Recent studies have raised critical concerns about the affordability and cost-effectiveness of weight-loss drugs like Zepbound (tirzepatide) and Wegovy (semaglutide), despite their proven health benefits. According to a study published on March 14, 2025, in the JAMA Health Forum, these medications, which show promise in addressing obesity-related complications such as heart disease and diabetes, are economically inefficient when considering their high costs.
High Costs Outstrip Health Benefits
The study evaluated the long-term effects of four anti-obesity medications: tirzepatide, semaglutide, naltrexone-bupropion, and phentermine-topiramate. The results revealed that while these drugs could potentially reduce obesity-related health risks, their costs—$12,648 yearly for tirzepatide and $13,618 for semaglutide—far exceed the standard cost-effectiveness threshold of $100,000 to $150,000 per quality-adjusted life-year (QALY), a key metric used to assess whether treatments are financially justifiable.
The authors concluded that substantial price reductions are essential to make these medications viable options for widespread use. Specifically, tirzepatide’s price would need to be reduced by 30.5%, while semaglutide would require an 81.9% price cut. The research highlighted that without these reductions, the drugs will remain inaccessible to many patients, particularly those from low-income backgrounds or racial and ethnic minorities, further exacerbating health disparities.
The Role of CMS and Manufacturer Pricing Efforts
This research coincides with efforts from the Centers for Medicare & Medicaid Services (CMS) to address high drug costs. Earlier in 2025, CMS announced plans to negotiate the prices of 15 drugs, including Ozempic and Wegovy, with the aim of lowering Medicare prices by 2027. Additionally, drug manufacturers like Novo Nordisk and Eli Lilly have introduced direct-to-consumer pricing options, offering reduced prices for patients who pay out-of-pocket.
Despite these efforts, however, the high prices of GLP-1 medications continue to raise concerns about their affordability and access. The cost of tirzepatide and semaglutide, combined with inadequate insurance coverage, has led to fears that these medications will remain out of reach for a significant portion of the population, including those with the greatest need for obesity-related treatments.
Comparative Effectiveness and Cost
Simulations from the study using data from the 2017-2020 National Health and Nutrition Examination Survey revealed that, when combined with lifestyle modifications, all four medications could yield more favorable outcomes in terms of obesity, diabetes, and cardiovascular disease rates over 60 years. However, the high costs of tirzepatide and semaglutide negate the potential healthcare cost savings and reduced productivity losses associated with improved health outcomes.
The average per-person healthcare expenditures for tirzepatide and semaglutide were estimated at $154,028 and $160,974, respectively, leading to incremental cost-effectiveness ratios (ICERs) of $197,023 and $467,676 per QALY. These values far exceed the generally accepted cost-effectiveness threshold, suggesting that the benefits of these medications do not justify their high price tags.
The Limitations of Alternatives
One of the study’s critical points was the limited development of alternatives to GLP-1 medications. Although compounded variations of GLP-1 receptor agonists exist, their safety and efficacy have yet to be rigorously evaluated. This leaves few options for patients seeking more affordable alternatives.
While some analyses suggest that semaglutide may be cost-effective compared to no treatment, others argue that both semaglutide and tirzepatide are less cost-effective than lifestyle modifications. The current pricing of these medications continues to challenge their viability as a sustainable solution to obesity and its associated diseases within the U.S. healthcare system.
A Challenge to Healthcare Access and Equity
The economic viability of weight-loss drugs like tirzepatide and semaglutide hinges not only on their high costs but also on their ability to provide long-term health benefits. A recent analysis concluded that these drugs would not be cost-effective over their projected lifetimes unless their prices were significantly reduced—by 30% for tirzepatide and 82% for semaglutide.
Moreover, trends in insurance coverage present additional challenges. Many insurers and employers are tightening coverage for high-cost medications, limiting access for patients who may benefit most. Additionally, “non-persistence,” or the high rate of patients discontinuing treatment, plagues the use of GLP-1 medications. Studies have shown that only about 25% of patients continue using Wegovy or Ozempic two years after starting treatment, with some estimates falling as low as 15%.
Conclusion
While GLP-1 medications like tirzepatide and semaglutide offer considerable health benefits, including cardiovascular advantages and obesity-related disease prevention, their high costs present significant barriers to access. As researchers call for price reductions to ensure equitable access to these treatments, the U.S. healthcare system faces a critical question: Can these medications be made sustainable, or will their price tag limit their widespread use and effectiveness?
The future of obesity treatments—and the ability to make a meaningful dent in the obesity epidemic—depends on whether these medications can become affordable and accessible for all. Until then, healthcare providers and patients will likely face an ongoing struggle between cost and benefit, with the goal of finding a balance that ensures both health and financial sustainability.
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