Access to GLP-1 medications for weight loss through ACA marketplace plans is shrinking, according to a new analysis from healthcare advisory group Leverage|Axiaci shared with Becker’s.
The analysis was conducted with funding from the Robert Wood Johnson Foundation. Leverage|Axiaci reviewed the policies of the 300 carriers offering marketplace plans in 2026 to determine the coverage and conditions of coverage for three GLP-1 drugs, Wegovy, Zepbound, and Saxenda.
Six notes:
1. GLP-1 coverage for weight loss declined from 3.6 million enrollees in 2024 to 2.8 million in 2026.
2. If the same 24.5 million people enrolled in ACA plans in 2025 were re-enrolled in 2026, less than 10% would have coverage, and a fraction of those individuals would meet the more restrictive requirements established for GLP-1 coverage in 2026.
3. Out of the 300 carriers offering marketplace plans in 2026, 26 offer coverage for GLP-1s for treating obesity.
4. Nine states have marketplace plans available that offer coverage for GLP-1s for obesity treatment: California, North Dakota, New York, Vermont, Pennsylvania, West Virginia, Rhode Island, Delaware and Georgia. In California and North Dakota, all carriers offer plans that cover GLP-1s.
5. All but four carriers offer GLP-1 coverage only for those with morbid obesity (40 BMI and above).
6. All carriers require documentation of participation in a diet and exercise program for three to nine months prior to a request for GLP-1s, as well as proof that the enrollee was unable to lose weight.
