Navigating Cost and Access Barriers for Medications in the Treatment of Obesity: A Guide for Patients and Primary Care Clinicians

Obesity is a chronic disease associated with increased prevalence of and risk for multiple chronic comorbidities (1). The number of people living with obesity in the U.S. is increasing at a rapid pace. The U.S. prevalence of obesity increased from an estimated 30.5% of adults in 1999–2000 to 41.9% in the period spanning 2017–2020, disproportionally affecting Black and Hispanic populations (2). Notable consequences of obesity include, but are not limited to, hypertension, hyperlipidemia, type 2 diabetes, obstructive sleep apnea (OSA), osteoarthritis, and gallbladder disease (3). Adults with obesity are also at higher risk for stroke and cardiovascular-related morbidity, several types of cancer, clinical depression and anxiety, and premature death (3). The estimated annual obesity-related medical care costs in the United States were nearly $173 billion in 2019 dollars (3), a doubling of medical expenditures in adults relative to adults without obesity (4).

The American Diabetes Association (ADA) additionally incorporates achieving and maintaining individualized weight management targets as a central goal within its Standards of Care in Diabetes clinical practice guidelines (5,6). Although lifestyle intervention is a core component of a comprehensive weight management plan (5), it is often insufficient to achieve and maintain the desired degree of weight loss (7).

For individuals unable to achieve and maintain weight management goals with lifestyle changes alone, anti-obesity medications (AOMs) represent an important therapeutic option. The ADA therefore recommends that AOMs be considered in people with diabetes and obesity along with lifestyle changes, with level-A evidence supporting their use (5). The most effective AOMs for both weight loss and mitigation of obesity-related complications are the glucagon-like peptide 1 (GLP-1) receptor agonist semaglutide and the dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonist tirzepatide (8), which have been the focus of substantial medical, scientific, and public interest and therefore patient interest.

Although millions of people in the U.S. meet criteria for treatment with AOMs to improve their overall health and mitigate weight-related morbidity and mortality, there are many cost- and access-related barriers to the accessibility and use of these medications. Both U.S. Food and Drug Administration (FDA)-approved semaglutide and tirzepatide products are only available as brand-name medications, with list prices exceeding $1,000 (Table 1) (9,10). Both have complex prior authorization procedures, and both are often in shortage and unavailable (11). This article briefly reviews currently available AOM options and strategies for primary care clinicians to address current barriers to optimized use and access to obesity pharmacotherapies.

Table 1.

Cost Estimates for Obesity Medications

Medication		Median Product AWP, $*	Median Product NADAC, $*
Generic Name	Brand Name(s)
Phentermine†	Lomaira, others	9–98	3–79
Orlistat	Alli (OTC)	41–82	Not available
	Xenical (Rx)	781–904	629–724
Phentermine-topiramate ER	Qsymia	237	Not available
Naltrexone-bupropion ER	Contrave	750	Not available
Liraglutide	Saxenda	1,619	1,296
Semaglutide	Wegovy	1,619	1,296
Tirzepatide	Zepbound	1,272	1,017

*Median AWP and NADAC prices are listed for a 30-day supply at the maximum FDA-approved dose and frequency as of 1 July 2024 (9,10). †Range is inclusive of all commercially available products and includes costs for generic options. AWP, average wholesale price; ER, extended release; NADAC, national average drug acquisition cost; Rx, prescription.

Obesity Pharmacotherapy: Available Options and Costs

Multiple AOMs are commercially available in the United States. Available AOMs work through a variety of mechanisms to promote weight loss. A brief review of currently available agents is provided below.

Phentermine

Phentermine, originally approved in 1959 for short-term use (≤3 months), is a centrally acting sympathomimetic weight loss agent (12). Few data are available on its long-term efficacy and safety. One randomized controlled trial (RCT) of 6 months’ duration found that phentermine dosed at 7.5–15 mg was associated with weight loss ranging from 5.5 to 6.1% versus 2.3% weight loss in the placebo group (13). Of the currently available AOMs, phentermine is the least expensive (Table 1). The most common side effects associated with phentermine use include xerostomia, insomnia, headache, constipation, and increased blood pressure (12).

Orlistat

Orlistat is a lipase inhibitor that blocks the digestion and absorption of dietary fat in the gastrointestinal (GI) tract, thus leading to a reduction in caloric intake (14). Orlistat was initially approved by the FDA in 1999 and is currently available in both prescription (120 mg) and over-the-counter (OTC; 60 mg) strengths (15). When compared with newer AOMs, the weight-lowering efficacy of orlistat is relatively modest; a meta-analysis of 52 RCTs found that orlistat treatment resulted in a 3.1% greater weight loss compared with placebo (16). Given orlistat’s mechanisms of action, it is associated with a high rate of GI side effects, including flatulence, fecal urgency, and steatorrhea (15).

