As evidence grows supporting the potential health benefits of obesity drugs like Novo Nordisk’s Wegovy and Eli Lilly & Co.’s Zepbound, so too— frustratingly — do the barriers to accessing them.

The latest obstacle is a deal between Novo Nordisk and CVS Caremark, the pharmacy benefit manager (PBM) for many of the nation’s employers. Under the agreement, Wegovy is now the preferred treatment, while Zepbound is no longer covered for most people.

The change, which took effect in July, affects potentially tens of thousands of privately insured Americans. As one of the country’s three largest PBMs, Caremark manages prescription drug access for approximately 103 million people.

Caremark’s decision means patients who had been successfully using Zepbound face a difficult choice: switch to Wegovy (which some had previously tried), navigate potentially weeks-long appeals to persuade their insurer to continue covering the Lilly drug with no guarantee of success, or pay out of pocket for Zepbound, which costs around $500 per month through Lilly’s direct-to-consumer platform.

And more barriers are coming. Numerous surveys indicate that most employers are either considering or already implementing restrictions that will make it even harder for employees to access these drugs in 2026.

The imperfect choices these patients face are a heightened version of what many providers navigate daily in the US health care system, where critical decisions are too often made not by doctors in consultation with their patients, but behind closed doors between drug manufacturers and the middlemen who negotiate prices on behalf of employers.

That’s frustrating for everyone — and in the case of obesity drugs, it’s forcing doctors and patients to spend excessive time and resources navigating coverage, instead of focusing on improving patients’ health.

“Obesity is a complex disease,” says Shauna Levy, medical director of the Tulane School of Medicine’s Bariatric and Weight Loss Center. “The fact is that not everyone responds to the same treatments, and to limit it to just one option is a disservice to patients.”

Levy, like other obesity medicine specialists I spoke with, said Caremark’s decision reflects what she sees as the company’s prioritization of profits over consumers. “To me, it screams ‘money.’ It doesn’t scream ‘care,’” she says.

It’s true — cost is a significant obstacle to making GLP-1 medications widely available.

With a sticker price exceeding $1,000 a month and a large portion of the US population eligible for them — KFF estimates that about 42% of privately-insured Americans qualify — the drugs are straining health care budgets.

A recent survey of employers by the Business Group on Health found that 79% are seeing an increase in GLP-1 use, which is driving up overall health care costs. Caremark has said that switching from Zepbound to Wegovy as the preferred treatment could save employers between 10% and 15% on obesity drug spending.

It’s also true that both Wegovy and Zepbound are effective drugs. Both mimic a naturally occurring hormone that regulates blood sugar and satiety. Zepbound also targets a second hormone.

Both medications help patients lose significantly more weight than older treatments. However, in a head-to-head study, Zepbound led to greater weight loss — and, crucially, a greater reduction in belly fat — a key factor in heart disease.

These drugs also offer a range of additional health benefits. Wegovy, for example, has been shown to lower the risk of heart attacks and strokes and was recently approved to treat an increasingly common form of liver disease. Zepbound, meanwhile, is approved for the treatment of sleep apnea.

However, doctors stress that there’s no one-size-fits-all approach to care — no matter what Caremark’s policy may dictate.

Obesity specialists are, by now, used to navigating the ever-shifting landscape for GLP-1 medications. Initially, supply dictated access — many times forcing patients to take whichever drug they could get. Now insurers are continuously reassessing coverage and often adding restrictions. Meanwhile, new clinical data showing benefits beyond weight loss have expanded the number of eligible patients.

All of this has trained specialists to maneuver through a complex system, ensuring their patients can access treatment. Larger obesity medicine practices — some of which tell me that they have thousands of patients affected — have dedicated staff to help manage the chaos. That has meant fielding hundreds of anxious calls and emails from patients, scheduling consultations to explain options, transitioning patients to the appropriate dose of Wegovy, or navigating the appeals process to maintain access to Zepbound for those who genuinely need it.

Their tenacity is appreciated. But the fact that so much time and energy must be spent getting medications covered — rather than caring for patients — is absurd. And while major obesity centers might be equipped to manage the insurance upheaval, primary care providers, already stretched thin, often don’t have the time or resources.

Even before the Caremark decision, some insurance companies that had finally opened up access to GLP-1s had begun pulling back — primarily by adding new layers of red tape. Their tactics include requiring patients first to try older, less effective medications, or to prove they’ve attempted to lose weight through diet and exercise.

What was once as simple as a doctor checking a box has become more burdensome. Some insurers are requiring patients to sign up for an app that tracks daily behavior — prompting them to step on a scale and log their meals and exercise, says Beverly Tchang, associate professor of clinical medicine at Weill Cornell Medicine in New York. Support for making lifestyle changes can be helpful, said Tchang, but her patients — at least half of whom are affected by the Caremark change — find the level of scrutiny invasive.

And some insurers that previously approved GLP-1 treatment for anyone classified as obese based on their body mass index now restrict access to those whose BMI puts them in the highest category: “class 3 obesity.” Others, meanwhile, are removing coverage altogether or limiting how long they will pay for the drugs in hopes that people can maintain their weight loss without the cost burden.

The never-ending tug of war over access is, in the end, demoralizing for patients, many of whom have spent years trying different diets and lifestyle changes with little success — until GLP-1s offered results.

Many hope that things will improve once Medicare can negotiate prices and more competitors enter the market — especially pills and longer-acting treatments — which could drive down costs and expand access.

Let’s hope so. But a better solution would be for drug companies to make their products more affordable for both patients and employers.

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This column reflects the personal views of the author and does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.

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