GLP-1 drugs continue to transform care for diabetes, obesity and chronic disease, driving new approvals, pricing debates, coverage shifts and evolving health system strategies.
Since late 2025, developments in the GLP-1 landscape have unfolded on multiple fronts, from novel formulations and payer policy shifts to access challenges and emerging clinical data.
Here’s what you need to know about the latest with GLP-1s:
New drugs and regulatory milestones
GLP-1 therapies continued to hit major regulatory and pipeline milestones in December, reflecting rapid momentum across obesity and diabetes care.
In December, Pfizer struck a $2 billion deal with YaoPharma to develop and commercialize a phase 1 small-molecule GLP-1 receptor agonist for chronic weight management. The agreement includes $150 million upfront and up to $1.935 billion in milestone payments.
On Dec. 22, the FDA approved the first oral GLP-1 for weight loss. Novo Nordisk’s once-daily 25-milligram semaglutide pill, an oral version of Wegovy, was cleared to reduce body weight and lower cardiovascular risk. The pill launched Jan. 5.
CMS also unveiled its BALANCE model, a voluntary Medicare and Medicaid coverage pathway for GLP-1s that includes price negotiations and supplemental lifestyle support. Coverage will begin in 2026 for Medicaid and 2027 for Medicare Part D.
Drugmakers advanced next-generation therapies as well. Novo Nordisk filed for FDA approval of CagriSema, while Eli Lilly reported positive trial results for oral GLP-1 orforglipron and triple-hormone agonist retatruti.
Coverage, pricing and employer pressure
GLP-1 coverage for weight loss remains contentious as insurers and employers grapple with rising specialty drug spending.
Pricing pressures have surfaced across payer earnings, with organizations such as Highmark Health and Blue Cross Blue Shield of Massachusetts citing GLP-1 costs. In April, BCBS Massachusetts dropped coverage for GLP-1s for weight loss, while availability under ACA plans continues to decline nationally.
Employers have also pulled back. In 2025, Idaho and Louisiana moved away from GLP-1 coverage for state employees, and estimates suggest employer-sponsored plans that include GLP-1s could raise premiums by 5% to 14%. Surveys show cost management for these drugs is a top prescription benefits concern.
However, some insurers are expanding access with guardrails. During a May earnings call, Cigna said it is focusing on programs to manage GLP-1 costs and delivery, and has capped out-of-pocket spending for Wegovy and Zepbound at $200 per month.
Health system strategies and service line impact
Growing GLP-1 use is forcing health systems to rethink long-term planning as the drugs begin to reshape demand across high-margin service lines.
GLP-1 uptake is already influencing executive decision-making, particularly as elective surgery volumes show signs of decline. Bariatric surgery has been among the most immediately affected areas, with surgeons reporting a 10% to 20% drop in case volumes as GLP-1 use increased. Some health systems have responded by scaling back or closing bariatric programs.
Other service lines may see longer-term shifts. GLP-1s are helping some patients qualify for transplants, while orthopedic, spine and cardiovascular procedures could decline over time as obesity-related conditions decrease. How hospitals and ASCs adapt to these changing utilization patterns remains uncertain.
Surgical alternatives and payer calculus
Rising GLP-1 costs are prompting more payers and employers to reconsider surgical alternatives for weight loss.
A 2024 survey found most employer-sponsored plans covered bariatric surgery, while coverage for GLP-1s was far less common. Most organizations with at least 5,000 employees said GLP-1 coverage had a significant impact on prescription drug spending, leading some insurers to view bariatric surgery as a more predictable and cost-effective option.
While a recent federal deal will lower obesity drug prices for Medicare and Medicaid, payer leaders say any pricing relief for commercial plans will likely take time.
Cost impact and long-term outcomes
New data suggest sustained GLP-1 use may slow medical cost growth, even as total spending remains higher in the short term.
In findings published Jan. 13, Aon analyzed claims data from 192,000 GLP-1 users and found medical cost growth was lower for both diabetes and weight loss patients compared to non-users, particularly among individuals with high adherence. Cost growth slowed further for patients with at least 80% adherence.
The analysis also found additional health benefits among female GLP-1 users, including lower hospitalization rates for major cardiovascular events and reduced incidence of several conditions, though some risks , such as gallbladder surgery, were higher. Overall costs for GLP-1 users remain higher due to drug expenses, though Aon noted prices may compress over time as oral formulations and direct-to-consumer models expand.