Phentermine-Topiramate Extended Release

Phentermine-topiramate was initially approved in the United States for long-term use in adults in 2012, with an expanded indication for adolescents >12 years of age granted in 2022 (17). As previously noted, phentermine is a centrally acting sympathomimetic weight loss agent, and topiramate is an antiepileptic agent. Although topiramate is associated with relatively modest weight loss as monotherapy, the combination of topiramate and phentermine result in more robust weight loss (15). A meta-analysis of five RCTs conducted in adults with obesity found that phentermine-topiramate treatment was associated with a placebo-subtracted weight loss of 8.0% (16). The most common side effects are consistent with those expected with its component parts, including constipation, insomnia, xerostomia, and increased blood pressure (5).

Naltrexone-Bupropion Extended Release

Naltrexone-bupropion is another fixed-ratio combination AOM. It was approved for long-term use in adults with obesity in 2014 (18). Naltrexone-bupropion is a centrally acting AOM that reduces appetite (12). A meta-analysis of six RCTs conducted in adults with obesity found that naltrexone-bupropion treatment resulted in a placebo-subtracted weight loss of 4.1% (16). Naltrexone-bupropion is administered twice daily, and the most common side effects associated with use include constipation, headache, xerostomia, insomnia, and increased blood pressure and heart rate (5).

GLP-1 and Dual GIP/GLP-1 Receptor Agonists

GLP-1 and dual GIP/GLP-1 receptor agonists, originally approved by the FDA as glucose-lowering agents, are now recognized as potent AOMs. Three products in the class carry expanded indications for the treatment of obesity: liraglutide, injectable semaglutide, and tirzepatide (5). Nausea is the most common dose-limiting side effect associated with the use of GLP-1 and dual GIP/GLP-1 receptor agonists (12).

Table 1 summarizes the median average wholesale prices and national average acquisition costs of FDA-approved AOMs. The presented costs are meant to illustrate the relative costs of these agents do not necessarily reflect what people may pay out of pocket because of variability in insurance availability and coverage (including health benefit design, coverage of AOMs, the specific pharmacy where the prescriptions may be filled, and where individuals fall with deductibles and out-of-pocket maximums, if present, at the time of the fill).

Barriers to Optimal Pharmacologic Management of Obesity

Affordability Barriers

As highlighted in Table 1, many of the newer AOM options are expensive and unaffordable on a cash pay basis for many individuals, with cost- and coverage-related access barriers having the potential to exacerbate disparities in obesity management (19). AOMs are not currently covered by many Medicare, state Medicaid, and private insurance plans. When covered, plans often require completion of complex prior authorizations and weight-monitoring plans to meet coverage requirements and also may have rigid requirements for dose titration schedules that are clinically infeasible for patients. Out-of-pocket costs for covered AOMs can also be prohibitive, with coinsurance and copayment amounts exceeding what individuals can pay, particularly if they have a high-deductible health insurance plan. Research has shown that people with higher out-of-pocket costs are less likely to receive GLP-1 receptor agonists when indicated (20), and higher out-of-pocket costs may lead to cost-related prescription drug rationing of GLP-1 receptor agonists for obesity and cardiovascular risk reduction (21). A detailed discussion of AOM coverage and payment considerations is provided below in Legislative Updates.

Clinical Inertia

Clinical inertia is another important barrier to optimized AOM management. Weight loss pharmacotherapies require frequent follow-up to assess therapeutic response (i.e., weight loss), facilitate dose titration, and ensure tolerability and safety. The ADA recommends assessing AOM efficacy and safety at least monthly for the first 3 months and at least quarterly thereafter (5). Ideally, AOM treatment will result in a weight loss ≥5% after 3 months of use. In the case of GLP-1 and dual GIP/GLP-1 receptor agonist use in people with type 2 diabetes and obesity, doses are sometimes not optimally titrated to maximize weight loss efficacy due to glucose levels (e.g., A1C) being at or below goal. Thorough education of both care teams and people with type 2 diabetes and obesity, including addressing weight-related stigma and bias (22), is crucial to optimize efficacy, safety, and desired outcomes.

