Becker's Healthcare December 26, 2025
Navigating GLP-1 coverage for weight loss has been a sore spot for insurers and employers. These drugs — alongside other specialty drug spending — have been behind price hikes going into 2026.
Still, as some employers, states and insurers hesitate to expand coverage, a handful of organizations are trying to boost accessibility, including by negotiating lower costs.
Here are four notes on the state of GLP-1 coverage in 2025:
1. The Trump administration and CMS have been getting more involved in negotiating drug prices. CMS published plans in late December for its “Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth” — or BALANCE — model, which will encompass drug affordability and lifestyle support for weight management. Leading up to...
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