Understanding Insurance Coverage Policies for Incretin Mimetics for Weight Management

ABSTRACT

Objectives: Given the wide variation in insurance coverage for incretin mimetics for weight management (IMWM) in the US, we aimed to understand (1) coverage policies for IMWM and influencing factors, (2) coverage policies for other weight management treatments, and (3) opportunities to support weight management while constraining health care costs.

Study Design: Qualitative study.

Methods: Participants were leaders and high-level employees from large health insurance organizations in the US. Our aim was to survey 20 participants, 10 from organizations that covered IMWM and 10 that excluded coverage for IMWM. Participants completed a 30-minute interview. Interviews were audio recorded, transcribed verbatim, and analyzed using directed content analysis.

Results: Twenty individuals completed an interview; 9 interviewees were from organizations that covered IMWM at the time of the study, and 11 were from organizations that excluded coverage for IMWM. We identified 5 key themes: (1) high cost as the primary barrier to coverage of IMWM, (2) perception of obesity as a lifestyle choice, (3) current or planned use of varied utilization management strategies to limit initial and ongoing prescribing of IMWM, (4) coverage for lifestyle-change programs to support weight management, and (5) perceived responsibility of pharmaceutical companies to lower list prices for IMWM to enable broad coverage and advance health equity.

Conclusions: High cost of IMWM is the primary limiting factor in coverage policies. There is variability in plan design, with utilization management strategies that aim to reduce near-term spending. Health plan leaders call on pharmaceutical companies to reduce list prices to increase equitable access to IMWM.

Am J Manag Care. 2025;31(7):In Press

Takeaway Points

• Leaders of large US health plans identified high cost as the primary barrier to coverage of incretin mimetics for weight management (IMWM).
• Health plans use varied utilization management strategies to limit initial and ongoing prescribing of IMWM. Such strategies aim to reduce near-term spending but may not support a comprehensive, equitable, or patient-centered approach to effective, longitudinal weight management treatment.
• Best-practice guidelines are needed to standardize insurance coverage policies and optimize treatment and outcomes for individuals with obesity.
• Health plan leaders call on pharmaceutical companies to reduce list prices to increase equitable access to IMWM.

Among individuals with obesity, as little as 5% weight loss can improve measures of cardiometabolic health¹ and prevent type 2 diabetes (T2D).² Greater weight loss (≥ 10%) may be needed to manage or reverse weight-related conditions including sleep apnea, metabolic dysfunction–associated steatotic liver disease, and T2D.³ Multiple evidence-based weight loss treatments, including lifestyle-change programs, antiobesity medications (AOMs), and bariatric surgery, can support clinically relevant weight loss. Yet most treatments are underused, and most patients with obesity (75%) do not achieve 5% or greater weight loss.⁴

Newer AOMs, including semaglutide (Wegovy) and tirzepatide (Zepbound), can support initial and sustained weight loss of 15% to 20%.^5-8 For clarity, these medications are referred to hereafter as incretin mimetics for weight management (IMWM) to distinguish them from the same agents used for T2D.^9,10 The weight loss effectiveness of new IMWM, coupled with direct-to-consumer marketing approaches,¹¹ has accelerated unprecedented AOM prescribing practices.^12-14 Yet there is wide variation in insurance coverage for IMWM due, in part, to high treatment costs (~$1000/month^15,16 with recommendation for lifelong use to prevent weight regain) and the vast number of individuals potentially eligible for treatment (at least 50% of the US adult population).^17,18 As of May 2024, only approximately one-third of employer-sponsored health plans covered IMWM.^19,20 Few state Medicaid plans (~30%) and almost no Affordable Care Act Marketplace plans (< 1%) cover IMWM.^21,22 And Medicare prohibits coverage of all AOMs as of January 2025,²³ although Medicare Part D now covers semaglutide for certain individuals with cardiovascular disease.²⁴

