Even as glucagon-like peptide-1 (GLP-1) receptor agonists have changed how the medical field approaches obesity, access to consistent care remains a significant hurdle. This was the central theme of a recent discussion among health professionals in Boston, who gathered to examine the operational and policy barriers preventing patients from receiving effective treatment. The group, including physicians, pharmacists, and economists, met on June 16, 2026, for a Population Health Roundtable moderated by Fatima Cody Stanford, an obesity medicine physician-scientist.
Referral Systems Vary Across Boston
The way patients enter weight management programs differs widely depending on the hospital system. Samar Hafida, an endocrinologist and obesity medicine specialist at Boston Medical Center (BMC), described a multidisciplinary center cofounded by Caroline Apovian. She noted that patient referrals originate from everywhere within the BMC system, including internal medicine, family medicine, pediatrics, and community clinics, rather than just the endocrine department.
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At Massachusetts General Hospital, the protocol is stricter. Chika Anekwe, the clinical director of obesity medicine, said a rising BMI threshold of 32 for referral means primary care doctors must now handle initial evaluations for milder cases. Apovian pointed out that staffing has not kept pace with demand, leading to long waiting lists. She explained that primary care providers face numerous obstacles when trying to see these patients.
Alexa Triot, a primary care physician and obesity medicine specialist at Beth Israel Deaconess Medical Center, argued that weight management is a core responsibility of primary care. “We look at patients’ chronic disease, and often this is the precursor to other chronic diseases,” she said. Sree Bodepudi of KnownWell added that many patients in her caseload are self-referred because they have not discussed the issue with their primary care provider.
Pharmacists Step In to Fill Gaps
Pharmacists are increasingly taking on clinical roles to ease the burden on doctors. Ana Safri, a pharmacist at BMC’s cardiology clinic, outlined a model focused on cardiovascular risk reduction where pharmacists handle screening, insurance approvals, and initial teaching visits. They also conduct monthly telehealth check-ins to monitor dosage increases. Josephine Li, clinical director of the Diabetes Center at Massachusetts General Hospital, noted that pharmacists are essential for titrating GLP-1 medications in patients taking insulin, as rapid weight loss can increase the risk of hypoglycemia.
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Shifting routine clinical tasks to pharmacists offers a practical workaround for workforce shortages, but it highlights a system where administrative overhead frequently outweighs direct patient care time. This reliance on workarounds suggests that without structural changes to insurance requirements, the operational burden will simply shift from one provider to another rather than disappearing.
Rizo agreed that pharmacists function as an “extra arm of clinical care,” rather than just dispensing medication. The logistics of managing these prescriptions are often times burdensome for everyone involved.
Insurance Red Tape Creates Delays
The topic of prior authorization drew the sharpest criticism from the panel. Rizo described the process as a “colossal waste of our education and time,” diverting focus from patients to electronic records. Matija Burtis, a former medical director at Maine Medical Center, said the administrative requirements cause significant delays in care and contribute to provider burnout. Some institutions have resorted to contracting with overseas teams to manage the paperwork.
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Abeer Bader, clinical nutrition manager at the Massachusetts General Hospital Weight Center, pointed out a common pitfall: patients often lose coverage simply because they did not know their prior authorization had expired. The group also discussed governance and screening. George King, chief scientific officer at Joslin Diabetes Center, said his clinic screens broadly for cardiovascular, renal, and hepatic issues because GLP-1 therapy now offers positive outcomes for those conditions. Apovian connected fragmented governance to stigma, noting that bias exists not just against obesity but against surgery, which she considers the most effective treatment.
Future Coverage Concerns
Looking ahead, the group expressed concern about the Medicare GLP-1 Bridge Program, which launched in July for Part D beneficiaries. Triot predicted “chaos” regarding implementation, while Apovian noted that insurers will likely vary in what evidence they require for conditions like sleep apnea. Joseph Newhouse, a Harvard health economist, warned that the loss of coverage for Medicaid patients might be a more pressing issue than the Medicare changes. The discussion concluded with calls for better tracking of prior authorizations and stronger coordination across specialties. Hafida emphasized the need for continued dialogue to find solutions.
