Obesity treatment is entering a transformative era — and few therapies have garnered more attention or raised more questions than GLP-1 receptor agonists. In a featured session at Becker’s Fall 2025 Payer Issues Roundtable, Lia Gass Rodriguez, MD, chief medical officer at CVS Healthspire Payor Solutions, explored the complex terrain of GLP-1 drugs, outlining a strategy grounded in clinical science, care integration and fiscal responsibility.
Here are four key takeaways from her session:
1. Obesity is a chronic, multifactorial disease, not a failure of willpower.
Dr. Rodriguez began by reframing obesity not as a lifestyle issue, but as a chronic, complex condition driven by behavioral, environmental and genetic factors. While healthy habits remain important, the stigma surrounding obesity often obscures its underlying neurochemical, hereditary and environmental drivers.
“We can’t create a continual culture of shame around the diagnosis of clinical obesity,” she said. “We need to really understand that it is a multifactorial chronic condition that requires comprehensive treatment plans to be addressed.”
2. GLP-1s are reshaping the clinical and coverage landscape.
Originally developed for diabetes, GLP-1s like semaglutide and tirzepatide are now FDA-approved for obesity and are being studied for additional indications, including cardiovascular and kidney disease, obstructive sleep apnea and even Alzheimer’s.
According to Dr. Rodriguez, the rise of GLP-1s has expanded interest but not necessarily equitable access.
“We continue to experience access and affordability challenges,” she said. “These drugs are egregiously priced.”
She emphasized that payers must weigh the clinical benefits against the steep prices, which are among the highest for any therapy used to treat a highly prevalent chronic condition.
3. Coverage strategies must be clinically sound and cost-sensitive.
Dr. Rodriguez explained that only 29% of commercial health plan members currently have access to GLP-1s for obesity — compared to around 70% of those covered through employers — and outlined a three-pronged framework for decision-makers: coverage, cost and care.
Some employers are expanding access due to employee demand, while others use management protocols and prior authorization to ensure appropriate utilization. She also noted the rise of direct-to-consumer GLP-1 programs, which she cautioned is not a sustainable nor equitable solution.
“I’m not sure that the direct-to-consumer solution is actually going to be the savior that it’s being proposed to be.” Employers should weigh the continuum of coverage options and ensure their strategies align to their company culture and benefits philosophy.
4. Lifestyle and behavioral support is essential for lasting outcomes.
Dr. Rodriguez made a strong case for pairing pharmacotherapy with structured lifestyle interventions. CVS’ own weight management program, which includes registered dietitian-led medical nutrition therapy, showed significant results: patients who previously lost just 2% of body weight on GLP-1s alone — based on claims data indicating consistent medication use — achieved nearly 8% loss within three months after joining the program.
But these drugs are not without complexity, she cautioned, citing the delivery mechanism (injections), GI side effects, nutritional impacts and the importance of preserving muscle mass. She stressed that long-term success depends on sustained behavior change and clinical integration, not medication alone.
“We’re seeing clinical outcomes that actually exceed what the clinical trials promise,” Dr. Rodriguez said. “In our program, on average we’re seeing weight loss of over 18% in individuals regardless of the anti-obesity medication they use. We also see that individuals who discontinue the drug but remain engaged with our registered dieticians in the program for at least six months actually retain 90% of the weight they lost despite no medication.”
Looking ahead
CVS Healthspire continues to invest in real-world data collection to evaluate long-term cost and clinical impacts. A yearlong claims analysis is underway, with findings expected in early 2026, Dr. Rodriguez said.
She also noted that while lifestyle support may reduce unnecessary utilization, the high price of GLP-1s means total cost of care is still likely to rise for those who cover them. Until the new data arrives, leaders are urged to view GLP-1s not as silver bullets, but as one part of a broader, evidence-based strategy to treat obesity at scale.