Product Shortages

Increased demand for GLP-1 and dual GIP/GLP-1 receptor agonists as weight loss therapies has resulted in product shortages and the emergence of compounded versions, often purchased through online vendors or wellness spas (23). Of most concern are counterfeit GLP-1 and dual GIP/GLP-1 receptor agonist products, with a recent study reporting issues with product purity, concentrations, and contamination when assessing semaglutide products purchased online (23,24). Despite these concerns, non–FDA-approved compounded GLP-1 and dual GIP/GLP-1 receptor agonist products are sold at lower cost to patients without insurance coverage, so patients and clinicians may consider these options when affordability is a barrier. Because of persistent questions about the safety of these products, the ADA recently published a statement strongly discouraging compounded GLP-1 and dual GIP/GLP-1 receptor agonist use, highlighting concerns about the safety, quality, and effectiveness of these products (23). A summary of key ADA guidance statements on compounded incretin mimetic agents is summarized in Table 2.

Table 2.

ADA Guidance Statements on the Use of Compounded Incretin Products (23)

Non–FDA-approved compounded incretin products are not recommended for use due to uncertainty about their content and resulting concerns about safety, quality, and effectiveness. If an incretin medication is unavailable (e.g., in shortage), switching to a different FDA-approved medication is recommended as clinically appropriate to achieve and maintain individualized glucose-lowering, weight management, and/or cardiovascular and kidney risk reduction goals. Upon resolution of incretin product unavailability, reassess the appropriateness of resuming the original FDA-approved incretin medication.

In line with ADA guidance against the use of compounded incretin mimetic agents, several strategies can be considered in response to shortages or other barriers to GLP-1 and dual GIP/GLP-1 receptor agonist access. Such strategies may include within-class interchange (e.g., switching from an unavailable GLP-1 receptor agonist to an alternative GLP-1 receptor agonist); use of alternative glucose-lowering, weight loss, or cardiorenal protective therapies; or use of alternative dosing strategies when a specific GLP-1 or dual GIP/GLP-1 receptor agonist dose is temporarily unavailable (11).

Legislative Updates

The cost burden of AOMs is particularly steep for individuals with Medicare prescription drug plans compared with those who have commercial insurance, for three reasons. First, Medicare part D plans have historically excluded AOMs from their formularies. This exclusion was due to early-generation AOMs having limited efficacy, concerns with safety, perception of cosmetic use, and lack of data indicating improved outcomes for other chronic diseases (25). Additionally, coverage for GLP-1 and dual GIP/GLP-1 receptor agonists has the potential to significantly increase spending (26), although this concern does not account for potential savings from the improved health outcomes (and therefore health savings) associated with substantial weight loss (25,27). Second, individuals with government-funded prescription drug plans are excluded from using manufacturer copayment savings cards available to commercially insured beneficiaries for most brand-name medications. Third, Medicare prescription drug coverage is subject to coverage gaps, commonly referred to as the donut hole, which subject individuals to high copayments when plan coverage thresholds are met.

In March 2024, the Centers for Medicare & Medicaid Services (CMS) issued guidance for Medicare part D coverage inclusion of AOMs with an additional medically accepted FDA indication (28). At the time of writing, semaglutide (Wegovy) (29) has an FDA indication to reduce the risk of major cardiovascular events in adults with established cardiovascular disease (CVD) and obesity or who are overweight, and tirzepatide (Zepbound) (30) has an indication for treatment of moderate-to-severe OSA for patients with obesity.

What constitutes a disorder of the cardiovascular system for insurance coverage purposes is unclear, may differ by insurer, and is likely to require documentation as part of prior authorization. Insurers may use inclusion criteria from the SELECT trial, which found a reduction in death from cardiovascular causes, nonfatal myocardial infarction (MI), or nonfatal stroke in participants with obesity or overweight and preexisting CVD (MI, stroke, or symptomatic peripheral artery disease) (31). Insurance requirements for coverage of tirzepatide for OSA may be based on inclusion criteria from the SURMOUNT-OSA trials (≥15 apnea-hypopnea index events per hour) (32). This change in CMS guidance may encourage other AOM manufacturers to seek similar additional indications.

Medicaid coverage of AOMs is determined on the state level, and in 2024, 11 states provided coverage, including California, Delaware, Kansas, Massachusetts, Michigan, Minnesota, Mississippi, New Hampshire, Pennsylvania, Rhode Island, and Virginia. Prior authorizations are generally required for coverage and follow FDA-approved indication criteria. The preferred AOMs on these formularies differ but have evolved to now include at least one of the more effective, once-weekly GLP-1 or dual GIP/GLP-1 receptor agonists on formulary.

