Boston Panel Confronts Access and Coordination Gaps in Obesity Care

Even as glucagon-like peptide-1 (GLP-1) receptor agonists have reshaped the obesity treatment landscape, access to specialty care, pharmacist support, and consistent insurance coverage remains fragmented. This was the throughline of a discussion among physicians, pharmacists, a dietitian, and a health economist from across Boston's major health systems who gathered on June 16, 2026, at an American Journal of Managed Care^® Population Health Roundtable exploring operational and policy barriers to comprehensive obesity care. The discussion was moderated by Fatima Cody Stanford, MD, an obesity medicine physician-scientist at Mass General Brigham and Harvard Medical School.

Care Origination Splinters Across Health Systems

Samar Hafida, MD, an endocrinologist and obesity medicine specialist at Boston Medical Center (BMC), described a multidisciplinary weight management center founded by Caroline Apovian, MD, of Brigham and Women's Hospital and Harvard Medical School. The center includes endocrinologists, primary care physicians, pharmacists, and advanced practice providers.

"Where it originates is, I would say, everywhere that patients are seen within the Boston Medical Center system," she said, noting most referrals come from internal medicine, family medicine, and pediatrics rather than the endocrine clinic itself. Ivania Rizo, MD, director of obesity medicine at BMC, added that the system is working to meet patients earlier, "within the community and the churches and where people are."

Chika Anekwe, MD, obesity medicine clinical director at Massachusetts General Hospital, said a rising BMI threshold of 32 for referral to the specialized Weight Center "really does force primary care to do some initial triage evaluation and management of some of the milder obesity cases." Apovian, who codirects the Center for Weight Management and Wellness at Brigham and Women's Hospital, said staffing has not kept pace. "We still have quite a waiting list,” she explained. “It's very difficult for the primary care providers to see these patients because of various obstacles."

Alexa Triot, MD, a primary care physician and obesity medicine specialist at Beth Israel Deaconess Medical Center, put it more simply. "This originates in primary care; in my opinion, pediatrics or adult medicine,” she said. “We look at patients' chronic disease, and often this is the precursor to other chronic diseases. So, this is really our bread and butter." Sree Bodepudi, MD, of KnownWell, said much of her caseload is self-referred, since patients may or may not have had this conversation with their primary care provider.

Pharmacists Extend GLP-1 Access and Titration Beyond Dispensing

Ana Safri, PharmD, who practices in BMC's cardiology clinic, described a model built around cardiovascular risk reduction: pharmacists handle screening, prior authorizations, an initial teaching visit, and "monthly telemed follow-ups to ensure that they're quickly being titrated up, and they're not staying on the same dose for a while, and that they're tolerating it as we go up on the doses.” Josephine Li, MD, clinical director of the Diabetes Center at Massachusetts General Hospital, said Brigham colleagues have used pharmacists to titrate GLP-1 medications in patients on insulin since "they're becoming insulin sensitive, they're losing weight, there is going to be the risk of hypoglycemia that needs to be closely followed." Rizo agreed pharmacists function as "an extra arm of clinical care," not simply medication dispensers.

Prior Authorization Burdens Providers and Delays Care

No topic drew sharper language than prior authorization. Rizo called it a "colossal waste of our education and time" spent on the electronic record rather than patient care. Matija Burtis, DO, who previously served as medical director at Maine Medical Center and now works with KnownWell, said the process "causes a delay in care, a tremendous delay in care and disruption. It causes provider burnout." Several institutions described contracting with overseas or prematch physician teams to manage submissions, while Abeer Bader, MS, RD, clinical nutrition manager at the Massachusetts General Hospital Weight Center, noted that patients often lose coverage simply because they didn't know their prior authorization expired.

Boston Systems Vary in Governance and Screening Approach

George King, MD, chief scientific officer at Joslin Diabetes Center, said his clinic screens broadly for cardiovascular, renal, and hepatic comorbidities alongside diabetes, since GLP-1 therapy now carries positive outcomes for renal and heart health as well as sleep apnea. Anekwe designed a formal Epic-based referral pathway after pediatric patients were being sent to "multiple subspecialty clinics for the same end goal."

Apovian tied fragmented governance directly to stigma toward the field's most effective intervention: "The stigma is not just about the obesity, but it's about the most effective treatment that we have, which is surgery."

Hafida said she pushes patients to take that fight to their own employers and insurers directly. "Go raise your voice, go write op-eds,” she said, emphasizing the need for employer insurance coverage of obesity treatments. “Obesity is a disease, and it should be treated as a disease."

Medicare GLP-1 Bridge Program Raises Access, Coverage Questions

The group anticipated disruption from the Medicare GLP-1 Bridge Program, which launched in July for Part D beneficiaries meeting cardiometabolic criteria. Triot predicted "chaos on July 1st," and Apovian said insurers will vary in what they require patients to prove for conditions like sleep apnea or metabolic dysfunction–associated steatohepatitis.

Joseph Newhouse, PhD, a Harvard health economist, cautioned that the bigger threat may lie elsewhere. "A lot of Medicaid patients are going to lose coverage,” he said, stressing that Medicaid may be a more important focus than Medicare.

Participants closed with a call for better prior authorization tracking, stronger referral coordination across specialties, and continued patient advocacy, with Bader, Anekwe, Bodepudi, and Safri each naming care coordination as a priority for the next 6 to 18 months. Hafida summarized the group's sentiment simply: "We need more discussions. Have more of these things and talk more. So we can find a solution."