The clinical value of GLP-1 receptor agonists is now well established. Multiple trials have linked them to not only meaningful reductions in body weight, but also improved outcomes in cardiovascular, kidney, liver, arthritis, and sleep apnea disorder. Policymakers have responded accordingly. Programs such as the CMS BALANCE model and the Medicare GLP-1 Bridge initiative reflect a broader shift towards treating obesity as a chronic disease and expanding access to pharmacotherapy within public programs. This shift is significant and, given already ongoing GLP-1 adoption, overdue.
But as public stakeholders expand coverage, attention must also turn to: what happens after access is established? Expanding coverage will likely address the affordability barrier, but it alone does not guarantee durable outcomes at scale. In addition to medication coverage, the success of obesity care will depend on whether payers and providers can build the longitudinal care infrastructure needed to support adherence and lifestyle requirements over time.
Coverage without longitudinal support
The Adherence Challenge
As is common with clinical studies, trials evaluating GLP-1 are conducted in highly structured environments with consistent follow-up, nutrition monitoring, lifestyle optimization, and behavioral support. Real-world care is considerably less controlled.
A 2025 study found that nearly 65% of patients without diabetes and 47% of patients with diabetes discontinued GLP-1 therapy within one year. The causes of discontinuation ranged from costs to access, tolerability, side effects, and plateaued weight loss.
This matters because the long-term value proposition of GLPs, which includes downstream savings associated with reductions in hospitalization events and obesity-related comorbidity burden, depends heavily on adherence. Clinical research shows that the benefits of GLP-1 receptor agonists are not sustained after discontinuation, with most patients regaining substantial weight within one year of stopping treatment.
While some degree of regain is expected in chronic disease management, widespread cycling on and off therapy raises important clinical and economic questions. If adherence remains low, the healthcare system may ultimately end up financing intermittent weight loss rather than durable obesity management.
The Lifestyle Support Need
Obesity management depends on more than pharmacotherapy alone. Across clinical guidelines and trial protocols, effective weight loss interventions consistently pair medication with foundational lifestyle inputs, including nutritional guidelines (e.g., adequate protein intake) and regular physical activity, particularly resistance training.
When these supportive inputs are absent, outcomes become clinically incomplete and potentially harmful. For instance, inadequate protein intake, in the absence of resistance training, is associated with greater lean mass loss, an effect that is particularly concerning in older adults.
Why these challenges are amplified in Medicare and Medicaid
As of now, much of the GLP-1 market has been concentrated among commercially insured individuals and higher-income patients who are able to pay through employer coverage or out-of-pocket. Expanding obesity pharmacotherapy into Medicare and Medicaid populations reflects a broader recognition that obesity is a national chronic disease burden, particularly among lower-income and medically complex populations that experience disproportionately high rates of obesity-related comorbidities. But this also means the healthcare system is entering a very different operational environment.
Though entire healthcare has struggled with medication adherence across nearly every major chronic condition category, this issue is often amplified in Medicare and Medicaid populations, where multimorbidity, disability, food insecurity, and social instability are more prevalent. In that context, adherence cannot be treated as an individual patient problem alone; it is fundamentally a care delivery and longitudinal support challenge.
The same barriers intensify the need for lifestyle support. The BALANCE model has some provisions to take care of this – drug manufacturers are expected to provide education on healthy eating, physical activity, and medication adherence. However, these requirements alone may be insufficient for two reasons. First, providing guidance is not the same as ensuring low-income or older patients have access to affordable healthy food, safe exercise environments, transportation, or clinically appropriate support programs. Second, the model has no requirement for providers to verify whether patients are actually engaging with these interventions, nor is there a standardized benchmark for what meaningful participation should look like or how it should be measured. That accountability gap matters because sustained member engagement remains a persistent challenge in chronic disease management, particularly within Medicaid populations.
The next phase of obesity care
The coverage landscape that Medicare and Medicaid bring into this moment reflects how the healthcare system has historically approached obesity: not as a chronic disease requiring long-term management, but as a condition addressed primarily through episodic interventions and nutritional counseling.
The next phase of obesity care will require structured care pathways comparable to those already established for conditions such as heart failure, diabetes, kidney disease, and hypertension – where risk stratification, coordinated care planning, patient engagement, outcome measurement, and stakeholder accountability are embedded into the delivery model. A sustainable obesity management model would require capabilities such as:
- Identifying members at elevated risk of suboptimal adherence, unmet lifestyle support needs, or abrupt treatment discontinuation
- Determining the barriers most likely to affect the adherence and engagement, whether related to social needs, mobility limitations, behavioral health conditions, or care access
- Deploying engagement and care coordination capabilities that managed care organizations already use across other chronic conditions, including community health workers, telephonic care management, provider navigation, digital engagement tools, and in-person support programs tailored to members’ needs and health literacy
- Pairing member engagement with tangible support such as healthy food benefits, fitness programs, and transportation assistance, so that lifestyle recommendations are realistically actionable
- Moving these models over time toward value-based arrangements that reward sustained outcomes and long-term engagement rather than treatment initiation alone
Expanding access to GLP-1 therapies is an important step. Building the systems required to support durable outcomes is the more consequential one.
Pankhuri Sharma is Strategy & Operations Leader at Humana. She is based in Chicago and can be reached at psharma60@humana.com.
The views expressed in this opinion are those of the author and do not necessarily reflect the official policy or position of her organization.
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