Health plans that cover IMWM are struggling to manage their high utilization and untenable costs.²² Of these, some have announced or initiated policy changes to end or limit coverage of IMWM.^25-27 Most have implemented utilization management strategies, including prior authorization criteria and step therapy (ie, initial trial of lifestyle change and/or an older AOM).^20,22,28,29 A recent survey of health plan leaders reported use of additional strategies, including targeted provider and member communication about alternative weight management treatments and use of Food Is Medicine programs.²⁸

To date, little is known about factors that influence variation in coverage policies for IMWM and potential opportunities to support weight management among eligible plan members while constraining costs. Prior survey work, lay press reporting, and economic analyses suggest high treatment cost as the primary barrier to coverage of IMWM.^19,30-32 Yet, for decades, other factors have hindered health plans’ coverage of more affordable AOMs, including perceptions of obesity as a lifestyle choice rather than a chronic condition.^20,32,33 To advance understanding about the full range of factors guiding insurance coverage policies for IMWM, we conducted qualitative interviews with leaders of large health plans in the US. The objectives of this study were to obtain an in-depth understanding of (1) coverage policies for IMWM and influencing factors, (2) coverage policies for other weight management treatments, and (3) opportunities to improve delivery of effective obesity treatment while controlling health care spending.

METHODS

Study Design

This was a qualitative study. The study was reviewed by the University of Michigan’s Institutional Review Board (IRB) and deemed exempt from IRB oversight (HUM00245319). We report our procedures and findings using the Consolidated Criteria for Reporting Qualitative Research.³⁴

Research Team

Our team includes members with expertise in clinical obesity medicine (D.H.G., L.O., A.K.), pharmacy benefit management (S.L.), health services and qualitative research (D.H.G., L.O.), and health policy (A.M.F., L.O., S.L.).

Participants and Recruitment

Participants were leaders and high-level employees from 167 of the largest US health insurance organizations. We aimed to recruit 10 leaders from health plans that cover IMWM and 10 from health plans that exclude coverage for IMWM. We worked with a custom market research firm, which specializes in surveying and interviewing senior executives, to identify, recruit, and interview participants.³⁵ Potentially eligible individuals were contacted by email, direct messaging on networking platforms, or telephone from February 12, 2024, to April 24, 2024; respondents were asked to complete a brief screening questionnaire by telephone. The screening survey was adapted from prior work²⁸ and is shown in eAppendix 1 (eAppendices available at ajmc.com). Exclusion criteria were (1) uncertainty about health plans’ IMWM coverage policies, (2) lack of involvement in discussions about IMWM coverage policies, (3) employment by a health plan with fewer than 50,000 covered lives, or (4) exclusive responsibility for a Medicare Advantage plan. Eligible individuals were invited to participate in a 30-minute interview; interviews were conducted between February 23, 2024,
and April 26, 2024.

Qualitative Data Collection

The research team developed 2 interview guides, with one tailored to health plan leaders from organizations that cover IMWM and the other tailored to health plan leaders from organizations that exclude coverage for IMWM (eAppendices 2 and 3). Both interview guides explored (1) coverage policies for IMWM, (2) coverage policies for other weight management treatments, and (3) opportunities to improve delivery of effective obesity treatment while controlling health care spending. Interview guides were iteratively refined by research team members through team meetings and mock interviews.

Semistructured interviews with participants were conducted by videoconference. Participants provided verbal informed consent prior to interview participation. Interviews were approximately 30 minutes long; participants were compensated with a $200 gift card.

Qualitative Data Analysis

All interviews were audio recorded and transcribed verbatim. Two authors (D.H.G. and E.W.C.) reviewed transcripts and drafted the initial codebook using directed content analysis, which is to say that initial codes were developed to reflect prior literature and main interview topics and were used to categorize the data; codes and their definitions were refined during data analysis, and new codes were added if text could not be categorized with existing codes.³⁶ These authors independently reviewed all transcripts, applied preliminary codes, and developed new codes and subcodes inductively. They met regularly to compare results until they established the reliability of the coding process (> 80% agreement). Thematic saturation (ie, the point at which no new information emerged from the data)^37,38 was reached after 16 interviews. Coding discrepancies were resolved by consensus. Qualitative data analysis was performed using MAXQDA 24 (VERBI Software). The study team met regularly to discuss code summaries and used a consensus approach to refine the codebook and to synthesize final themes.³⁹

