The Global Obesity Market Access Landscape: How Evidence and Policy Are Redefining Reimbursement

Obesity is one of the fastest evolving commercial opportunities in the pharmaceutical industry – yet access, pricing, and reimbursement remain major barriers for manufacturers and patients. In this article, Louise Maddison (Senior Consultant – Global Pricing and Market Access, Petauri Evidence) explains how shifting disease recognition, payer expectations, and real-world evidence are reshaping the landscape, and what manufacturers must do to secure sustainable access and long-term value, globally.

Soaring Obesity Rates and Costs

Obesity rates have increased dramatically over the last 30 years, with estimates of more than 1 billion people now living with obesity – or 1 in 8 people globally, making it a significant public health threat. From 1990 to 2022, global obesity rates more than quadrupled in children, nearly tripled in men, and more than doubled among women (1).

High prevalence of obesity has a significant impact on healthcare systems, with associated complications driving expenditure in every category of care. It is expected that half of the world’s adult population will be living with a high body mass index (BMI) by 2035 and that the global economic impact will reach US$4.32 trillion annually. This is roughly equivalent to the entire annual Gross Domestic Product (GDP) of Germany (2).

In adults, a BMI ≥30 kg/m² is defined as clinically obese (3). Obesity is associated with increased risk of various metabolic, cardiovascular, and skeletal comorbidities, as well as cancer and psychosocial health (4,5).

Medical weight management is one treatment option. Recent drug advances have led to modern obesity therapies that are highly effective, revolutionizing treatment alongside lifestyle changes in diet and exercise. These new therapies also offer options for those who are not candidates for bariatric surgery, which remains the ‘gold standard’ for weight loss.

Recognition of Obesity as a Disease

When obesity is recognized as a disease, not only is the social stigma reduced, but healthcare systems can establish frameworks for their activities and pathways for treatment.

Recognition of the disease brings it to the attention of policymakers and the public, and enables education programs for healthcare professionals to receive time and budget. It also facilitates creation of reimbursement and access routes for Pharmaceutical and Medtech interventions.

Several medical and healthcare organizations such as the World Health Organization, American Medical Association, and US Centers for Disease Control and Prevention now consider obesity to be a chronic disease.

In some countries, however, there is debate over its classification. In the UK, obesity is not formally classed as a disease for several reasons including that the evidence base is considered too weak (e.g., no symptoms are unique to obesity), there is a lack of agreed diagnostic criteria, and there are limitations to using BMI as a diagnostic tool (6,7).

Evaluating the Cost and Value of Anti-Obesity Medications

Anti-obesity medications (AOMs) are now an acceptable part of the treatment landscape. Prior to these medications being made available, there were very few effective and durable interventions to reduce body weight and target the increased cardiovascular risk of obesity.

Despite the clinical benefits for those with obesity and the broader benefits to the healthcare ecosystem and wider economy, coverage and reimbursement of AOMs have historically been limited and remain challenging. With an ever-growing eligible population for long-term use of these innovative medicines, the potential high costs to payers and healthcare systems are difficult to bear.

Indeed, Bernard Sanders, in his role as the Chair of the US Senate Committee on Health, Education, Labor and Pensions (HELP), released a report that modeled the impact of AOM prescriptions. This model demonstrated that AOM spending could bankrupt the US healthcare system, with estimates of more than US$411 billion per year if uptake was at 50% of adults with obesity (8).

Similarly, Canada’s Drug Agency (CDA-AMC) estimated that, based on public list prices, the budget impact for one AOM in a narrower indication of obesity with pre-existing cardiovascular disease could exceed CA$3.5 billion over 3 years (9).

However, if AOMs are viewed through the wider lens of macroeconomics with benefits to the healthcare system, population health, and economy, there are substantial gains for payers to realize.

Economic modeling undertaken by the Tony Blair Institute in the UK suggests that faster and broader access to AOMs could deliver cost-benefit neutrality by 2035, with net gains in following years, leading to a cumulative saving of £52 billion by 2050 (10).

Reimbursement for Anti-Obesity Medications across Global Markets

Despite the evidence base for these therapies, there are a variety of reasons for the lack of reimbursement for AOMs in different markets; however, pressure is mounting on policymakers to expand access.

