Companies are tightening their belts on Americans' ability to tighten their belts

Kristi Turner had lost 108 pounds on Zepbound when her insurer cut her off.

For ten months, her prescription was available with a $25 copay through her husband's employer health insurance. The now 47-year-old was the strongest she had been in years: Her mobility and blood sugar had improved, she was sleeping better, and she had more energy for Pilates and pickleball with friends.

So it was a surprise when, in January 2025, her coverage disappeared. Her insurer said she no longer qualified for coverage because she didn't have diabetes, according to documents reviewed by Business Insider. It gave her only one avenue to restore coverage — a six-month program of diet counseling, physical therapy, mental health check-ins, and lab tests. Even if she jumped through every hoop, there was no guarantee her coverage would be restored.

Turner added up all the time the program would take, and declined. She's been paying around $500 a month out of pocket to stay on Zepbound.

Her husband, Keith, who takes Mounjaro for his type 2 diabetes, has kept his coverage and still pays a $25 monthly copay.

As Kristi sees it, their insurance will readily cover an obesity-related disease like diabetes, but not obesity itself. "We have the same disease. We're just at different points," she says.

"Financially, it stinks," she says. "But the medicine is life-changing for me."

Nearly five years after GLP-1s hit the market as a treatment for weight loss, their skyrocketing popularity has caught insurers off guard. They've responded by tightening eligibility, adding administrative hurdles, or dropping coverage altogether.

An analysis by GoodRx found that insurance coverage for Novo Nordisk's Wegovy and Eli Lilly's Zepbound — two drugs designed for weight loss, and not diabetes treatment — became "more restrictive" in 2026. The number of people without commercial insurance coverage for Wegovy jumped by 42% from 2025 to 2026, while the number for those without Zepbound coverage increased by 12% during the same period.

Over 16 million people with private insurance don't have any coverage for this class of drug in 2026 when prescribed for weight loss, the analysis, which included people on employer-based and marketplace plans, found.

Patients, doctors, and researchers interviewed by Business Insider described several instances of coverage being unexpectedly scaled back or cut off entirely.

And it's not just GLP-1s. Insurers are quietly canceling or restricting coverage for all kinds of cutting-edge treatments, from immunotherapy to mental healthcare to IVF.

Amanda Nguyen, GoodRx's senior health economist, calls it "coverage with a catch."

"Despite your insurance status, more consumers are exploring things like a cash option, bypassing insurance, shopping around to get the best price," Nguyen says. "Just because they have health insurance doesn't mean the medication they need will be covered by their plan."

The gap between what medicine can do and what insurance will cover is only getting wider — and even those with "good" insurance are being left with overwhelming bills.

GLP-1s have revolutionized weight loss treatment. Initially developed to treat type 2 diabetes, studies show the drugs could help alleviate symptoms of sleep apnea, arthritis, heart disease, and addiction. To maintain the benefits, research shows many people will need to stay on these drugs long-term.

KFF, the nonprofit health research organization, estimates that 36 million people enrolled in employer-sponsored insurance plans could qualify for GLP-1s based on their body mass index.

The question is: Who will foot the bill?

"More people wanted to take GLP-1s than employers were expecting," says Matt Rae, associate director of KFF's Health Care Marketplace Program. When you multiply millions of people by anything, "you get an astronomical sum of money."

Ballooning healthcare costs are pitting insurance companies against drugmakers and stirring frustration among workers dissatisfied with their employer-sponsored benefits.

A spokesperson for America's Health Insurance Plans, a national trade association that represents major insurers, pointed to "the exorbitant prices drugmakers set and which they alone can lower" as a driver of rising costs.

For their part, Novo Nordisk and Eli Lilly both offer direct, self-pay options, and prices have dropped significantly — in some cases, by half — since they first became available.

Employers, meanwhile, faced with surging healthcare costs, have been passing more costs onto employees. Many workers entered 2026 with higher premiums and less generous employer-based plans. Private insurance premiums jumped an average of nearly 9% for employers between 2025 and 2026, and many employees are paying hundreds more each month to maintain coverage.

Employers have scaled back access, introducing a laundry list of qualification criteria or connecting GLP-1 use to often-uncovered "lifestyle management" treatments. In 2025, KFF found that only 1 in 5 companies with 200 or more employees covered weight-loss drugs.