RESULTS

Twenty-nine individuals completed the screening survey, and 21 (72%) completed an interview. Ten interviews were completed with individuals from organizations that cover IMWM (referred to hereafter as IMWM-covered), but 1 interview was excluded because the interviewee revealed the identity of their employer. Eleven interviews were completed with individuals from organizations that exclude coverage for IMWM (referred to hereafter as IMWM-excluded). Eight individuals screened ineligible or did not respond to interview scheduling requests. Characteristics of interviewees are shown in Table 1. We identified 5 key themes: (1) high cost as the primary barrier to coverage of IMWM, (2) perception of obesity as a lifestyle choice, (3) current or planned use of varied utilization management strategies to limit initial and ongoing prescribing of IMWM, (4) coverage for lifestyle-change programs to support weight management, and (5) perceived responsibility of pharmaceutical companies to lower list prices for IMWM to enable broad coverage and advance health equity. These themes are detailed below. When findings were similar between IMWM-covered and IMWM-excluded groups, the results are presented in aggregate. When findings differed, we specify the reference group. Representative quotes are shown in Table 2.

Theme 1: High Cost as the Primary Barrier to Coverage of IMWM

Most interviewees (n = 18; 7 [78%] IMWM-covered and 11 [100%] IMWM-excluded) perceived high cost as the primary barrier to coverage of IMWM, with one noting, “I don’t know how either as a plan, an industry, or a nation, we’re going to pay for trillions of dollars of [incretin mimetics]” (interviewee 1, IMWM-covered). Seven interviewees (4 [44%] IMWM-covered and 3 [27%] IMWM-excluded) remarked on increased insurance premiums to offset the cost of IMWM, with one noting, “[B]road coverage of [IMWM] is going to bring everybody’s insurance premiums [up by] several hundred dollars a month.… [Patients] don’t really understand that when they say, ‘I want my insurance to cover it.…’ ” (interviewee 4, IMWM-covered).

Four IMWM-excluded interviewees (36%) commented that coverage for IMWM is not financially viable for their health plan: “I was looking at some of our data last year and if we had approved everyone [who] got denied, it would have been a $40 million hit per year to the organization” (interviewee 11, IMWM-excluded). In addition to cost concerns, some IMWM-excluded interviewees (3 of 11 [27%]) cited concerns about the lack of long-term safety and effectiveness data, with one noting, “[These medications are] FDA approved, but we don’t have evidence, experimentally, with longitudinal studies to prove that this is a value-based effective treatment” (interviewee 10, IMWM-excluded).

IMWM-covered interviewees discussed 3 reasons their health plan opted to cover IMWM despite the high cost. First, some (3 of 9 [33%]) perceived an opportunity to reduce spending on weight-related conditions: “You’re saving in hospital stays, etc, that come with obesity.… You may increase your pharmacy spend, but the patients are going to be healthier” (interviewee 7, IMWM-covered). Second, some (3 of 9 [33%]) noted the decision was driven by market pressure, with one stating, “Just to be honest, [we looked at] what competitors were doing and once they started covering, we started covering” (interviewee 7, IMWM-covered). Third, some (3 of 9 [33%]) noted that rebates on IMWM from pharmaceutical companies guided coverage and formulary decisions; interviewees did not discuss the details of rebate contracts or how cost savings offset drug prices.

Theme 2: Perception of Obesity as a Lifestyle Choice

In addition to citing high cost as the primary coverage barrier, 4 IMWM-excluded interviewees (36%) discussed their organization’s long-standing exclusion of AOMs due to the perception of obesity as a lifestyle choice rather than a treatable chronic condition. Two interviewees endorsed this belief, with one stating, “Diet and exercise should be the way you lose weight” (interviewee 11, IMWM-excluded) and another referring to AOMs as “lifestyle medication” (interviewee 19, IMWM-excluded). Two IMWM-covered interviewees (22%) discussed the perception of obesity as a lifestyle choice, with one acknowledging this as a pervasive belief and calling for “people [to] start thinking about this as a medical condition, not as a lifestyle thing” (interviewee 6, IMWM-covered).