Reimbursement of Anti-Obesity Medications in Europe

In Germany, AOMs are excluded from the statutory health insurance system as they are viewed as ‘lifestyle drugs’. Italy and Spain take a similar stance. Paradoxically, these countries do recognize obesity as a medical condition, yet there is little in the way of policy to support treatment of the disease, and payers may eventually shift their thinking towards reimbursement of AOMs (11-13).

In France, the Haute Autorité de Santé (HAS) has issued favorable opinions on the reimbursement of glucagon-like peptide-1s (GLP-1s) in obesity, but under strict criteria:

• Only as an adjunct to diet and physical activity for weight management
• In adults with a BMI ≥35 kg/m²
• In cases where well-conducted nutritional management has failed

Since June 2025, however, access to AOMs has broadened. French general practitioners (GPs) are now able to prescribe these medications, rather than just hospital specialists (14).

The Netherlands is taking a cautious, evidence-first approach to access. Zorginstituut Nederland (ZIN) has begun a new assessment of GLP-1s for obesity to determine if they should be included in the basic health insurance package (15). Previously, these drugs were excluded based on lack of long-term data on health benefits. ZIN will focus on two patient populations: those with BMI >30kg/m²  and related health conditions (e.g., heart failure, chronic kidney disease), and those with severe obesity, i.e., BMI >35 kg/m².

The approach by HAS and ZIN demonstrates that health technology assessment (HTA) bodies may consider different target populations (e.g., higher BMI, greater number of comorbidities) than the European Medicines Agency label, targeting patients with the highest unmet need, but further restricting access.

Reimbursement of Anti-Obesity Medications in the US and Canada

In the US, Medicare was prohibited from offering coverage for AOMs by law due to older AOMs having extremely poor safety profiles. However, from mid-2026, injectable GLP-1s will be covered for non-obesity indications as part of Most-Favored-Nation (MFN) policy (16,17). Additionally, coverage was extended for new oral GLP-1s for obesity, prior to approval by the US Food and Drug Administration (FDA).

Unfortunately for patients, many US health insurers are dropping AOMs from coverage due to cost challenges (18). Recently announced cost-cutting strategies from US insurers have included the requirement to complete a 6-month behavioral modification program before accessing AOMs, and narrowing coverage using a high BMI (>40 kg/m²). As an alternative strategy, some insurers are exploring the use of outcomes-based agreements.

When Canada’s CDA-AMC recently revisited the assessment for an AOM, new clinical information based on a cardiovascular outcomes trial provided enough evidence for them to recommend reimbursement. However, uncertainty remained over long-term patient benefits (9).

Across markets, people with obesity are tired of waiting for AOMs to be reimbursed, and are eager to pay out of pocket (OOP). AOMs are becoming the driving force for changing how treatments are accessed via the emerging frontiers of the private self-pay market and direct-to-patient platforms. The downside is the risk of greater healthcare inequity since, for many people, paying privately for AOMs is not an option.

Strict Access Criteria on Coverage of Anti-Obesity Medications

If payers do cover the use of these drugs, then there are often restrictions to access. These can include:

• Quantity limits – either by duration of usage or dosage
• Prior authorization requirements
• Covering medications following ‘step-through’ of other treatments
• High co-payments from patients
• Eligibility only in patients with obesity and comorbidities (19)

Further evidence demonstrating long-term effectiveness and safety could be required before greater coverage and reimbursement is allowed; however, innovation needs to be balanced with affordability.

Overcoming Global Shortages of Anti-Obesity Medications

Global shortages of AOMs, seen through 2024 and the start of 2025, have now mostly been resolved as industry has worked to increase their manufacturing capacity to meet the demand.

Despite supply chain gaps being closed, regulators in Europe and the US recently warned against the ‘sharp rise’ in counterfeit versions of branded AOMs. As reported in the British Medical Journal (BMJ), one of the factors driving UK patients to seek medication through the black market is the recent price hikes in the direct-to-consumer market (20). UK private direct-to-consumer prices have risen to close the huge gap in AOM prices, which previously varied by more than tenfold, between the US and Europe (8).