Resources and Tools for the Primary Care Team

With the increasing demand and use of AOMs, the need for regular medication titration based on toleration and effectiveness, and the barriers to patient access that stem from both administrative and clinical challenges, the burden of obesity management on primary care teams is significant and growing. To face the challenge, primary care clinicians need an integrated interdisciplinary team with diverse skill sets tailored to patients’ needs. For clarity, common insurance terms that are discussed below are explained in Table 3 (33).

Table 3.

Definitions for Terms Pertinent to Insurance Coverage

Term	Definition
Deductible	The predetermined amount that must be paid annually before any insurance cost-sharing
Copayment	The set amount paid for a particular service (e.g., $10 for a visit to a primary care clinician or $15 per medication prescription filled)
Coinsurance	The percentage individuals pay after they meet their deductible and insurance pays their portion; only applies to prescriptions and services that are covered under their health plan
Medication tier	Levels of insurance coverage, with lower tiers having a lower patient cost-share and higher tiers having a higher patient cost-share
Out-of-pocket maximum	The annual limit for patient cost-sharing, after which the insurance plan pays 100% of covered services; deductibles, copayments, and coinsurance all apply toward the out-of-pocket maximum
Prior authorization	A request made from a prescribing clinician to a patient’s insurance company for provisional coverage of a medication or service
Quantity limit	A formulary limitation on the number of medication or service units that are covered per period of time
Step therapy	Medication(s) that must be documented as failed, insufficient, or intolerable before approval of a requested medication (e.g., a requirement to document step therapy with metformin before approval of a brand-name noninsulin diabetes medication is granted)

Reprinted with permission from ref. 33.

Overcoming Administrative Barriers

The most significant administrative burden for primary care teams treating patients with AOMs is navigating the prior authorization process. Because the most effective AOMs are expensive brand-name medicines, insurers either exclude them from their prescription formulary entirely or require prior authorization to ensure that patients have an appropriate indication (with differences in how insurers define “appropriate”) and/or have first tried and failed with less expensive options, even if those other options are not recommended by clinical practice guidelines as appropriate first-line therapies. The prior authorization process can be time-consuming and includes submitting a formal request for insurance coverage, typically electronically or by fax, along with clinical documentation that supports the use. Turnaround times on prior authorization decisions vary but can take several days.

The first steps to navigating prior authorizations are determining whether patients have an appropriate indication for an AOM and, if so, which indications are included on their prescription plan formulary. This process is important to prevent unnecessary work submitting prior authorizations that are unlikely to be approved, wasting resources, and delaying care. Generally, if private or public insurers in the U.S. include AOMs on their formularies, they follow FDA-approved indications for prior authorization criteria. A common error in practice is prescribing a GLP-1 or GIP/GLP-1 receptor agonist specifically indicated for type 2 diabetes (i.e., Ozempic or Mounjaro, rather than Wegovy or Zepbound, respectively) for a patient without type 2 diabetes, which is unlikely to be approved.

Not all comorbidities with scientific evidence of benefit from GLP-1 or GIP/GLP-1 receptor agonist use may be considered appropriate indications by insurers; indications include reducing the risk of major cardiovascular events in adults with established CVD and either obesity (BMI ≥30 kg/m²) or overweight (BMI 25–30 kg/m²) with a weight-related comorbidity. A weight-related comorbidity may be narrowly defined as history of hypertension, hyperlipidemia, or diabetes, but these vary by specific health plan. Many electronic health record (EHR) systems have accurate real-time formulary information available at the time of prescribing, provided patients, insurance information is up-to-date in the system. For practices without this resource, the smart device application Fingertip Drug Coverage (Clarivate Analytics) can provide free access to private and public formularies conveniently organized by state.

Once an FDA-indicated treatment option is selected and formulary status has been determined, the next steps include submitting a prior authorization, issuing a prescription, and arranging follow-up to determine the efficacy of the medication and indication for continued use. Prior authorizations should be submitted with specific documentation verifying the FDA-approved indication, including recent BMI, all present weight-related comorbidities if overweight (although this can be helpful to support coverage even in the setting of obesity), previously tried and failed or contraindicated alternative therapies, adherence to a reduced-calorie eating pattern, and increased physical activity. Figure 1 is a sample documentation template that may be useful for practices. A centralized prior authorization team that is well-versed in the submission process and can offload this work from the primary care team is ideal.

Figure 1.

