Why Access to GLP-1s Is Getting Harder — And What to Do About It

GLP-1 medications (Wegovy, Zepbound, Ozempic, etc.) have transformed care for obesity and metabolic disease. I can attest to this on behalf of my patients!  However, coverage is tightening—and the trend is accelerating. Here, I summarize what’s changing, why it’s happening, and how to navigate it.

What’s happening right now (Michigan + national signals)

• In West Michigan, an employer survey cited by Crain’s Grand Rapids shows only 15% of employers now cover GLP-1s for weight loss, down from 24% last year. Employers are also steering members toward price-shopping programs (GoodRx, Cost Plus Drugs) and even foreign pharmacies to curb spend. (Crain's Grand Rapids Business)

• BCBS of Michigan confirmed it stopped paying for GLP-1s for obesity on fully insured plans beginning Jan 1, 2025 (Blue Care Network included). (BCBSM Provider Info)

• Employer claims data show GLP-1 costs are taking a bigger slice of total spend: an employer benefits pulse survey found GLP-1s for weight loss averaged 10.5% of total annual claims in 2025 (up from 8.9% in 2024). Many employers report >15% of claims tied to GLP-1s. (IFEBP)

• States and public plans are also tightening: e.g., North Carolina Medicaid is ending GLP-1 coverage for weight loss (10/1/2025), while Pennsylvania plans to restrict to the highest-risk members—illustrating how quickly policies can shift. (KFF Health News)

Why it’s getting harder

1. Cost + utilization have outpaced budgets.
   List prices commonly hover around ~$1,000/month, and rapid uptake has driven double-digit prescription spend growth for many plans. Employers and insurers are responding with exclusions, step therapy, and stricter prior authorization. (Crain's Grand Rapids Business)

2. Coverage is narrowing to specific indications.
   Many plans that still cover GLP-1s limit them to FDA-approved non-obesity uses (e.g., diabetes, some cardiometabolic indications), not general weight loss. Expect tighter BMI cutoffs, documentation requirements, and re-authorization cycles. (Crain's Grand Rapids Business

3. The “generic relief” you’re hoping for is years away.
   Experts estimate ~6 years (at best) before lower-cost generics meaningfully reach the market, so price pressure likely persists. (Crain's Grand Rapids Business)

Visual: local employer coverage is falling.

Below is a graphical depiction of the results of the “Total Control Health Plans client survey” from Crain’s Grand Rapids:

What this means for you

• Expect more denials/delays (particularly for weight-loss indications). Prior authorization hoops and periodic re-checks are now standard. This has been a significant burden to our office, unfortunately. (KFF)

• Out-of-pocket exposure is rising. Even with coupons or cash-pay programs, monthly costs are going up instead of down as demand increases. (epocrates.com)

• Access will vary by plan and state. Employer size, plan type (self-funded vs fully insured), and state Medicaid policies all influence your options. (IFEBP)

Practical steps (Seeds of Health playbook)

1. Know your plan’s exact policy
   Ask these specifics: Is obesity covered? Do they cover GLP-1 for other conditions than diabetes? What BMI/criteria? Which GLP-1s are on formulary? What documentation is required? How often is re-auth needed? (Policies change—check at each renewal.)

2. Align indication + documentation.
   If you have diabetes or another covered indication, ensure your chart clearly reflects qualifying diagnoses and prior therapies tried/failed. How can you do this? Tell your doctor! This can speed approvals. (KFF)

3. Price-shop safely
   Proceed with caution when buying “knockoff” versions of the drugs. Use reputable tools (GoodRx/Cost Plus) and legitimate pharmacies. If cash-paying, verify manufacturer programs and watch dose-based coupon limits. (Crain's Grand Rapids Business)

4. Have a Plan B
   Discuss alternatives: different GLP-1s within class, adjuncts (e.g., metformin, SGLT2s where appropriate), or structured lifestyle protocols that can stand alone or bridge gaps during coverage lapses.

5. Play the long game
   Even with a GLP-1, you will still likely need to commit to long-term lifestyle changes to sustain results; otherwise, you are going to be married to the drug for life.  Some people may be no matter what.   And, because generic relief is years off, prepare for policy churn. We’ll help you reassess at renewals and pivot as needed.

Seeds of Health perspective

GLP-1s can be game-changers for the right patient, but access is now the pivotal variable. We’ll keep tracking Michigan-specific policies and national trends, advocate where possible, and work with you on individualized plans—whether that’s documentation for coverage, safe cash-pay strategies, or non-pharmacologic paths that protect your metabolic health.

If you’re on—or considering—a GLP-1, schedule a visit. We’ll review your goals, medical history, and coverage realities to map a sustainable plan and decide if the medication is right for you. 

Sources & further reading

• Michigan employers scaling back GLP-1 coverage; costs, generic timeline, and plan strategies. (Crain's Grand Rapids Business)

• BCBSM/BCN alert: ending obesity-drug coverage 1/1/2025 (fully insured). (BCBSM Provider Info)

• Crain’s Detroit follows up on BCBSM’s policy. (Crain's Detroit Business)

• IFEBP pulse survey: GLP-1s now ~10.5% of annual claims; many employers report >15%. (Word on Benefits)

• KFF Health News: state Medicaid programs tightening access (NC ending weight-loss coverage; PA restrictions). (KFF Health News)

• KFF brief: states that states that cover obesity GLP-1s rely on strict PA/BMI criteria. (KFF)

• Epocrates: list prices ≈ $1,000/month; payers are struggling with demand. (epocrates.com)