Ongoing Price Challenges for Anti-Obesity Medications

Pricing is likely to remain challenging globally. Whilst some may look to the US administration’s MFN approach to reduce prices, this may not achieve its intended objectives. The Trump administration aim to compel manufacturers to align US prices with those in other markets across a wide range of medications. Instead, we may find ex-US prices for new products converge upward toward the higher US price benchmark.

Therefore, it will be interesting to see if US health insurance plans consider innovative contracting solutions such as outcomes-based agreements to link coverage and reimbursement to real-world evidence. Such agreements are often used in Europe, but high prices coupled with significant demand for AOMs could drive a shift in strategies for access in the US.

The Future Landscape of Anti-Obesity Medications

As part of the next generation of AOMs, the first oral GLP-1 was launched in January 2026. Over the next few years, a variety of new AOMs will launch featuring different and multiple mechanisms of action (e.g., triple agonist), available as monotherapies and combination therapies, and offering the convenience of oral administration instead of injections (21).

However, within a crowded market, drug efficacy alone will not be enough to convince payers to provide access and reimbursement. Payers will increasingly rely on real-world outcomes to demonstrate value, especially within financially constrained healthcare systems that are facing chronic pharmacotherapy at population scale.

With the potential for patients to choose from a diverse therapeutic landscape, treatment will become more tailored to their needs. Further personalization combined with data-driven approaches may enable manufacturers and healthcare systems to overcome some of the current challenges with AOMs, including variability in responses, side effects, and long-term adherence. Incorporating digital support, data analysis, and behavioral interaction into the patient journey will be critical to generate evidence to demonstrate value to payers beyond efficacy.

Additionally, evidence demonstrates that patients who stop taking AOMs return to their original weight and lose cardiovascular benefits within 2 years (22). Therefore, healthcare systems need to consider the impact of a wave of patients coming off AOMs, and how weight loss and health advantages can be sustained after discontinuation.

AOMs, especially incretin-based therapies, are increasingly being explored for indications beyond type 2 diabetes and weight management, including:

• Kidney disease
• Cardiovascular disease
• Metabolic dysfunction-associated steatohepatitis (MASH)
• Arthritis
• Alzheimer’s disease

These expanding indications demonstrate the importance of such medications in managing comorbidities and the future positioning of AOMs (23,24).

Future Access Challenges and Opportunities For Anti-Obesity Medications

Access to innovative AOMs will likely remain challenging due to high prices and demand from the eligible patient population. Furthermore, as more AOM treatment options are launched, it is expected that increased competition will reduce prices. As older medicines lose patent protection, further downward pressure could be exerted on prices making these medicines more affordable.

However, payers will continue to manage spending via stringent step edits, narrow indication-based coverage, and value-based contracting. Wider consideration should be given to the valuable positive societal impact of reducing healthcare costs and increasing workforce productivity from obesity and associated comorbidities.

Manufacturers will need to start their launch planning early, shifting their thinking beyond traditional playbooks that consider the drug alone. Integrated care models, data-driven outcomes, and patient-centric journeys will be key to demonstrating and sustaining long-term value.

To explore how to optimize your launch success with our experts, email evidence@petauri.com.

 

 

