An analysis presented at the AMCP 2025 Annual Meeting found that, on average, less than one-third of commercial members currently have coverage for antiobesity medications, despite payers who track obesity outcomes observing positive impacts of these therapeutics. This study was included in part of the Meeting’s Moderated Poster Tours.
Cencora sought to understand their current management of antiobesity medications on commercial formularies as well as any challenges experienced. They conducted a web-based survey of US healthcare payers using their Managed Care Network research panel in October 2024.
A total of 48 payers from health plans (n=22), integrated delivery networks (n=13), and pharmacy benefit managers (n=13) completed the survey. Only 31% of commercial members have coverage for antiobesity medications, according to the findings.
For payers who cover these drugs, 52% (n=29) prefer semaglutide, and 44% (n=27) prefer tirzepatide. Payers are using quantity limits, supplemental care programs, and prior authorization to manage these agents.
For payers whose organizations are not currently covering antiobesity medications in 2024 or do not plan to cover them in 2025, 64% (n=36) said cost was the main reason. Payers face several challenges in managing antiobesity medications, including high budget impact (92%) and lack of long-term data on sustained weight loss (79%).
Payers who track obesity outcomes noted positive effects of antiobesity medications on body mass index (93%; n=29) and weight loss (96%; n=26).
To further inform antiobesity medications coverage decisions, payers are interested in medical cost offsets data (81%) and real-world evidence (73%). In 2025, three-quarters of payers said they expect to cover semaglutide and tirzepatide on commercial formularies.
Among payers that have opt-in rider policies with employer clients for antiobesity medications, 56% (n=36) anticipate moving them to traditional commercial formulary placement.
Reference
Yoshida S, Liu E, Friedman M. Payer coverage trends of anti-obesity medications (AOMs) on commercial formularies. Abstract E22 presented at: AMCP 2025; March 31-April 3, 2025; Houston, TX.
