mingnimit - stock.adobe.com

Expanding the Potential of GLP-1 Therapies in Obesity Care

Barlow began by highlighting the scale of the obesity epidemic and the transformative potential of GLP-1 medications, noting that obesity remains the most common chronic condition in the US. She noted that treating obesity has long been a “conundrum” for the health care system, with patient access to GLP-1 therapies remaining especially challenging.

The impact of GLP-1s extends beyond weight loss, with 2024 marking approvals for additional indications, namely major adverse cardiovascular events (MACE), sleep apnea, and metabolic dysfunction-associated steatohepatitis. Numerous ongoing clinical trials are exploring their potential benefits for other conditions, including Alzheimer disease and prediabetes.

Barlow also noted that more than 120 molecules are being developed to treat obesity, increasing competition and formulation options. She highlighted that JPMorgan analysts estimate the GLP-1 market could reach $100 billion by 2030, encompassing more than 30 million users, while Goldman Sachs projects up to 70 million users by 2028, especially if these expanded indications are approved.

“This is an area that’s here to stay, and it will continue to grow,” Barlow said.

Referencing an August 2025 Business Group on Health employer survey, she highlighted that 79% of employers saw increased GLP-1 utilization for obesity, outpacing concerns around cancer (74%) and mental health or substance abuse disorders (73%).2

To manage GLP-1 costs, 90% of employers use prior authorization, 54% require participation in weight management programs, and nearly half (48%) limit access based on body mass index or the presence of comorbidities beyond the FDA indications.1 Barlow explained that payers remain hesitant to expand coverage due to the “budget-busting” nature of GLP-1s, as they must balance potential future savings with immediate drug costs.

“This is going to evolve over time, and don't worry, there will be access for patients; it just is going to take a little time to get there,” Barlow concluded. “This is a system under tremendous financial constraints, and because they've absorbed some of these other innovations, it's making them harder to absorb this latest set of innovations. I think that's the glass half full, half empty approach; I'm not sure which way it’s going to play out, but I'm a half-full kind of gal...”

Innovative Payment Models Could Support Sustainable GLP-1 Access

Building on Barlow’s insights, Ryan offered a closer look at payer perspectives, describing GLP-1s as “one of the most transformative medical advances in recent years.” She added that the unprecedented demand, driven by clinical efficacy, media attention, and expanded recommendations from the American Diabetes Association, has created a “perfect storm” for payers.

“It’s a dream scenario for manufacturers, but it’s a nightmare for payers,” Ryan said.

Ryan explained that payers face difficulty balancing short-term affordability challenges with the long-term value opportunity of GLP-1s. She noted that treating more than 1% of the eligible population could result in an unsustainable budget threshold, as GLP-1 costs now account for 15% of pharmacy benefit spending. Weight management drugs accounted for 46.8% of total drug spending growth in 2024; GLP-1s emerged as the predominant driver, with a 210.2% one-year net trend increase in 2023 and 148.7% in 2024.

Despite these pressures, Ryan highlighted that untreated obesity costs the health care system nearly $1.4 trillion annually. In Medicare alone, she said, GLP-1 coverage could yield $245 billion in savings over the first 10 years through reduced diabetes, cardiovascular events, and comorbidities. She added that this could lead to achieving budget neutrality within 3 to 5 years.

As GLP-1 costs continue to rise, Ryan explained that many payers are dropping coverage to mitigate financial losses. While this may ease short-term budget pressures, she cautioned that it risks undermining long-term value. Ryan recommended the adoption of innovative payment models, such as risk-sharing and subscription-based agreements, to support sustainable access. With only about 19% of large employers covering GLP-1s, she pointed to AT&T’s high-retention lifestyle program as an example of a successful, value-based approach.

“We all just need to come together to build a healthier solution,” Ryan concluded.

Exploring Medicaid Approaches to Obesity Treatment

Moore rounded out the discussion by offering the Medicaid perspective, sharing Missouri’s experience since opting into anti-obesity medication coverage in January 2025. Under the program, obesity treatment is covered as an optional benefit for certain products and criteria, while coverage for diabetes, nonalcoholic steatohepatitis, sleep apnea, and MACE prevention is mandatory. He noted that Medicare and Medicaid coverage for these drugs remains across states but is expanding as evidence of their clinical benefits grows.

Since January, Missouri’s Medicaid program has enrolled more than 14,000 patients on GLP-1s. Utilization has shifted away from daily injectables and varying by age and indication; middle-aged patients primarily use them for obesity, while younger and older patients more often do so for diabetes, chronic kidney disease, or sleep apnea. Consistent with other chronic therapies, adherence stabilizes after an initial 20% to 25% drop in the first month. He added that providers are encouraged to make medication adjustments as patients lose weight.

Additionally, Moore emphasized Missouri Medicaid’s holistic approach, which includes biophysical and psychosocial support, provider education, and reduced administrative barriers. Early findings suggest broader benefits, such as improved food security and behavioral outcomes in vulnerable populations. However, Moore said that true success will be measured through long-term reductions in cardiovascular events, surgeries, and emergency department visits.

“For me, [success] means a patient stays on [GLP-1 therapy] and we then don't have heart attacks, we don't have strokes, we don't have as many knee replacements, and we don't have as many hip replacements,” he concluded. “These things that I just talked about aren't things that we'll see in six months or a year.”

References

1. Barlow JF, Ryan G, Moore J, Baldwin V. Improving outcomes for patients with obesity: impediments and solutions for sustainable access to anti-obesity medications. Presented at: AMCP Nexus 2025; October 27-30, 2025; National Harbor, MD.
2. Business Group on Health. 2026 employer health care strategy survey. August 19, 2025. Accessed October 30, 2025. https://www.businessgrouphealth.org/resources/2026-employer-health-care-strategy-survey