GLP‑1 Medications: What Pharmacists Want You to Know
By: Lori Dupree, PharmD, BCPS, BCGP
Senior Associate and Clinical Pharmacist
GLP-1 medications like Ozempic®, Wegovy®, Mounjaro®, and Zepbound® are reshaping how federal health programs approach weight management, chronic disease, and long-term population health. Originally developed to treat diabetes, this drug class is now used for obesity, sleep apnea, metabolic dysfunction–associated steatohepatitis (MASH), and to reduce the risk of heart attack and stroke. As research continues to explore benefits beyond weight loss, GLP‑1s are driving new clinical, operational, and policy considerations across government healthcare.
With pharmacists on staff and deep experience supporting large-scale federal health programs, including CMS, Rainmakers brings a practical, program-focused perspective to GLP‑1 use. As utilization expands and coverage policies evolve, clear, evidence-based guidance matters. Here are five key insights our pharmacists want you to know.
How do these drugs work?
Understanding GLP-1 mechanisms is essential for assessing clinical appropriateness, utilization management, and coverage policy. GLP-1 is a hormone released primarily from cells in the intestines when food is eaten. These medications lower blood sugar (i.e., glucose) by stimulating insulin production, lowering the amount of glucagon produced (i.e., reducing blood sugar), and slowing how fast food moves through the gastrointestinal tract. These effects help regulate appetite. The mechanisms by which these drugs affect MASH, stroke, and heart attack are not fully understood.
What are the most common side effects?
People taking these medications should watch for low blood sugar. Stomach issues, such as pain, nausea, vomiting, diarrhea, and constipation, frequently occur. Patients may also experience dizziness, headaches, fatigue, runny nose, cough, sneezing, and sore throat.
More serious side effects should be reported to the prescriber immediately. This includes severe stomach pain, vision changes, signs of dehydration, a lump in the neck, hoarseness, difficulty breathing, and difficulty swallowing.
How do you manage side effects?
Following instructions provided by the prescriber is key to minimizing bothersome side effects such as nausea, vomiting, and diarrhea. When starting these medications, a lower dose is used and then gradually increased to the target dose for each drug. In this case, if a little is good initially, more is definitely not. Keeping follow-up appointments with the prescriber is important to assess side effects or challenges is important for success. Patients should also ensure any laboratory monitoring ordered by the prescriber is completed.
Why is it so hard to get these medications covered by insurance?
Coverage challenges reflect both statutory limitations and evolving payer approaches to obesity and chronic disease prevention. Insurance coverage for GLP-1 medications can be complex and varies by plan. Coverage may be denied if the prescription is filled at a pharmacy outside the patient’s insurance network. Some insurance plans have exclusions for medications used to promote weight loss. For example, Medicare plans cannot cover drugs prescribed solely for weight loss.
Because these medications are expensive, insurance plans may require specific clinical criteria to be met and documentation to be submitted through the prior authorization process before approving coverage.
What is changing about insurance coverage of these medications?
Federal agencies and payers are actively testing new models to balance affordability, access, and long-term program sustainability. These medications are expensive, so they are often placed in higher insurance tiers. If covered, copayments (a fixed amount) or cost sharing (a percentage of the drug cost) may be higher than expected due to tier placement. Obesity is now recognized as a contributing factor in many chronic diseases, and the discussion has shifted from treating chronic disease to preventing it. As a result, new options are emerging to help patients access GLP-1 therapies.
For example, “Most Favored Nation” pricing agreements with Novo Nordisk and Eli Lilly have reduced the cost of GLP-1 medications in the United States. Another pathway is “TrumpRx,” a direct-to-consumer program connecting patients with manufacturers. Additional oral formulations of GLP-1 medications are expected in the future and may be priced lower than injectable products.
The Centers for Medicare & Medicaid Services continues to test alternative models to improve affordability and access to GLP-1 therapies across Medicare and Medicaid. These models reflect CMS’s broader shift toward prevention, value-based care, and long-term population health outcomes. One such model, the Medicare GLP-1 Bridge, provides short-term access to GLP-1 medications for Medicare beneficiaries for obesity treatment for the first time. This coverage occurs outside of Medicare Part D, with beneficiaries paying a low monthly copayment. The Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) model is designed to help Medicare and Medicaid patients obtain long-term access to GLP-1 medications specifically for weight loss. This model limits patient out-of-pocket costs and combines medications (i.e. GLP-1s) with lifestyle support programs to promote evidence-based, non-drug approaches to weight management.
GLP-1 medications are reshaping how federal health programs approach obesity, chronic disease, and prevention. Rainmakers pharmacists continuously monitor this evolving drug class, including FDA-approved uses, safety considerations, and the policy and regulatory changes that affect access and affordability. This clinical and policy fluency allows us to support CMS and other federal partners as they navigate emerging therapies, test new models, and design programs that balance evidence, equity, and sustainability.
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Rainmakers Strategic Solutions LLC (Rainmakers) is a woman-owned small consulting firm, founded in 2008 to provide expertise and highly practical solutions in support of the government and commercial sectors. Rainmakers’ principals are respected professionals with demonstrated success for clients facing evolving requirements and constituent needs. We develop, implement, and improve programs by applying insightful methodologies and delivering innovative results that address and simplify complex issues, streamline processes, and reduce costs. We have a genuine focus on achieving and maintaining an impeccable business relationship with our customers and supporting them in their efforts to improve processes. Client satisfaction is our most valuable asset and exceeding our customers’ expectations is our primary goal. For more information about our key cornerstones—excellence, passion, and knowledge—visit www.rainmakerssolutions.com, call (443) 348-8067, or connect with us on our social media channels:
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