Thirteen-dollar Ozempic

Year after year, Americans enter January with the same hope: this is the year we finally get healthy. According to a 2024 Forbes Health survey, roughly half of all resolutions were about fitness, and one in three people said weight loss was the top priority. There is no shock value here; we live in a nation with the highest rates of obesity in the developed world and some of the highest burdens of related chronic illness. At the same time, we also have millions of uninsured or underinsured people who can’t access even basic preventive care, much less cutting-edge treatment.

It’s no surprise that GLP-1 medications (with brand names like Ozempic, Wegovy, and Mounjaro) have become part of the national dialogue. Over the last five years, these drugs have helped millions of people lose significant amounts of weight and reduce their risk of Type 2 Diabetes, heart disease, stroke, and obstructive sleep apnea. For many patients, GLP-1s aren’t a vanity purchase. When you’re sitting in an exam room with your doctor hearing words like “comorbiity” you’re thinking about survival and the chance to slow or even reverse chronic conditions that kill.

In the United States, we still treat obesity as a personal failing even though it has been classified as a chronic disease by the National Institute for Health since 1998. Obesity is a medical condition shaped by biology, environment, trauma, and the social determinants of health. Poverty, food access, neighborhood design, marketing, education, stress, and generational disadvantage all influence weight far more than willpower ever could. This is complicated by our cultural views on poverty being similarly rooted in guilt and shame. The resulting system of policy and prejudice creates a huge barrier to access for many people who need help most.

​​Most peer nations regulate prescription drug prices through government negotiation or price caps. The United States does not. Instead, we allow pharmaceutical companies to set whatever price the market will bear. As a result, the monthly cost of a GLP-1 in the U.S. can run over $1,000, while the exact same medication in many European countries costs a fraction of that. In England, if you qualify through the NHS (England’s universal healthcare system) your monthly copay is 9.90 pounds, roughly $13 US. In Scotland and Northern Ireland, it’s free. Meanwhile, Americans are charged over $1,000 for the same dose, the same vial, the same medication.

Doing nothing is expensive. Wildly expensive. A 2018 study from the Milken Institute estimated the total cost of obesity in the United States at over $1.7 trillion annually when you combine medical spending and lost productivity. We talk about the “cost” of GLP-1s as if the alternative is free, and as though refusing to cover these medications somehow saves the system money. Denying access to these medications isn’t even just kicking the can down the road; the cost of allowing people to develop and live with the other chronic conditions associated with obesity is significantly higher.

Obesity is directly tied to higher rates of heart disease, stroke, Type 2 Diabetes, kidney failure, obstructive sleep apnea, and joint degeneration. Each of those conditions comes with its own long-term treatment plan: insulin, statins, blood pressure medication, CPAP machines, surgical interventions, dialysis, emergency room visits, lost wages, disability claims. We pay for all of that already. Public insurance programs like Medicare and Medicaid spend billions every year treating the downstream effects of obesity because we refuse to invest in upstream solutions.

Despite the overwhelming data, a stubborn narrative persists: that using a GLP-1 is “the easy way out.” If people only had more discipline, or more willpower, or more moral fiber, they wouldn’t “need” medication in the first place. These medications are tools, not shortcuts. There are side effects, sometimes including nausea, vomiting, and diarrhea so severe that a patient is unable to continue the medication. They work best when paired with lifestyle changes like improved nutrition, physical activity, better sleep. Patients still have to do the work of building better habits. That’s why it is so important that these medications be prescribed and taken under the supervision of a healthcare provider, rather than through a faceless online compounding pharmacy with very little guidance as to what happens next.

We also can’t ignore the cultural noise created by people using GLP-1s who aren’t living with obesity at all. Hollywood has treated these medications like a wellness trend, which distorts public understanding and reinforces the idea that they’re more luxury cosmetic than healthcare. That narrative spills over onto patients who genuinely need treatment, adding stigma where there should be support. It also affects access; when demand is driven by aesthetics instead of medical necessity, people managing chronic disease are pushed even further to the back of the line.

Access to care in the United States is determined by price, and the prices are set by companies for maximum profit with no guardrails. People who can comfortably pay out of pocket (often those seeking cosmetic changes) have access. Meanwhile, patients with legitimate medical need are stuck appealing insurer decisions, searching for coupons, or trying whatever unsafe compounded versions fit in their budget. The existing policy framework rewards disposable income over medical necessity.

In many ways, the story of GLP-1s reflects a deeper truth about American healthcare. Medical progress often outpaces access.. We have seen this before with insulin, with inhalers, with cancer treatments, with the most basic scans that help doctors catch disease early. Again and again, the price of care rises, coverage becomes uncertain, and people are left making choices between healthcare and the other necessary costs of living.

The science continues to advance. Our policies need to catch up.