What the U.S. Still Hasn’t Learned From Global Weight-Loss Drug Policy in 2025
- Yuchi Song
- Dec 30, 2025
- 5 min read
If you want to understand weight-loss drugs in 2025, it helps to look away from the United States—and toward global weight loss drug policy.
Not because the U.S. did nothing—it didn’t—but because the most instructive moments happened elsewhere. While Americans debated fairness, stigma, and sticker shock, other countries quietly did what health systems usually do when faced with an expensive, effective, wildly popular therapy: they negotiated, rationed, and planned.
By the end of 2025, the contrast was striking. Not flattering. But also not hopeless.
The moment that made everyone look up: China cut the price
Late in December, Novo Nordisk cut Wegovy prices by roughly 48% in several Chinese provinces, bringing monthly costs down to around $140–$180. No congressional hearings. No Twitter wars. Just a price change.
This wasn’t generosity. It was leverage.
China saw competition coming, patent protection narrowing, and demand rising. Its health system did what centralized buyers do: it applied pressure early. Novo responded accordingly.
For U.S. patients paying four to eight times more for the same drug, the message was uncomfortable but clarifying. The drug didn’t suddenly get cheaper to make. The system simply decided the price had to move.
That single episode did more to puncture the myth of “inevitable pricing” than a year of American outrage.
Europe didn’t argue about obesity—it budgeted for it
Across Europe in 2025, weight-loss drugs weren’t treated as lifestyle enhancements or moral tests. They were treated as cost problems.
Access was limited. Criteria were strict. But the logic was consistent: obesity drives downstream costs, and GLP-1 drugs might reduce them—if used deliberately. So systems negotiated prices, set eligibility rules, and funneled prescribing through structured programs rather than letting demand explode unchecked.
In the UK, for example, rollout plans for newer obesity drugs were phased over several years, with explicit prioritization. Wegovy prescribing was largely restricted to specialist services, not handed out casually in primary care. This wasn’t generosity. It was triage.
Was it perfect? No. Was it honest? Yes.
European systems didn’t pretend everyone could have everything immediately. They acknowledged scarcity and managed it openly—something the U.S. still struggles to do without hiding behind prior authorizations and fine print.
Japan chose restraint—and didn’t apologize for it
Japan’s 2025 story was quieter, and that’s exactly why it mattered.
Instead of racing to meet demand, Japan took a cautious approach: narrower indications, tighter monitoring, slower expansion. To outsiders, it looked conservative. To budget planners, it looked intentional.
Japan treated GLP-1s as a long-term commitment, not a viral moment. And in a year when many systems were overwhelmed by sudden demand, that restraint avoided chaos. No dramatic price cuts. No sudden coverage expansions. Just a steady insistence that effectiveness, cost, and sustainability be evaluated together.
It wasn’t exciting. But it was disciplined. And discipline is underrated in healthcare.
Emerging markets were blunt about limits—and that was refreshing
In middle-income countries, the conversation was even more direct.
Governments across parts of Latin America, Southeast Asia, and elsewhere didn’t pretend GLP-1s could be widely covered overnight. They set firm thresholds, limited access to high-risk patients, and acknowledged upfront that affordability mattered as much as efficacy.
There was no illusion of universal access. But there was also no performance art. Scarcity was named, not disguised.
In the U.S., scarcity often arrives months later in the form of denial letters. Elsewhere, it was part of the plan.
Meanwhile, back in the U.S., something did change
To be fair, the United States didn’t sleep through 2025.
Late in the year, the Trump administration pushed a pricing and coverage framework aimed at bringing GLP-1 drugs into Medicare and Medicaid at standardized, lower price points, explicitly referencing international pricing dynamics. CMS followed with the BALANCE model, designed to allow states and Medicare Part D plans to cover obesity drugs under negotiated terms.
That matters. It was real movement—not rhetoric.
But here’s where the comparison still stings: the U.S. adopted the idea of leverage without fully adopting the structure that makes leverage work.
BALANCE is voluntary. Rollout is slow. Participation depends on states, plans, manufacturers, and budgets aligning at the same time. And because the U.S. system is fragmented, progress in one place can be canceled out by retrenchment in another—sometimes simultaneously.
California’s decision to end Medi-Cal coverage for GLP-1s prescribed solely for weight loss, even as federal policy promised broader access down the road, captured the contradiction perfectly. The federal government moved forward. A state stepped back. Both were rational within their constraints.
Other countries avoid this whiplash by design. The U.S. absorbs it as normal.
So what, exactly, hasn’t the U.S. learned?
Not that prices matter—it finally acknowledged that.
Not that these drugs work—that’s no longer disputed.
What the U.S. still resists learning is subtler, and harder:
That rationing is inevitable, and pretending otherwise just makes it crueler.
That national problems need national rules, not fifty experiments running at once.
That speed matters, because demand doesn’t wait for pilot programs.
China cut prices. Europe structured access. Japan paced itself. Emerging markets drew lines.
The U.S. took a step in 2025. A meaningful one. But it’s still trying to solve a system-level problem with optional participation and future timelines.
That’s not refusal. It’s hesitation.
The bottom line
2025 didn’t prove the U.S. is incapable of learning from the rest of the world. It proved that learning, in the American healthcare system, happens slowly, unevenly, and under pressure.
The rest of the world treated weight-loss drugs like what they are: powerful tools with real trade-offs. The U.S. is starting to do the same—but it’s still negotiating with itself about how serious it wants to be.
In 2026, the question won’t be whether GLP-1s are worth it.
That debate is over.
The real question is whether the U.S. is ready to run a system that admits limits, sets rules, and lives with the consequences—like everyone else already has.
Sources & Further Reading
China pricing
Global competition
Europe / UK structured access
NHS England — Interim commissioning guidance for tirzepatide rollout (Mar 2025)
NICE — Semaglutide (Wegovy) for managing overweight and obesity (TA875)
NHS South West London ICB — Wegovy prescribing restrictions
EU regulation
European Medicines Agency — Wegovy EPAR
U.S. policy actions