More and more payers and employers have been getting on board with surgical alternatives to GLP-1s for weight loss.
A 2024 survey found most employer-sponsored plans covered these procedures, and covering GLP-1s for diabetes and obesity was much less likely. KFF reported that the majority of organizations with at least 5,000 employees said covering GLP-1 agonists had a “significant” impact on prescription drug spending.
One doctor told Becker’s that insurers see “more reliable outcomes and savings” when they pay for bariatric surgery. During a panel on GLP-1s at Becker’s Fall 2025 Payer Issues Roundtable this month, Select Health Senior Medical Director Kenny Bramwell, MD, echoed that sentiment.
“A handful of years ago, I never would have said this, but some people may need to consider — or we need to at least consider — the costs of surgical options,” Dr. Bramwell said. “Bariatric surgery suddenly seems inexpensive compared to $1,000 a month in perpetuity.”
Shortly after the event, though, the Trump administration established a deal to lower obesity drug costs for Medicaid and Medicare. Medicare prices for Ozempic, Wegovy, Mounjaro and Zepbound will be $245 per month, with patients having a $50 copay. Those prices will also be available to state Medicaid programs.
“The federal government has negotiating power that individual health plans do not,” said Malaika Stoll, MD, a family physician at a federally qualified health center and former health plan leader. “With the concern my patients have around potential Medicaid cuts, this is a welcome announcement, and, when it kicks in, it could improve and save lives.”
While this move may not directly impact employers and commercial plans, another payer from that same panel is thinking about the ripple effect.
“My understanding is that for commercial self-insured plans, we would not be directly affected by this initiative at all, though there is some speculation that this initiative will help create downward pressure for drug manufacturers to lower costs for commercial plans,” said Bruce Rogen, MD, chief medical officer of the Cleveland Clinic Employee Health Plan and chair of the Cleveland Clinic Quality Alliance.
“If true, I expect that will take time (months to years) for us to see acquisition costs for GLP-1s for weight loss go down. But this new development might help hasten the reduction in costs for weight-loss drugs that commercial insurers are waiting on,” he said.