Sample language for a clinical encounter during which a GLP-1 receptor agonist or a dual GIP/GLP-1 receptor agonist is prescribed that can meet common prior authorization requirements. This template (particularly the sections shown in blue) must be modified to reflect the health conditions and circumstances of the specific patient. Prescribers should review prior authorization requirements of their patients’ health insurance plans to ensure that all necessary information is included, as health plan requirements often differ. Text between @ symbols indicate opportunities for automated data pulling, if available within the institution’s EHR system.

Prescriptions for AOMs, particularly for GLP-1 or dual GIP/GLP-1 receptor agonists, should include the indicated diagnosis codes to prevent delays in prescription processing at the pharmacy. If an AOM requires regular titration to efficacious doses, sending multiple prescriptions for subsequent dosage steps can help streamline future fills.

Guidelines recommend assessing for a 5% loss of initial body weight after 3 months to warrant continued use, and insurers may require re-authorization after this time period (34). If re-authorization is required, this will be indicated on the initial prior authorization approval letter. Scheduling a weight check up front by 3 months after initiation of the medication can help ensure that this step is not missed and prevent lapses in coverage. It is also important to know whether patients’ insurance plans require them to escalate to specific doses on a specific schedule; if patients require deviation from such a schedule, it can be helpful to clearly document the reasons (and proactively submit them with the prior authorization) to avoid denial of coverage during treatment.

Overcoming Clinical Barriers

With the expanding use of AOMs coupled with increasing patient loads and limited primary care prescribers (35), a team approach to management is crucial to navigate access issues and prevent clinical inertia. Developing EHR order sets with informatics experts can improve the accuracy of prescribing and ensure that appropriate follow-up is considered in real time.

Protocols can allow other care team members such as nurses to work to the top of their licensure and have been implemented successfully to manage hyperglycemia in diabetes and hypertension (36). Extensive evidence supports clinical pharmacist management of chronic diseases such as diabetes in primary care (37); however, more robust data are needed for the management of obesity specifically (38). Patients prescribed AOMs should also work with a registered dietitian nutritionist to establish an eating plan to assist in weight loss and dietary strategies to best tolerate AOMs with a high incidence of GI side effects.

A common practice stemming from a lack of insurance coverage or high costs for brand-name phentermine/topiramate (Qsymia) or bupropion/naltrexone (Contrave) is to prescribe the generic components of these medications off-label. However, differences in each component’s available dosages, recommended administration, and release profiles compared with the brand-name products present challenges in matching regimens to ensure similar effectiveness. Naltrexone, which is FDA-indicated for the treatment of alcohol dependence and blocking the effects of exogenously administered opioids, has been affected by recent shortages, likely as an unintended consequence of off-label prescribing for patients treated for other FDA-approved indications, necessitating compounding to increase patient access.

Resources for Patients

Health care teams can also identify and mitigate barriers that patients may face in accessing and paying for AOMs as well as healthy food and physical activity resources that are foundational for obesity management and can seek out other financial supports to offset the health care costs incurred by treating obesity and other health conditions. Social workers, community health workers, and community paramedics can engage patients and their families to screen for social determinants of health and connect them with available community and public health resources. Health plans, particularly Medicare Advantage and commercial health plans, increasingly offer weight management and coaching services for weight loss, although their efficacy in achieving weight loss has not been studied. Some Medicare Advantage and Medigap plans partially or fully reimburse the cost of a gym membership (39). Low-income patients may also qualify for transportation assistance to medical appointments, which can be important to facilitate the clinical engagement necessary to support optimal AOM monitoring. In addition, a number of resources exist to offset some of the out-of-pocket costs associated with AOMs. Clinicians and pharmacists play an important role in connecting patients to appropriate care team and community resources to address medication affordability. Following are some specific tips and key resources that may aid patients.

Manufacturer Copayment Savings Cards

Manufacturers of most brand-name medications offer copayment savings cards on their respective websites that can significantly reduce costs for eligible patients. Unfortunately, patients with government-funded insurance plans are ineligible for these savings. Care teams should encourage commercially insured patients to access savings cards at the time of prescribing so pharmacies can apply these savings at the first fill. The amount of potential savings is variable and generally available in the small print or full details on the website or savings card. For example, if the total cost of a medication is $1,200 for a 28-day supply and the patient’s coinsurance covers 75%, the copayment savings card would be applied to the patient’s remaining copayment of $300. Understanding the details of these offers is important. As another example, if the card states that it can bring the copayment as low as $25, but caps the 30-day savings at $150, the patient will actually be left with a $150 copayment. Often, there are different maximum savings for different day supplies of the medication (e.g., $150 for a 30-day supply or $450 for a 90-day supply). The amount covered by the copayment card does not apply to patients’ insurance deductibles or out-of-pocket maximums.