"What you want if you're running a health plan is predictability," says Rae. "You want the amount you spend this year to be pretty similar to what you spend next year."

The enormous demand for GLP-1s at affordable prices — for those with or without commercial insurance — has fueled the fast-growing direct-to-consumer industry.

Eli Lilly has LillyDirect, which has partnered with Walmart and Amazon pharmacies, Ro, and others on savings programs and self-pay options. Last month, it also rolled out Lilly Employer Connect, designed to help employers reduce costs associated with Zepbound coverage.

Novo Nordisk announced last month it had partnered with Ro, Hims & Hers, WeightWatchers and other telehealth companies to offer a 12-month supply of Wegovy at competitive prices.

"We believe the best way for patients to access our medications is through their insurance benefit," Liz Skrbkova, a Novo Nordisk spokesperson, said in a statement. "Self-pay platforms are designed to fill gaps where patients do not have coverage, not replace insurance-based access."

Compounding pharmacies have similarly emerged as an alternative for people who can't get their insurer to approve a brand-name GLP-1 or who face too many roadblocks.

This increased competition has shifted the calculus for companies, making it easier to justify rolling back GLP-1 access when affordable alternatives exist.

"It's not worth it for employers to send someone to the direct-to-consumer market if you're going to make them feel very upset. You're spending all this money on a health insurance plan to keep them feeling good about their jobs," says Rae. "Now, we have direct-to-consumer options where these things are available much, much cheaper. It changes your strategy if you're an employer."

For providers, helping patients navigate their insurance can feel like a second job.

Chrissy Glenn, a psychiatrist and obesity medicine specialist at the University of Kansas, spends hours each week going back-and-forth with insurance companies after they deny coverage for treatments she has prescribed. The same goes for the nurses in her practice.

For patients who she believes would benefit from taking GLP-1s, she might prescribe the drug based on a patient's obstructive sleep apnea rather than their BMI if there's a risk that her patient won't meet their insurer's criteria. This, she hopes, will increase the likelihood of coverage.

"It's a waste of time, it's a waste of effort," she says, adding that it's "definitely the employer-based systems that seem to be the ones refusing to cover treatment."

"They don't train you when you're a doctor on the game of insurance," she says. "I don't think that we always appreciate that having insurance doesn't equate to coverage."

Others feel like the direct-to-consumer market is their only option.

Gianna Beasley panicked when she learned her insurer would stop covering Mounjaro. The 29-year-old has polycystic ovarian syndrome and has suffered from debilitating joint pain. Her symptoms had progressed to a point where she was struggling to function.

"I had tried all the medications that existed, supplements on top of supplements, and nothing really was able to fully grasp the insulin resistance piece for me," Beasley says. It was a "complete 180 for my body."

Roughly two years later, Beasley's insurer ended her coverage for GLP-1s because she isn't diabetic, putting her use of the drug in the "lifestyle management" category. In January, she paid $1,800 out of pocket for a one-year supply of generic tirzepatide from a compound pharmacy, according to documents viewed by Business Insider. "It's not a vanity drug," she says. "It's a critical medication."

Muddled coverage rules, coupled with the persistent social stigma around obesity, has driven others to the risky GLP-1 "gray market," an underground network of off-brand medications often sourced from Asia and the Middle East that people can order online without medical consultation.

Search for "affordable GLP-1s" and "no insurance coverage" on TikTok, and you'll find a flurry of posts where users unbox vials of "GLP-1 peptides," offer glowing reviews, or lay out advice for how to order these drugs and avoid scams. The situation prompted the Food and Drug Administration and at least five states to issue health safety alerts about "bootleg" weight loss injections.

Providers, of course, recommend that patients take GLP-1s only under close medical supervision. But they recognize that some patients become desperate, especially since going off the drugs can lead to rapid weight gain, high blood pressure, and fatigue.

"If you need access to medication, you're going to find it," says Glenn.

That so many people need to reach deep into their pockets to pay for GLP-1s has become a striking case study for America's Great Uninsuring. Coverage denials by major private insurers increased from 18% to 23% between 2016 and 2023, Komodo Health data compiled by The New York Times shows. These decisions are made by private actors, but the trend is likely due to the ballooning costs of weight-loss drugs and the greater use of AI in claims processing.

