Weight Loss Drugs Listed By Health Insurers Aren’t Necessarily Covered

InnovationHealthcareWeight Loss Drugs Listed By Health Insurers Aren’t Necessarily CoveredByJoshua P. Cohen,Senior Contributor.Forbes contributors publish independent expert analyses and insights. Joshua Cohen is a Boston-based writer who covers health policy.Follow AuthorJun 01, 2026, 09:24am EDT--:-- / --:--This voice experience is generated by AI. Learn more.This voice experience is generated by AI. Learn more.Eli Lilly's Foundayo weight loss oral pill competes against Novo Nordisk's oral Wegovy. (Photo by: Michael Siluk/UCG/Universal Images Group via Getty Images)UCG/Universal Images Group via Getty ImagesThe drug maker Eli Lilly announced last week that both of its obesity medicines will soon be on the formularies of all three of the nation’s largest pharmacy benefit managers, OptumRx, Express Scripts and CVS Caremark. As the drug manufacturer noted, this is a meaningful step forward towards expanding access for millions of Americans. But having a product listed on formulary or coverable doesn’t necessarily mean it’s covered.PBMs work at the behest of plan sponsors (employers, health plans and government entities). This applies in the commercial sector, but also the public programs Medicaid and Medicare. Subject to regulatory rules and laws that differ in the public and private sectors, PBMs carry out what plan sponsors direct them to do in terms of the products to actually cover for enrollees.Employer-sponsored health plans and Medicaid in particular are not expanding access to weight loss drugs. In fact, quite a few payers have pulled back coverage this year. We don’t know yet how 2027 will shape up, though PBMs, employers, health plans and government entities are currently planning ahead for next year. It could be that lower net prices for branded obesity medicines cause more plans to cover the products.But the fact that a federal government program designed to expand access to weight loss treatments has been put on hold should give pause. The Bett...