ICER report demonstrates both the value and challenges in financing of weight loss medications.

Two out of 5 US adults live with obesity, generating substantial clinical and economic burden. Recent glucagon-like peptide-1 receptor agonists (GLP-1 RAs), including semaglutide and tirzepatide, demonstrate significant weight loss and cardiometabolic benefits and were found by the Institute for Clinical and Economic Review (ICER) to be cost-effective compared with lifestyle modifications alone. However, even limited uptake exceeds ICER's annual budget impact threshold, prompting access concerns. The latest real-world evidence demonstrates that persistence for these drugs is lower than in clinical trials, resulting in frequent weight regain after discontinuation, tempering expectations of long-term medical cost offsets. Evidence on medical spending impact is mixed, with cost-offset signals only observed among patients with obesity and diabetes receiving high-potency injectable agents, whereas obesity-only populations often show spending increases. Given current coverage restrictions, this commentary recommends combining drug coverage with lifestyle management programs, avoiding arbitrary duration limits, using targeted prior authorization, and exploring innovative payment models to improve access while managing budget impact.