Theme 3: Current or Potential Use of Varied Utilization Management Strategies to Limit Initial and Ongoing Prescribing of IMWM

Strategies to limit initial prescribing of IMWM. Most interviewees (n = 18; 7 [78%] IMWM-covered and 11 [100%] IMWM-excluded) discussed concern about clinicians’ off-label prescribing of incretin mimetics for T2D to patients without the condition: “[We’re] getting pummeled by…the off-label use of [incretin mimetics].… The cost is just crippling us” (interviewee 10, IMWM-excluded). Strategies to reduce off-label prescribing included look-back procedures to confirm members’ historic diagnosis of T2D. One interviewee estimated that “…upwards of 35% of all of the [incretin mimetics] prior authorization requests…are denied because they’re coming through on the diabetes indication, [but] they’re [being used] for weight loss” (interviewee 4, IMWM-covered).

Among IMWM-covered interviewees, most (8 of 9 [89%]) discussed their health plans’ current use of prior authorization criteria (eg, body mass index, comorbidities) and approximately half (5 of 9 [56%]) discussed current step therapy requirements, including nonachievement of weight loss goals with participation in a lifestyle-change program (n = 4) and/or use of older AOMs (n = 1). One interviewee commented on the potential effectiveness of step therapy, which “can divert 40% [to] 45% of the patients to other older, cheaper therapies [that] will be effective, and [the patient] won’t ever graduate to the incretin mimetics” (interviewee 5, IMWM-covered).

Among IMWM-covered interviewees, none restricted prescribing IMWM to specialist groups (eg, endocrinology, obesity medicine), although one acknowledged that “[not all] provider[s] [have] the right tool set in their bag to manage obesity as a disease” (interviewee 3, IMWM-covered).

Among IMWM-excluded interviewees, approximately two-thirds (7 of 11 [64%]) discussed strategies their health plan may use to limit IMWM prescribing if coverage were offered. Such strategies include required participation in a lifestyle-change program (5 of 11 [45%]) and use of step therapy (3 of 11 [27%]). Approximately one-third (3 of 11 [27%]) anticipated use of prescribing restrictions, with one voicing concern about telehealth platforms: “[There are] bad actors…that don’t have any patient interactions or they’re just script mills”(interviewee 14, IMWM-excluded). This same interviewee speculated on processes, including retrospective audits and in-person visit requirements, to ensure “members are being taken care of by providers that have proper training and education to manage the weight loss.…”

Strategies to limit ongoing prescribing of IMWM. Among IMWM-covered interviewees (n = 9), 5 (56%) noted their organization’s current requirement for documented achievement of a minimum weight loss threshold (eg, ≥ 5%), 1 (11%) noted their organization’s requirement for continued participation in a lifestyle-change program, and 1 (11%) noted their organization’s long-standing 12-month limit on all AOMs: “We don’t cover [them] beyond a year under any circumstances” (interviewee 8, IMWM-covered).

Three interviewees (2 [22%] IMWM-covered and 1 [9%] IMWM-excluded) discussed the need for benefit design strategies to support adherence to IMWM when effective for weight loss. Referring to the high potential for weight regain with IMWM discontinuation, 1 interviewee described the need to avoid “a situation that we euphemistically call ‘the high school reunion diet.’ It’s something people do, but it’s one thing if it involves not going to McDonald’s until your high school reunion. It’s another thing to get involved with a $1300-a-month drug” (interviewee 4, IMWM-covered).

