GLP-1 medications are reshaping what’s possible in chronic disease and obesity care—but they’re also forcing the U.S. to confront a harder question: who actually gets access to the treatments that work?
Third Horizon (TH) spends a lot of time thinking about equitable, efficient, and economic approaches to reducing health care costs in America. Few topics embody that challenge as clearly as GLP-1 medications: drugs that have demonstrated remarkable clinical results, and a demonstrable gap between the people who can afford them – and the people who cannot.
In our latest video, Third Horizon Founder & CEO David Smith shares his personal experience with GLP-1s—what it felt like to struggle losing weight, hit a plateau, and finally see his health begin to change in ways that went beyond the scale: better sleep, clearer thinking, and renewed confidence.
David’s experience reflects what clinical data now confirms: GLP-1 medications work. A January 2026 study from Aon, analyzing data from more than 50 million people including 192,000 GLP-1 users over 30 months, found that sustained GLP-1 use correlates with six percent lower medical cost growth for people with diabetes compared to non-users. For patients maintaining 80 percent adherence, that number climbed to nine percent. The study also found reduced hospitalizations for major cardiovascular events and, among women, approximately 50 percent lower incidence of ovarian cancer and 14 percent lower incidence of breast cancer.
Although the data increasingly supports that GLP-1s can improve outcomes and may reduce downstream medical costs, access remains a major barrier. With list prices often exceeding $1,000 a month, coverage is inconsistent across employers and public programs—creating what looks more and more like a two-tier health system, where patients with generous employer coverage or the financial means to pay cash can access medications, and everyone else faces barriers that often prove insurmountable.
The video also features Alice Jaglowski, vice president at the National Association of Chronic Disease Directors (NACDD), who zooms out from the medication itself to the broader reality of chronic disease prevention: even the most effective drugs can’t do the work alone. Without the right “wraparound” supports—nutrition access, behavioral health, and long-term clinical engagement—adherence drops and inequities deepen. For a deeper dive into these issues, NACDD’s seminar “Perspectives on Obesity Treatment in the GLP-1 Era” offers an excellent overview of the clinical landscape, public health implications, and unanswered questions surrounding these medications.
GLP-1 medications represent a genuine opportunity to reduce chronic disease burden in America. The clinical evidence is strong. The economic case—given that obesity-related costs are projected to triple over the coming decade—is compelling. The question is whether we can build the coverage, care models, and public health infrastructure needed to ensure the benefits reach the people who need them most.
Watch the full video to hear David and Alice’s perspectives on what’s changing, what’s at stake, and what the future of obesity treatment could look like in the GLP-1 era.