By Healthesystems
Six percent of U.S. adults – an estimated 15.5 million people – report using injectable diabetes medicine to reduce weight, including 3% who are using such medicine specifically for weight loss, according to a May 2024 Gallup poll.
These drugs are part of a medication class called glucagon-like peptide 1 (GLP-1) receptor agonists, which was originally utilized to treat type 2 diabetes and demonstrates significant weight loss when combined with diet and exercise. The most well-known of the drugs, Ozempic® (semaglutide), has received endorsements from public figures such as Oprah.
We introduced workers’ comp stakeholders to these weight loss agents in our summer 2024 RxInformer magazine article, Weighing the Options: Keeping Track of New Obesity Drugs. We also addressed the implications of obesity in workers’ comp in a 2024 blog. Now, with weight loss drugs becoming more widespread – and making their way into workers’ comp – we’re taking a fresh look at the issue.
Case-by-Case Coverage in Workers’ Comp
Obesity is a common co-morbidity for injured workers and can impede recovery from injury. It can also be an obstruction to surgery, which may require patients to lose weight in order to safely proceed.
Despite this, current workers’ compensation guidelines do not directly support the use of GLP-1 agents. And it would be unreasonable to expect workers’ comp payers to assume financial responsibility for treating a condition outside the work-related injury – especially when that treatment may very well last a lifetime. These are some of the reasons why the workers’ comp industry has “mostly rejected” covering weight loss injections, according to Business Insurance.
Silvia Sacalis, Healthesystems Vice President of Clinical Services, explained that payers are likely rejecting the prescriptions because of “the long-term effects, the required monitoring and lifestyle changes needed to maintain weight loss, and the high costs of the brand-name drugs.”
However, in certain cases, payers are covering GLP-1 medications for injured workers who need to reach a short-term milestone, such as a needed surgery, because it will ultimately result in a better outcome for the patient and the claim.
Outside workers’ comp, coverage for weight loss drugs is trending up in some states. In March 2025, Maryland proposed a bill (SB 876) that would require Medicaid to provide “comprehensive coverage for the treatment of obesity” – including FDA-approved anti-obesity medications – beginning in July 2026.
And in North Carolina, the State Health Plan is seeking to reinstate coverage of weight loss drugs for its more than 700,000 state government employees, retirees, and family members. WRAL notes that plan administrators stopped coverage of GLP-1 drugs in 2024 due to rising healthcare costs.
But not all states are following suit. Due to rising costs, Connecticut is looking to eliminate Medicaid coverage of GLP-1 medications when prescribed only for obesity, according to the Connecticut Mirror. The Mirror notes that in fiscal year 2024, GLP-1s cost Connecticut’s Medicaid program $85 million after factoring in rebates.
FDA Ends Drug Shortages, Drug Makers Lower Prices
Due to the lack of insurance coverage and the high cost of weight loss drugs – upwards of $1,000 per month without insurance – many patients are using compounds. These are copies of U.S. Food and Drug Administration (FDA)-approved medications that come at a much lower price than the brand-name versions.
The catch is that compounded drugs are only allowed when a drug is on the FDA’s shortage list – as GLP-1s have been for several years now. However, according to ABC News, in early 2025 the FDA declared the GLP-1 shortages as resolved, effectively ending the ability of compounding pharmacies to supply the medications. This change has prompted GLP-1 manufacturers to offer those who lack insurance coverage the option to buy the drugs at a lower cost.
In March 2025, Novo Nordisk, the maker of Wegovy® (semaglutide), launched a direct-to-patient delivery option that offers cash-paying patients all doses of the drug at a reduced cost of $499 per month. Later that same month, Novo Nordisk made another announcement that customers can buy Wegovy® at the $499-per-month price at their local pharmacy. Eli Lilly, the maker of Zepbound® (tirzepatide), also lowered the price of its medications to $349 to $499 per month, depending on the dose, when patients order directly from the manufacturer.
The story of weight loss drugs is far from over, and we’ll continue to provide updates on this evolving topic as they pertain to workers’ comp.