Theme 4: Coverage for Lifestyle-Change Programs to Support Weight Management

Most interviewees (n = 18; 8 [89%] IMWM-covered and 10 [91%] IMWM-excluded) reported coverage for programs to support healthy lifestyle habits. Programs aimed to increase members’ access to healthy foods through Food Is Medicine initiatives such as coverage for “healthy food with a non–prescription drug card” (n = 6; 3 [33%] IMWM-covered and 3 [27%] IMWM-excluded), physical activity resources (n = 14; 7 [78%] IMWM-covered and 7 [64%] IMWM-excluded), and nutrition counseling (n = 8; 5 [56%] IMWM-covered and 3 [27%] IMWM-excluded). None of the interviewees discussed plan members’ engagement in or outcomes with the offered programs, although one noted that “the people [who] use [wellness resources] are the people [who] generally are healthy now” (interviewee 15, IMWM-excluded). Another noted, “I think it’s well-known…that dietary and behavioral modifications for the plurality of patients have little to no effect. [These programs] are more a marketing incentive” (interviewee 1, IMWM-covered).

Theme 5: Perceived Responsibility of Pharmaceutical Companies to Lower List Prices for IMWM to Enable Broad Coverage and Advance Health Equity

Ten interviewees (4 [44%] IMWM-covered and 6 [55%] IMWM-excluded) remarked that the high costs of IMWM may potentiate health disparities, with one stating, “If only people [who can] pay cash, or people [who can] work their way through shortages to get drugs, or only high-end commercial insurance covers [IMWM], it could significantly worsen health disparities” (interviewee 1, IMWM-covered). Five interviewees (2 [22%] IMWM-covered and 3 [27%] IMWM-excluded) discussed the responsibility of pharmaceutical companies to offer affordable pricing in the US, with several referencing lower price points in international markets. Two IMWM-excluded interviewees (18%) speculated that pharmaceutical companies could maintain profits, even with lower list prices, with one saying, “…[I]f the drug companies would consider decreasing their price, their market share would increase significantly.…” (interviewee 18, IMWM-excluded).

Despite perceived feasibility of lower list prices for IMWM, 1 interviewee doubted this would occur, saying, “Rather than make their drugs economically make sense for a weight loss indication, we expect [pharmaceutical companies] to push [new] FDA indications for…adverse cardiovascular events and for fatty liver disease…kidney insufficiency…and in effect get us into a position where, essentially, we end up covering [IMWM] without it actually being a weight loss indication” (interviewee 4, IMWM-covered). Another voiced a more optimistic perspective, saying, “I think you can get to a level where it really could be very profitable for the pharmaceutical industry and cost saving or close [for health plans]. That’s my hope. What a great story it would be.…” (interviewee 12, IMWM-excluded).

DISCUSSION

In this qualitative study, we interviewed leaders of large US health plans to elucidate factors influencing insurance coverage policies for IMWM and opportunities for health plans to support delivery of effective obesity treatment while controlling health care spending. Consistent with findings from recent surveys of health plan leaders,^20,29,32 most interviewees expressed concern about the high cost of IMWM and off-label prescribing of incretin mimetics indicated for T2D. Our findings also suggest that health plans’ coverage policies remain influenced by the perception of obesity as a lifestyle choice rather than a treatable chronic condition. This perception was directly discussed by some interviewees and suggested by all organizations’ willingness to cover incretin mimetics without reservation when indicated for other chronic conditions (eg, T2D, cardiovascular disease). Recent survey data have similarly demonstrated variation in perceptions of obesity as a chronic condition among health plan leaders,^20,32 and coverage policies that reflect such perceptions may potentiate existing weight bias among health care professionals.⁴⁰ To optimize care for patients with obesity, multilevel strategies are needed to mitigate weight bias and advance treatment of obesity as a medical condition.

Our findings underscore heterogeneity in utilization management strategies among health plans that cover IMWM. Key areas of variation include requirements for (1) step therapy, (2) initial and continued participation in a lifestyle-change program while prescribed an IMWM, and (3) documented achievement of at least 5% weight loss. Recent survey data similarly demonstrate limited use of step therapy (18%-41%).^20,28,41 This may be a missed opportunity to effectively support weight management among health plan members while also limiting spending on IMWM, as older, less expensive options may be highly effective for individual patients.^4,42,43 Moreover, many individuals do not desire to use an IMWM⁴⁴ and may prefer and benefit from other options, including lifestyle-change programs, first-generation AOMs, and bariatric surgery.^4,45 Thus, strategies are needed to support treatment of obesity as a heterogeneous chronic condition, with benefit design decisions that enable individually tailored use of the full range of weight management treatment options.

