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Every time David Davis talks to a nurse at Vida Health, he thinks he'll finally get the OK for Zepbound.
And every time so far he has been wrong.
"I thought, 'All right, I'll go through their hoops — I'll jump through their hoops,'" he says. "The more they wanted, the more frustrated I would get."
The 57-year-old power plant worker who lives near Santa Cruz, Calif., had already gotten a Zepbound prescription from his primary care doctor last December to treat the obstructive sleep apnea that was leaving him exhausted every morning.
But before Davis could fill it, his company added a new requirement. He'd have to get a new prescription through Vida Health. The benefits team called Vida "a cardiometabolic weight loss solution" and framed it as a perk.
"Like we would want it," Davis says.
Telehealth companies such as Vida Health and its rivals offer lifestyle support so people taking drugs like Wegovy and Zepbound can have the most success on the drugs. But the companies often have another job: limiting obesity drug costs for employers.
Davis was frustrated that he now had to work with Vida, but he did as he was told: He got new blood work, filled out health questionnaires and did video visits with a nurse.
The Vida Health nurse said he was a good candidate for Zepbound but insisted he try two generic drugs first: naltrexone, a drug used to curb alcohol and opioid use, and bupropion, an antidepressant. Neither drug is approved for obstructive sleep apnea.
Davis was discouraged and called his insurer's patient advocate. "What's the deal with this?" he recalls saying. "And the patient advocate said, 'I've never heard of that, but that's not a rule.'"
Davis eventually gave up and decided instead to pay out-of-pocket for a cheaper, compounded version of the drug made by an online pharmacy.
Vida Health didn't answer questions about Davis' care, despite his willingness to waive patient privacy. It also didn't answer questions about how its business model works.
Instead, Vida said in a statement that its providers adhere to clinical eligibility criteria and plan sponsors' coverage policies when prescribing medication: "At Vida Health, our top priority is delivering personalized, clinically appropriate care for every patient."
In an emailed statement, Blue Cross and Blue Shield of Texas, which handles Davis' insurance, said it "is committed to providing its members access to safe, appropriate, and effective health care within the benefits provided by their own health plan." It wouldn't comment on Davis' situation but said it was reaching out to him.
Telehealth companies pivoted when obesity drugs became blockbusters
Telehealth companies like Vida Health existed before obesity drugs became blockbusters, says Jayne Hornung, the chief clinical officer at MMIT, a data company focused on the pharmaceuticals market. At the time, they provided extra support for Type 2 diabetes prevention and management. But that has changed.
"They've seen this opportunity in the larger market with the GLP-1s and all the wraparound services that they could provide," she says. "And it's just exploded."
These telehealth providers are hired by employers that are looking to minimize how much they spend on their employees' weight-related health care, including on obesity drugs, says Hornung.
The services are popular with employers. Exact numbers are hard to come by, but one company, Omada Health, told investors last month that its membership grew by 51% over the last year to more than a million people. The company said that at the end of 2025 it had "supported more than 150,000 members on GLP-1s, compared with more than 50,000 at the end of 2024."
"Omada is neither a gatekeeper of GLP-1s nor are we a vending machine," company President Wei-Li Shao says. "And you'll find both extremes of that spectrum out there in the marketplace."
He says Omada provides evidence-backed care with providers who already know what your plan will cover.
But MMIT's Hornung sees it differently. She says the telehealth companies can be useful, but they also offer employers "utilization management under the guise of lifestyle intervention."
"The endgame is to eventually get the patient healthy, get them on an exercise program and get them off the GLP-1s," she says. "Employers don't want to pay for this forever either."
Primary care physicians raise the alarm
Dr. Catherine Varney is the obesity medicine director for UVA Health in Charlottesville, Virginia. When telehealth providers hired by employers to manage costs try to get her patients to come off their obesity medications, she's alarmed.
"I'm like, whoa, whoa," she says. "They're offering medical advice outside the scope of their practice, and they're pushing the patients to come off the medications when the evidence is clear in the research clinical trials that showed that when patients came off these medications, they regained two-thirds of their weight back, just the same as if you would come off blood pressure pills. Your blood pressure would go up. If you came off cholesterol pills, your cholesterol would go up."
That's what happened to one of Varney's patients, 64-year-old Penny Byer, a homemaker who raised five children in Stuarts Draft, Virginia.
She started on Wegovy in April 2025 and got to a healthy body mass index. Then, Virta Health, a telehealth provider, was added to her family's benefits package. Virta kicked her off the drug in December.
Her weight and her cholesterol returned to where they were before Wegovy.
"Everything's come back with a vengeance," she says. "After about a month of arguing back and forth with them and [they] just kept saying, 'No, we're not — no, we're not prescribing it anymore.' No matter what I done or papers I brought them or texts I sent them and — nothing mattered."
Virta declined to answer questions about Byer's care despite her willingness to give it permission to do so.
The company said its own research found that patients could sustain weight loss after stopping obesity drugs. That is at odds with a much larger systematic review published in The BMJ, formerly known as the British Medical Journal. That review included 37 studies and 9,341 patients, and it concluded that cessation of obesity medicines is followed by "rapid weight regain."
The layered roles of telehealth services
Dr. Carolynn Francavilla, vice president of the Obesity Medicine Association, says programs like Vida's can be helpful for some obesity-drug patients who like using telehealth apps for logging food and getting other support.
For example, Omada connected NPR with a user, Jackie O'Gorman of Pequannock Township, N.J., who says her Omada telehealth coaches helped her reach her goal weight and had become her "best friends."
But requirements like regularly stepping on the scale and logging weight into an app don't work for everyone, Francavilla says. For some people, that can be upsetting, especially if they have a history of disordered eating.
"If they don't follow those rules, then they may no longer be eligible to get the medication. So that's often a huge challenge and can be very distressing for patients," says Francavilla, who is sometimes paid by drugmaker Eli Lilly to educate other health professionals about how its obesity medicines work. "And, you know, that's not an evidence-based practice. That is not something that needs to be done to safely take these medications."
Too often, she says, these telehealth companies seem to be prioritizing gatekeeping the medications and keeping costs down over the needs of patients.
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