OBJECTIVES: Currently, 42% of adults in the United States (US) are living with obesity. In 2016, nationwide medical spending for obesity and related comorbidities was $261 billion. Effective anti-obesity medications (AOM; e.g., Wegovy^®) for long-term use are emerging that may lead to cost savings. The aim of this review was to summarize AOM coverage policies and utilization rates in the US.

METHODS: State Medicaid and commercial plan formularies were reviewed in May 2023 to identify coverage of AOM. Utilization rates were identified by a targeted review of grey and published literature presented before June 2023.

RESULTS: There was substantial variability in state-level coverage. Fifteen states had AOM listed on Medicaid formularies (9 of which included Wegovy^®), and 35 states had commercial coverage for AOM (15 of which included Wegovy^®). Most AOMs were listed as tier 3 or 4 with multiple restrictive criteria applied.

Seven published studies and two grey literature sources characterizing utilization rates were identified. In the US, utilization of AOM is low (≤1%). Authors suggested reasons for low utilization rates, including high out of pocket costs; stigmatization surrounding obesity; user unawareness of, or vague language in plan documents that do not clearly indicate, coverage; and prohibitive limitations. In one study of 11 million adults, AOM use (between 2010–2019) was more common among women, individuals ≤ 50 years of age, individuals of Black or non-Hispanic race/ethnicity, and those with commercial insurance. While Wegovy^® utilization rates, specifically, were not identified, one study characterized Semaglutide utilization rates among individuals with obesity but without type 2 diabetes mellitus.

CONCLUSIONS: Despite the availability of effective pharmacotherapy for weight loss, insurance coverage is sparse. An analysis of current utilization rates with the approval of Wegovy^® is warranted, and strategies to increase the uptake of AOM – ensuring equitable access – are recommended.