Another reason is that innovation can outpace insurance coverage. Doctors can now diagnose and treat illnesses faster and more efficiently than just a few years ago, and patients have more options for care. But it can take years for a new medicine to move through clinical trials, federal approvals, and insurance company bureaucracy.

Everyone is looking for ways to keep costs down. Healthcare spending has grown sharply over the last 10 years, reaching $5.28 trillion by 2024, while insurance companies' earnings have roughly tripled during the same period. Insurers cover a much greater percentage of healthcare costs compared to a few decades ago — 73% of total spending in 2023, compared to 27% in 1970. But the costs passed down to consumers can be crushing.

In some cases, Americans are spending more on healthcare and insurance premiums than on rent and groceries. Medical debt is a leading contributor to bankruptcy, and millions of patients are falling into credit card delinquency. It can also lower credit scores, making it harder to take out loans or buy a house.

Steep deductibles, surprise copays, and a tangled labyrinth of in- vs. out-of-network care is leaving privately-insured Americans drowning in bills.

Take cancer, for example: More Americans are staying in the workforce — and on their company healthcare plans — longer, while there's been an alarming rise in cancer diagnoses among people under 50. Advancements in treatment are allowing people to live longer, but the price tag is staggering. The United States spends over $200 billion annually on cancer care.

Getting the best medicine can require significant effort, even with health insurance. New and lifesaving treatments, like immunotherapy for certain cancers, are subject to strict approval requirements. Many plans will similarly limit coverage for diagnostic MRIs and fertility treatments like IVF. A Business Insider investigation last year found that a 35-year-old with colon cancer can expect to spend $45,000 out of pocket in the first year of their diagnosis, even with insurance.

About 6 in 10 insured adults encounter regular issues with their plans, one 2023 KFF consumer survey found. Another 2025 KFF poll found that over a third of insured Americans have skipped necessary care due to cost.

It can fall to patients to absorb the difference between short-term costs and long-term benefits, whether to reduce the risk of developing a more serious condition or the need for costly medical procedures.

When Annaliesa McCartney learned she was losing insurance for Mounjaro, she opened up to a coworker who, it turned out, had cracked the coverage code.

McCartney had started taking Mounjaro in 2022 to treat her osteoarthritis, a degenerative joint disease. The health insurance she had through her job covered it, and she paid about $25 a month. Over two years, she had lost 70 pounds, reduced inflammation around her joints, and increased her muscle mass. "It improved my quality of life significantly," McCartney says. "I'm 53 and probably in better shape than I was in my 30s."

There was more good news. McCartney says she was able to skip a planned knee replacement, which would have meant steep medical bills and a long recovery time, not to mention the two or three additional replacements she'd require over her lifetime.

When McCartney tried to contest losing her GLP-1 coverage, the answer she got was confusing. Her insurer raised the option of gastric bypass surgery even though McCartney says her doctor had not made that recommendation.

That was when McCartney learned about an alternative from her coworker. It was essentially the same deal that had been offered to Turner: If McCartney enrolled in a six-month program of assessments, behavior modification diet tracking, and nutrition appointments, she might be able to return to her $25 monthly copay.

McCartney decided it was an offer she couldn't afford to pass up. Going off the medication wasn't an option, and she'd already taken a second job to keep up with the new, roughly $400 monthly cost.

She completed the program, and her coverage was restored. She now says she wishes "more people knew how to appeal those denials and how to ask the right questions."

As for Kristi and Keith Turner, they've had to make sacrifices to keep up with the out-of-pocket costs for Kristi's Zepbound. They've had to postpone family vacations with their two college-age kids, and they're saving less for retirement. Kristi has been working more.

"It doesn't seem fair for my wife," says Keith. "We should be at the point in our lives where our salaries are allowing us to do fun things and extra things, or save a lot more money, or help our boys more with their college expenses."

Kristi has continued to lose weight on Zepbound. Keith, who's lost 170 pounds since starting Mounjaro, says his blood sugar levels are in a much healthier range. Both have more energy and more confidence, and that's led to them spending more quality time together, whether a trip to the mall or taking their dog to the park. They say their 26-year marriage is stronger than ever.

"Life is better all the way around," Keith says.

Allie Kelly is a reporter on Business Insider's economy team.

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