Forty-four percent of IMWM-covered interviewees (n = 4) noted that participation in a lifestyle-change program is required prior to initial IMWM prescribing; only 1 interviewee noted lifestyle-change program participation as a requirement for continued prescribing. Approximately half of IMWM-covered interviewees (n = 5) noted their organization’s requirement for documented weight loss (eg, ≥ 5%); this aligns with prior survey data demonstrating that 14% of health plans measure weight change and 42% planned to do so in the future.²⁰ At present, few strategies exist to objectively evaluate individuals’ lifestyle program participation and/or weight change via the electronic health record and claims data; innovative tools are needed to support a population health–based approach to weight management.⁴⁶

Most interviewees noted health plans’ coverage for lifestyle-change programs, including Food Is Medicine initiatives, physical activity programs, and nutrition counseling. Interviewees were unaware of specific data on members’ engagement in or outcomes with the offered programs, although several suggested that, in general, lifestyle-change programs have low levels of utilization and clinical effectiveness. These perceptions are consistent with prior literature demonstrating variable levels of uptake in and weight change with workplace and employer-sponsored lifestyle and wellness programs.^47-49 Efforts are needed to rigorously evaluate plan members’ uptake, engagement, and weight-change outcomes with covered lifestyle-change programs; coverage policies should be subsequently refined, as needed, to limit low-value spending.

An additional opportunity to optimize weight loss with IMWM may include prescribing requirements, including specific visit types (eg, face-to-face encounter) and/or clinicians’ training in obesity medicine to overcome knowledge gaps.^50-53 Although such requirements are not typically used among US health plans, there is international precedent for this approach,⁵⁴ and some interviewees anticipated their organizations’ future use of provider restrictions. Interviewees voiced concern about the rise of telehealth companies that promise prescriptions for IMWM⁵⁵ and suggested the need for strategies to ensure the appropriateness and effectiveness of obesity treatment practices. To better inform policy decisions, additional work is needed to determine whether weight loss among plan members prescribed IMWM varies based on clinical context (eg, telehealth vs primary care) and/or clinicians’ training in obesity medicine.

Limitations

This study has several key limitations. First, we interviewed 20 leaders from large health plans in the US, and the findings may not reflect the views of other health plan leaders, including those of smaller organizations. Second, given the voluntary nature of the interview, the results may be subject to respondent bias, as plan leaders with a specific interest in this topic may have been more likely to participate. Third, we evaluated health plan leaders’ self-reported coverage policies; due to the blinded nature of the interviews, we were not able to confirm the accuracy of interviewees’ responses by comparing with published policies. Fourth, few interviewees acknowledged the role of pharmacy benefit managers and rebate contracts in IMWM coverage policies. This suggests a potential information gap among health plan leaders because these may be key factors guiding coverage and formulary decisions. Fifth, our findings reflect a snapshot in time where the cost of IMWM exceeds the ability for open coverage without the need for utilization management; new clinical and cost-effectiveness data may emerge and lead to near-term changes in the views captured in this study.⁵⁶

CONCLUSIONS

New IMWM offer a promising tool to improve individual and population health by reducing weight-related conditions and their consequences. Yet, in the US, the high cost of these medications is financially untenable for patients and payers. Our qualitative interviews with health plan leaders reveal wide variation in coverage for IMWM, with policies that generally aim to reduce near-term health care spending but may not support a comprehensive, equitable, or patient-centered approach to effective, longitudinal weight management treatment. Such an approach might include (1) enhanced use of step therapy, (2) robust coverage for effective lifestyle-change programs, (3) exclusion of coverage for programs without demonstrable clinical benefit, and (4) requirements for IMWM prescribing. Best-practice guidelines are needed to standardize insurance coverage policy, and advocacy efforts are needed to encourage pharmaceutical companies to fulfill what one interviewee described as a “moral imperative…[to] price [IMWM] at a level that is sustainable for the country.”

