Insurers drop coverage for weight loss drugs despite patient need

Deborah Finley’s weight loss drug stopped working for her in the same way her insurance coverage did. At 50, she had spent years battling obesity, sleep apnea, and prediabetes, only to see her progress unravel when her insurer dropped coverage for Zepbound at the end of 2023.

The notice arrived without warning. Her insurer gave her 90 days to find another solution. “I was like: What am I going to do?” Finley recalled. “Hopefully I can just continue keeping this weight off.”

Her situation reflects a growing crisis. Between 2025 and 2026, 12 million people lost insurance coverage for Zepbound, while another 12 million faced the same for Wegovy, according to research by GoodRx. The trend marks a sharp reversal as insurers and employers cut back on these expensive medications despite rising demand.

Finley’s weight had ballooned during the early pandemic, when she observed how obesity worsened COVID-19 outcomes. As a single mother, the realization terrified her. “As a single mom, she was afraid ‘that I wouldn’t be here for my daughter,’” Finley said. Her doctor recommended bariatric surgery, but her insurer denied it. Diet and exercise helped temporarily, but at 223 pounds, she felt stuck. “Look, I’m at 223 pounds. I feel like I’m hitting this wall. I don’t know what else I can do,” she told her physician.

Her doctor then prescribed Zepbound, a GLP-1 drug approved for chronic weight management. It worked—her sleep apnea improved, and she lost weight. Then, abruptly, her coverage vanished.

Financial Pressures Drive Coverage Cuts

GLP-1 drugs like Zepbound and Wegovy cost insurers billions annually. The financial burden has triggered widespread coverage restrictions, even for patients with obesity-related conditions like diabetes or fatty liver disease.

Finley’s insurer offered a potential workaround: coverage would continue if Zepbound was prescribed specifically for obstructive sleep apnea or MASH (metabolic dysfunction-associated steatotic liver disease). But proving medical necessity became a major obstacle.

She obtained a 17-page prior authorization report from her doctor, documenting how the drug improved her sleep apnea and liver function. With assistance from ChatGPT, she drafted an appeal. Yet when she attempted to refill her prescription in January, the pharmacist rejected it. The insurer said there was not sufficient data to back up the request.

Finley said she had to dig through her online medical records to uncover what went wrong. Her doctor had submitted a prior authorization, but somewhere in the process, her test results disappeared from the insurer’s review.

Obstacles Built Into the System

Caleb Alexander, a professor at Johns Hopkins, explained that undiagnosed diabetes remains the most reliable path to coverage under most plans. “Undiagnosed diabetes, he said, is ‘the most likely scenario that would allow for someone to go from not being qualified to being qualified.’”

Finley’s appeal, filed in February, remained unresolved as of mid-June. Without new injections since January, she turned to a compounded version of Zepbound, though these drugs lack FDA approval. She used the National Association of Boards of Pharmacy’s online pharmacy verification tool to confirm her pharmacy’s California license.

Her experience also reveals the emotional toll of handling these barriers. Finley had lost 40 pounds on Zepbound before coverage ended, but the weight regain has been both physical and psychological. “She said it’s been stressful because she hasn’t been able to get new injections of Zepbound since mid-January.”

Alternatives to Brand-Name Obesity Drugs

Compounded versions of Zepbound and Wegovy are available through specialized pharmacies, though they are not approved by the FDA. These medications use the same active ingredient as the brand-name drugs but are prepared by pharmacists rather than manufacturers. Patients can often find lower out-of-pocket costs by purchasing through discount platforms, though insurance may not cover them.