The Weight of Inequality: GLP-1s’ Promising Future Clouded by Cost and Access

The medical landscape has undergone significant changes in recent years, largely due to the introduction of GLP-1 drugs such as Ozempic, Wegovy, and Zepbound. These medications have revolutionized obesity treatment by shifting focus from late-stage interventions to proactive weight management that can prevent disease before it starts.

According to Robin Wenzel, head of Wells Fargo Industry Insights, GLP-1s have “broken the script” on obesity treatment, highlighting a more pressing issue than the disease itself: who can afford to wait for them to take effect. The numbers support this assertion. A 2026 JAMA Surgery analysis found that as GLP-1 use increased by over 140% between 2022 and 2024, bariatric surgery volumes fell by 34.1% during the same period. This is a direct substitution effect, where patients opt for newer, more effective treatments rather than undergoing invasive surgery.

While GLP-1s have shown promise in reducing major adverse cardiovascular events and substance abuse, including alcohol use disorder, there’s a significant cost barrier. The list prices of Wegovy and Ozempic can reach $1,000 to $1,300 per month, making them inaccessible to many patients. The Congressional Budget Office has estimated that authorizing Medicare to cover anti-obesity medications broadly would add approximately $35 billion to federal spending between 2026 and 2034.

The economics of GLP-1s are complex, but one thing is clear: the benefits only emerge gradually, much like statins’ role in cholesterol treatment. Patients may need to remain on these medications for life, where meaningful results – losing a significant percentage of body weight – take time to materialize. This subtler problem points to a deeper issue than affordability alone: the economics work only for patients and payers who can absorb years of cost before the benefit arrives.

In effect, there’s a “patience tax” layered on top of a price tag – and patience is not evenly distributed. Two inequalities stand in the way of the game-changing revolution in healthcare that GLP-1s represent: wealth and time. Those with more resources can afford to wait for the benefits, while those without are left behind.

When asked about the potential of GLP-1s as a general-purpose technology, similar to AI’s potential, Wenzel noted it was a fair comparison – but one that will play out over time. Novo Nordisk has announced plans to cut U.S. list prices for Wegovy and Ozempic by 50% and 35%, respectively. However, this won’t be enough to address the underlying issue of access and affordability.

Policymakers must tackle the entrenched inequalities that stand in the way if they want to truly unlock the potential of GLP-1s. This is a complex challenge, but one that can no longer be ignored. As Wenzel so astutely noted, “We all need to continue talking about the affordability of these drugs.” The time for action is now – not just for patients, but for the healthcare system as a whole.

The promise of GLP-1s has been tantalizingly close for years, only to be snuffed out by the harsh realities of cost and access. But perhaps this is an opportunity in disguise: to rethink our assumptions about what it means to be “affordable” and “accessible.” As we consider the long-term benefits of these medications, let’s not forget that time itself is a luxury – one that’s not equally distributed among us.