— Paper analyzes policy reforms and market actions to achieve affordable and equitable access for GLP-1 obesity medications; developed as part of ICER’s Policy Leadership Forum with input from diverse stakeholders —
BOSTON, April 9, 2025 – The Institute for Clinical and Economic Review (ICER), in collaboration with researchers from Brown University, has published a new white paper today that provides clear policy and market solutions to help manage affordable and equitable access to GLP-1 obesity medications. The paper, entitled, “Affordable Access to GLP-1 Obesity Medications: Strategies to Guide Market Action and Policy Solutions,” seeks to present insights and lessons learned from experts, while offering a menu of options that will help all stakeholders play an active part in an innovative future of pricing, coverage, and payment for new obesity medications.
“Obesity treatments have the potential to transform thousands of lives, but only if we ensure sustainable access for all patients,” said Sarah K. Emond, MPP, President and CEO of ICER. “It is incumbent upon the entire health care system to focus on innovative pricing, coverage, payment, and delivery solutions, with the goal of broadening access to effective obesity medications. This paper outlines the policies and market reforms available to move beyond responding to the high costs with reduced access, while meaningfully addressing the concerns around budget impact.”
The white paper highlights the tension between the scale of the opportunity for improved health with the use of new obesity medications and the magnitude of the financial implications for those paying for the costs of these interventions. ICER analyzes several market and policy options to address this tension, and the relative advantages, barriers, and potential unintended consequences of each option. The white paper also explores the pros and cons of combining strategies internally within an insurance system or externally through stand-alone weight management providers.
ICER examined several potential solutions, including enhanced evidence-based coverage criteria, formulary and provider network management, carve-out programs for obesity management services, and a reduction of costs at the federal level through aggressive drug price negotiation in the Medicare program.
The analysis relies on data and perspectives gathered from a targeted literature review and interviews with a wide range of stakeholders including pharmacy benefit managers, manufacturers, patient advocacy groups, benefit consultants, and state and Medicaid experts. The white paper went through several iterations following ICER’s Policy Summit in December 2024, where patient advocacy, employer, state, and Medicaid experts joined with ICER’s Policy Leadership Forum (PLF) to deliberate on the potential market strategies and federal policy interventions and provide suggestions for revisions to a draft version of this paper. None of the individuals involved in this meeting, nor their organizations, should be assumed to support any part of this report, which is solely the work of the ICER team and its affiliated researchers.
ICER develops annual white papers in collaboration with the ICER Policy Leadership Forum. Previous papers have addressed topics such as Managing the Challenges of Paying for Gene Therapy, Strengthening the FDA’s Accelerated Approval Pathway, Cornerstones of ‘Fair’ Drug Coverage, Reforms to Orphan Drug Development, Pricing, and Coverage, Alternative Models for Pharmaceutical Rebates, and White Bagging, Brown Bagging, and Site of Service Policies.
Public Webinar
ICER will host a public webinar at 12:00pm ET on April 22, 2025 to discuss the potential market strategies and federal policy solutions outlined in the white paper. Webinar panelists will include:
- Sarah K. Emond, MPP, President and CEO, ICER
- Maisha Draves, MD, MPH, Associate Executive Director, The Permanente Medical Group
- Kimberly Lenz, PharmD, MBA, FAMCP, Chief Pharmacy Officer, MassHealth
- Joe Nadglowski, President and CEO, Obesity Action Coalition
About ICER
The Institute for Clinical and Economic Review (ICER) is an independent, non-profit research institute that conducts evidence-based reviews of health care interventions, including prescription drugs, other treatments, and diagnostic tests. In collaboration with patients, clinical experts, and other key stakeholders, ICER analyzes the available evidence on the benefits and risks of these interventions to measure their value and suggest fair prices. ICER also regularly reports on the barriers to care for patients and recommends solutions to ensure fair access to prescription drugs. For more information about ICER, please visit www.icer.org.