I have spent years caring for patients with obesity, and one of the most meaningful parts of this work is seeing what happens when people finally receive comprehensive, evidence-based treatment. I have watched sleep apnea disappear, blood pressure normalize, joint pain ease, and liver disease reverse. I have watched people who spent years feeling dismissed by the health care system finally start to feel healthy and hopeful again. Those outcomes do not happen by accident, and they certainly do not come from a prescription alone. They are the result of continuity, trust, careful medication adjustments, nutritional counseling, lab monitoring, and a clinician who actually knows the human being sitting across the exam room.
That is why this rapidly growing trend in obesity medicine is so frustrating to watch. Across the country, employers and insurers are no longer content with standard prior authorization hurdles. They are increasingly requiring patients to enroll in third-party online weight management programs, complete weigh-ins, log information in apps, and jump through extra layers of administrative work just to access a medication for a chronic disease. That alone is frustrating for patients who are already doing everything they can to improve their health.
At the same time, I want to be fair. Additional support is not inherently a bad thing. If a patient is getting a GLP-1 from a busy primary care setting with limited obesity counseling, a weight management program offered by a large pharmacy chain or digital health vendor may offer an added layer of education, accountability, and follow-up while still allowing the patient to remain under the care of the clinician already treating them.
What crosses the line are models in which the health plan effectively dictates which clinician is allowed to prescribe the medication. That is where support stops and interference with established medical care begins. Imagine if an insurance company told a heart attack survivor doing beautifully on a statin that their cardiologist was no longer authorized to write their prescription, and that they must transfer their care to a corporate telehealth company. We understand that statins are long-term therapies for a chronic disease. We universally agree that continuity of care matters. Yet, when the disease is obesity, patients are treated as if their established clinical relationships are completely expendable.
I have a patient whose story captures just how irrational and cruel this system has become. She is a Massachusetts teacher with state employee insurance coverage who had been thriving under my care for years, losing over 100 pounds. In 2025, her pharmacy benefit manager abruptly removed her tirzepatide product from her formulary, forcing a switch to semaglutide. She developed severe nausea and could not tolerate the change. I fought through the appeals process to get her back on the therapy she could tolerate, which was eventually approved under a different brand name of the same molecule. She stabilized and continued her remarkable progress. Months later, at prior authorization renewal time, the approval flipped back to the original product, triggering another round of pharmacy delays, new savings cards, and explanations. We navigated it all, happy to at least be able to preserve her therapy.
And then came the third-party vendor mandate. As of April 1, 2026, a new policy required her to get the medication prescribed by a vendor-assigned provider in order for it to be covered. Suddenly, a patient doing exceptionally well, achieving double the expected weight loss with our clinic’s help, was forced to enroll in a new program and send over chart notes, schedule new appointments and meet with a completely new provider she had never seen before. This whole process creates unnecessary refill delays, disrupts continuity of care, and puts her at risk of gaps in treatment, all just to keep a medication she was already approved for.
To make this maze even more maddening, the plan recently announced that starting July 1, 2026, they are eliminating GLP-1 coverage for obesity entirely. This poor patient was dragged through a stressful, fragmented vendor handoff in April for a benefit the state plans to terminate in July.
These mandates are not harmless administrative tweaks. They result in delayed care, missed doses, confusion, and immense anxiety. They destroy continuity of care for a chronic, relapsing disease where treatment interruption has very real medical consequences.
These programs are part of a much bigger problem. Across the country, access to obesity medication is getting worse. Employers and insurers are dropping coverage, adding restrictions, and putting up more roadblocks to save money in the short term. That is what so many of these vendor mandates really are: another layer of red tape designed to make treatment harder to get. I am not angry at the programs themselves. I am frustrated with the employers and payers using them as another tool to limit access to medications that are changing and improving lives for patients with a chronic disease.
One particular type of vendor model illustrates another incredibly concerning angle of this trend. Some vendors openly market a nutrition-first model that requires a ketogenic diet, restricting carbohydrates to roughly 30 grams a day. While a ketogenic approach can work well for some individuals, forcing patients into a highly restrictive diet as a condition of access to GLP-1 medication is outrageous. Furthermore, some of these programs explicitly list transitioning patients off GLP-1s as a primary goal. Deprescribing a highly effective medication for a chronic metabolic disease simply to save a health plan money is a dangerous precedent.
Underneath all of these barriers lies the same exhausted stigma. Obesity is still treated as a condition of personal failure rather than a chronic disease. Even now, with overwhelming evidence that obesity is biologically complex and influenced by genetics, hormones, environment, medications, sleep, stress, socioeconomic factors, and neurobiology, patients are still treated as though they must prove they are worthy of treatment. They must prove they are trying hard enough. They must prove they are eating the right way, weighing in often enough, logging enough data, engaging with enough digital modules, and submitting to enough oversight before they are allowed to keep the medication that is helping them.
That is stigma, even when it is dressed up in the language of wellness.
There is a simple solution for health plans that genuinely care about comprehensive treatment. Create a straightforward opt-out pathway for patients already engaged in established medical weight loss programs. If a patient is under the care of a licensed clinician, receiving evidence-based medication management, and actively participating in nutritional counseling, that should be enough. Let that established relationship count as meeting the program’s requirements.
Patients with obesity deserve the exact same dignity, clinical respect, and continuity of care that we universally demand for every other chronic disease. Do not force patients who are finally succeeding to abandon the clinicians who helped them get their lives back. Let us do our jobs, and let our patients keep the care that is actually working.
Joseph Zucchi is a physician assistant.