References

1. Phelps NH, et al. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults. The Lancet. 2024; 403(10431):1027-50.
2. World Obesity Federation. World Obesity Atlas 2023. Available from: https://data.worldobesity.org/publications/WOF-Obesity-Atlas-V5.pdf. Accessed on: 13 February 2026.
3. World Health Organization. Obesity and Overweight fact sheet. 2025. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed on: 13 February 2026.
4. GBD 2015 Obesity Collaborators. Health Effects of Overweight and Obesity in 195 Countries over 25 Years. N Engl J Med. 2017;377(1):13-27.
5. Dandgey S, Pattern E. Psychological considerations for the holistic management of obesity. Clin Med (Lond). 2023;23(4):318-22.
6. Luli M, et al. The implications of defining obesity as a disease: a report from the Association for the Study of Obesity 2021 annual conference. EClinicalMedicine. 2023;58:101962.
7. Health Innovation Network South London. Reclassifying obesity in the UK: the importance of language around weight management. 2025. Available from: https://healthinnovationnetwork.com/insight/reclassifying-obesity-in-the-uk/. Accessed on: 6 February 2026.
8. Sanders B. United States Senate HEALTH, EDUCATION, LABOR, AND PENSIONS COMMITTEE; Breaking point: How Weight Loss Drugs Could Bankrupt American Health Care. 2024. Available from: https://www.sanders.senate.gov/wp-content/uploads/Wegovy-report-FINAL.pdf. Accessed on: 3 February 2026.
9. CDA-AMC; Canadian Journal of Health Technologies. Reimbursement Recommendation: Semaglutide (Wegovy). 2025. Available from: https://www.cda-amc.ca/sites/default/files/DRR/2025/SR0841-Wegovy_FINAL_Rec.pdf. Accessed on: 30 January 2026.
10. Tony Blair Institute for Global Change; Refsum C, et al. Anti-Obesity Medications: Faster, Broader Access Can Drive Health and Wealth in the UK. 2025. Available from: https://institute.global/insights/public-services/anti-obesity-medications-faster-broader-access-can-drive-health-and-wealth-in-the-uk. Accessed on: 16 February 2026.
11. German Parliament Recognises Obesity as a Disease. 2020. Available from: https://easo.org/german-parliament-recognises-obesity-as-a-disease/. Accessed on: 19 January 2026.
12. OPEN Italy. Obesity in Italy. 2026. Available from: https://obesityopen.org/open-italy/. Accessed on: 19 January 2026.
13. OPEN Spain. Obesity in Spain. 2026. Available from: https://obesityopen.org/open-spain/. Accessed on: 19 January 2026.
14. GLP-1 analogues indicated in the treatment of obesity: the ANSM changes their prescription and dispensing conditions. 2025. Available from: https://ansm.sante.fr/actualites/analogues-du-glp-1-indiques-dans-le-traitement-de-lobesite-lansm-fait-evoluer-leurs-conditions-de-prescription-et-de-delivrance. Accessed on: 19 January 2026.
15. Healthcare Institute: Obesity drugs first available for people with the highest disease burden. 2025. Available from: https://www.zorginstituutnederland.nl/actueel/nieuws/2025/11/06/zorginstituut-obesitasmedicijnen-eerst-beschikbaar-voor-mensen-met-hoogste-ziektelast. Accessed on: 19 January 2026.
16. Sullivan SD. Drug Pricing in Theory and in Practice: Value in Health Showcase. Presented at: ISPOR Europe Conference; 9-12 November; Glasgow, UK; 2025.
17. The White House. Fact Sheet. President Donald J. Trump Announces Major Developments in Bringing Most-Favored-Nation Pricing to American Patients. Available from: https://www.whitehouse.gov/fact-sheets/2025/11/fact-sheet-president-donald-j-trump-announces-major-developments-in-bringing-most-favored-nation-pricing-to-american-patients. Accessed on: 19 January 2026.
18. As Insurers Drop GLP-1 Coverage, Advocates Search for a Hero in Obesity. 2025. Available from: https://medcitynews.com/2025/10/insurers-glp1-coverage-cost/. Accessed on: 30 January 2026.
19. Peterson-KFF; Lo J, Cox C. Insurer strategies to control costs associated with weight loss drugs. 2024. Available from: https://www.healthsystemtracker.org/brief/insurer-strategies-to-control-costs-associated-with-weight-loss-drugs/#Share%20of%20ACA%20Marketplace%20plans%20including%20GLP-1%20agonists%20in%20formularies. Accessed on: 9 February 2026.
20. Mahase E. Weight loss jabs: Patients are using black market to obtain drugs still in clinical trials, experts warn. BMJ. 2025;390:r1917.
21. Melson E, et al. What is the pipeline for future medications for obesity? Int J Obes. 2025;49;433-51.
22. Spreckley M, et al. Nutrition Strategies for Next-Generation Incretin Therapies: A Systematic Scoping Review of the Current Evidence. Obes Rev. 2026;e70079.
23. Imperial College London. Two clinical trials have recently delivered contrasting results on GLP-1 drugs for Alzheimer’s disease. 2026. Available from: https://www.imperial.ac.uk/news/articles/medicine/brain-sciences/2026/weight-loss-drugs-and-alzheimers-disease–is-there-hope-for-future-/. Accessed on: 4 February 2026.
24. gov. Results from search input for GLP-1. 2025. Available from: https://clinicaltrials.gov/search?term=GLP-1&page=1. Accessed on: 13 February 2026.