Why is the GLP-1 market likely to remain controversial?
Only 22% of commercial insurers cover GLP-1s for obesity; Florida's lawsuit extends the insulin rebate theory to Ozempic; Trulicity enters Medicare negotiation effective 2028; and unresolved compounding, advertising and NAION litigation make GLP-1s the new centre of the drug pricing debate.
Because the stakes are enormous. Obesity affects a large share of US adults, and coverage decisions could add tens of billions to Medicare costs; the CBO estimated that Medicare obesity-drug coverage would cost about $35 billion from 2026 to 2034. Only 22% of commercial insurers cover GLP-1s for obesity, leaving many to pay cash. Florida's September 2026 lawsuit extends the insulin rebate theory to GLP-1 drugs including Ozempic and Trulicity, and Trulicity was selected for Medicare price negotiation effective 2028. Add unresolved compounding litigation, the Novo-Lilly advertising fight and NAION litigation, and GLP-1s look set to replace insulin as the central battleground over drug pricing and access in the US.