By Megan R. Wilson

In today’s issue:

• Drug companies are spending hundreds of millions of dollars to convince doctors to prescribe GLP-1 drugs
• Patient and employer groups are the latest voices pushing for reforms to the law meant to protect people from surprise medical bills

This is the Health Brief newsletter. Former CVS executive Helena Foulkes won a contentious gubernatorial Democratic primary in Rhode Island, becoming the first candidate to defeat a sitting governor running for reelection since 2018. Read more from The Post.

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Carlos Campos, a Texas-based physician who speaks about the benefits of GLP-1 medications, interacts with staff. (Ilana Panich-Linsman/For The Washington Post)

The pharmaceutical industry’s old playbook is getting a workout from the GLP-1 boom.

Drug companies have long spent money on or paid doctors to talk to other clinicians about their medications and treatments, often hosting the conversations over steak dinners or catered meals. It’s even recognized by the Food and Drug Administration as an important source of information for prescribers.

But the scope of the spending on physicians, nurse practitioners and other providers from the makers of blockbuster weight-loss drugs such as Wegovy and Zepbound has been staggering, according to an analysis of federal data by Christopher Rowland, Lydia Sidhom and Ariana Eunjung Cha for The Post.

The analysis found that Eli Lilly and Novo Nordisk, the largest manufacturers of GLP-1 weight-loss drugs, have made at least one payment to more than a quarter of a million doctors and other prescribers since 2018, the first full year that Novo Nordisk’s Ozempic was on the market. No other class of prescription drugs was promoted as heavily over this period.

Drug companies spent more than $270 million on promotional efforts for their weight-loss and diabetes medications, according to payment disclosures that drugmakers submit to the Centers for Medicare and Medicaid Services. In 2025 alone, payments reached 140,000 prescribers, the most of any year in The Post’s analysis.

The story provides a deep dive into the data that also includes perspectives from doctors receiving payments, critical voices about the practice — and clinicians who say they’ve ultimately been won over by the drugs’ results in their own patients.

Market watch: The GLP-1 market is already enormous, and doctors remain the gatekeepers for access. In 2025, payments from insurance companies and patients for Ozempic, Wegovy, Mounjaro and Zepbound reached more than $110 billion, excluding rebates and discounts.

In addition to diabetes and weight loss, the drugs are now also approved for reducing cardiovascular risk and sleep apnea, and many other indications are being researched — which could further expand the eligible patient population.

What drugmakers are saying: Eli Lilly and Novo Nordisk defended their promotional practices as appropriate and important for health, arguing that they’re grounded in science and are subject to compliance standards.

Why it matters: The payment data offers a look at how the companies are working to influence those prescribing decisions — and the physicians who help shape the broader conversation about obesity and diabetes treatment.

For example, one Texas family physician, Carlos Campos, has received nearly $1 million over seven years to promote GLP-1s — making him one of the highest-compensated providers to boost the medications.

Campos said he visits with doctors and physician assistants in their offices over takeout or at local restaurants, often traveling to other states. He is typically accompanied by a sales representative, whose job is to market the drug while Campos explains how it works, he said.

“I’m a lot like an evangelical preacher man,” Campos, told my colleagues. “They hire me to sell the science.”

These doctors, known in the industry as “key opinion leaders,” can play an influential role in how other physicians view new treatments.

Who gets paid: Many of the 50 doctors who received the most money from the drug companies are also among the country’s most influential voices on obesity and diabetes — including leaders of the nation’s most prominent medical societies in endocrinology and obesity, who write or help shape clinical guidance, and physicians who lecture in continuing medical education programs.

The doctors involved say they’re educating peers about a treatment area many physicians weren’t taught much about in medical school. They say the programs help colleagues overcome skepticism about obesity medicine and understand how the drugs work.

The conflict question: The line between education and promotion is part of what makes the practice controversial, with critics raising conflict-of-interest concerns. Decades of research has shown that financial relationships between physicians and pharmaceutical companies are associated with higher prescribing rates of the sponsoring company’s drugs.

Read the full story: “The largely hidden force helping drive America’s craze for weight-loss drugs.”

Patient groups are the latest to chime in with criticism over how the law meant to protect patients from surprise medical bills is being implemented, joining a growing chorus urging lawmakers and regulators to institute reforms to it.

Families USA on Thursday released a paper about what it calls a gaming of the system set up through the law, called the No Surprises Act, to resolve billing disputes. The group has also put together a report detailing how certain states have tackled the issue — doing so much better, the organization says, than the federal government.

→ It’s the latest in a series of studies and white papers on the surprise-billing topic. The data is coming from providers, the middlemen that help them file dispute claims and from insurers. That’s a larger, more complex topic I want to cover soon.

But, despite their differences, all sides agree that the No Surprises Act isn’t working. It involves a lot of finger-pointing and back-and-forth. For today, let’s focus on some of the solutions coming from those not directly involved in the disputes.

→ Alongside the release of the reports, Families USA sent a letter, leading more than 60 other patient advocacy organizations and employer groups, to congressional leaders asking Congress to reopen the law to enact changes.

“Despite the NSA’s clear success in protecting consumers from surprise out-of-network bills, the law failed to institute a method for setting fair and reliable payments to out-of-network providers that would have helped protect consumers from rising health care premiums,” the letter reads. “We call on Congress to get the No Surprises Act back on track.”

The coalition’s general asks include implementing an overhaul to the No Surprises Act’s dispute-resolution process to replace the baseball-style arbitration set up by the law with a “predictable, transparent benchmark payment methodology” for out-of-network care.

The groups also want what they call a clearer, market-based approach that they argue would reduce incentives to game the system and keep payment awards from getting inflated, while preserving the law’s protections against surprise medical bills for patients.

What to watch: While there is a growing call for reforms, Capitol Hill doesn’t appear eager to reopen the No Surprises Act — at least not yet. This could potentially spur more states to enact their own systems.

→ States including California, Ohio and Virginia have implemented their own laws to protect patients from surprise medical bills that Families USA argues avert some of the pitfalls of the federal system, the organization said in one of the separate reports.

• California: Uses a payment benchmark tied to insurers’ contracted rates or 125 percent of Medicare and requires providers to exhaust internal appeals before heading to the arbitration process. It’s resulted in a decrease of out-of-network charges from providers. And just 269 payment disputes reached California’s arbitration process between 2018 and early 2025, according to the report.
• Ohio: Uses a benchmark based on in-network, out-of-network or Medicare rates. Arbitrators primarily consider in-network rates and cannot consider providers’ billed charges. Just 578 cases reached state independent dispute resolution in 2023, according to the Ohio Department of Insurance. Providers still prevailed more often (about 60 percent of the time), but the results were less lopsided than the federal outcomes, where providers win about 85 percent of the time.
• Virginia: Requires a “commercially reasonable” payment amount based on comparable rates for similar services, and limits providers to one arbitration request per seven days. The report found that has also resulted in a lower number of medical claim disputes sent to arbitration.

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