Mail Order Programs

Mail order programs are available for phentermine/topiramate (Qsymia) and bupropion/naltrexone (Contrave), with costs as low as $98 for a 30-day supply without billing insurance. This may be a more affordable option for patients who lack insurance coverage for these medications or who have copayments that exceed this amount. These programs use specific mail-order pharmacies where prescriptions must be sent, and patients can be connected through information available on the respective medications’ websites.

A self-pay option for lower doses of tirzepatide (Zepbound) is available through LillyDirect pharmacy (40). At the time of writing, prices are $399 and $549 for a 4-week supply of tirzepatide 2.5 mg and 5 mg, respectively. Prescriptions must be sent to the LillyDirect mail-order pharmacy and should include the FDA- approved indication diagnosis code, patient contact information, and LillyDirect pharmacy’s National Provider Identification (1689411712) and National Council for Prescription Drug Programs (3692539) numbers. Because no claim is submitted through insurance, the cost does not count toward insurance deductibles.

Patient Assistance Programs

Manufacturer-sponsored patient assistance programs supply eligible uninsured or Medicare-insured patients with brand-name medications free of charge. At the time of writing, there are no patient assistance programs available that cover AOMs. However, this may change as more AOMs receive FDA indications for improved cardiovascular outcomes or other benefits. NeedyMeds (needymeds.org) is a helpful resource to find information on patient assistance programs that offers eligibility information and links to application forms (41). As with prior authorizations, the patient assistance program process can be extremely burdensome to both patients and care teams, and a centralized team familiar with the process and form requirements should be used when possible.

Medicare Prescription Medication Plans

With the recent CMS recommendation for Medicare part D coverage of AOMs with an additional medically accepted FDA indication, more high-cost AOMs may become affordable for Medicare beneficiaries. However, even if Medicare insurance plans cover a significant portion of the copay for AOMs, the high list price of these medications may still render copayments unaffordable because Medicare patients are ineligible for manufacturer copayment cards to offset the costs of the remaining out-of-pocket balance. Medicare part D improvements from the Inflation Reduction Act may make prescription medications more affordable starting in 2025 by allowing (and requiring) price negotiations for medications with highest total part B and part D spending, capping out-of-pocket spending by Medicare part D beneficiaries, and expanding the part D low-income subsidy (42,43). The annual out-of-pocket cost for medications for part D beneficiaries will be capped at $2,000 in 2025, whereas the estimated maximum out- of-pocket cost in 2024 was between $3,300 and $3,800 for most beneficiaries reaching the catastrophic coverage phase (44). Also new in 2025, any part D beneficiary can enroll in a Medicare prescription payment plan, which spreads medication expenses into monthly payments throughout the year. This option may be preferrable for patients on expensive brand-name medications with high upfront costs. To enroll, patients must contact their insurer, and a fact sheet is available with additional important information (45). Qualifying patients can save through the low-income subsidy and extra help program, with application information available on the Social Security Administration website (46). Patients who have reached their out-of-pocket limits should be encouraged to work with their pharmacies to refill expensive medications with as large a supply as clinically appropriate before the new year, when thresholds reset.

Access to Medicaid

Individual state Medicaid programs vary widely with regard to eligibility, with additional information, including contacts and application instructions, on the Medicaid.gov website (47). Social workers and community health workers can guide patients through this process and connect them with relevant public health resources.

Conclusion

With the growing prevalence of obesity and the development of life-changing but expensive medications, it is crucial to arm clinicians, care teams, and patients with tools to help navigate the increasingly complex health care system. Simply sending a prescription is rarely adequate to ensure access and affordability, and a proactive and cost-centric approach is key to increasing the likelihood of success. Taking appropriate upfront steps can save downstream work resulting from insurance denials and patients declining high copayments at the pharmacy.

Funding Statement

This effort was funded by the National Institutes of Health (NIH) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant R01DK135515 (to R.G.M.). The contents of this article are the sole responsibility of the authors and do not necessarily represent the official views of the NIH. R.G.M. is an investigator at the University of Maryland Institute for Health Computing, which is supported by funding from Montgomery County, MD, and the University of Maryland Strategic Partnership: MPowering the State, a formal collaboration between the University of Maryland, College Park, and the University of Maryland, Baltimore.