Acknowledgments

The authors would like to thank the University of Michigan’s Elizabeth Weiser Caswell Diabetes Institute for its support with this work. They would also like to thank Beresford Research for its support in identifying and recruiting interview participants and conducting the interviews presented in this work.

Author Affiliations: Department of Internal Medicine (DHG, EWC, AK, AMF) and Department of Family Medicine (LO, JG), University of Michigan Medical School, Ann Arbor, MI; US Department of Veterans Affairs Ann Arbor Healthcare System (DHG), Ann Arbor, MI; University of Michigan Institute for Healthcare Policy and Innovation (DHG, LO), Ann Arbor, MI; Department of Health Management and Policy, University of Michigan School of Public Health (AMF), Ann Arbor, MI; Center for Value-Based Insurance Design, University of Michigan (AMF), Ann Arbor, MI; University of Michigan Prescription Drug Plan (SL), Ann Arbor, MI.

Source of Funding: This research was supported by a Pilot and Feasibility Grant from the Michigan Center for Diabetes Translational Research (National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases [NIH/NIDDK] P30-DK092926).

Author Disclosures: Dr Griauzde has received grant funding from NIH/NIDDK (K23 DK123416-01A1), receives compensation from the Michigan Collaborative for Type 2 Diabetes for serving as a low-carbohydrate diet consultant, and received honoraria from Blue Cross Blue Shield of Michigan to plan and host an obesity summit for health care professionals in Michigan and from the Michigan Bariatric Society for a presentation on primary care-based obesity treatment. Dr Oshman has received honoraria from the Academy for Continued Healthcare Learning to teach about obesity treatment including incretin mimetics. Dr Gabison has received compensation from Eli Lilly and Company to serve on the 2024 Diabetes and Obesity US-Focused Strategy and Education Tactics Advisory Board. Dr Fendrick reports serving as a consultant to AbbVie, CareFirst BlueCross BlueShield, Centivo, Community Oncology Alliance, EmblemHealth, Employee Benefit Research Institute, Exact Sciences, Grail, Health at Scale Technologies,* HealthCorum, Hopewell Fund, Hygieia, Johnson & Johnson, Medtronic, MedZed, Merck, Mother Goose Health,* Phathom Pharmaceuticals, Proton Intelligence, RA Capital Management, Sempre Health,* Silver Fern Healthcare,* Teladoc Health, US Department of Defense, Virginia Center for Health Innovation, Washington Health Benefit Exchange, Wellth,* Yale New Haven Health System, and Zansors* (asterisks indicate equity interest); research funding from Arnold Ventures, National Pharmaceutical Council, Patient-Centered Outcomes Research Institute, Pharmaceutical Research and Manufacturers of America, and Robert Wood Johnson Foundation; and outside positions as co–editor in chief of The American Journal of Managed Care, past member of the Medicare Evidence Development & Coverage Advisory Committee, and partner at VBID Health, LLC. Dr Lott received compensation from Eli Lilly to participate in a paid advisory board on health care effectiveness and outcomes research data in March 2024. The remaining authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (DHG, EWC, LO, AMF, SL); acquisition of data (DHG, EWC, LO); analysis and interpretation of data (DHG, EWC, LO, JG, AK, AMF, SL); drafting of the manuscript (DHG, EWC, JG, AK, AMF, SL); critical revision of the manuscript for important intellectual content (DHG, EWC, LO, JG, AK, AMF, SL); obtaining funding (DHG, AMF, SL); administrative, technical, or logistic support (DHG, EWC); and supervision (DHG).

Address Correspondence to: Dina H. Griauzde, MD, MSc, DABOM, University of Michigan, 2800 Plymouth Rd, Bldg 16, Room 16-371C, Ann Arbor, MI 48109-2800. Email: dhafez@med.umich.edu.

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