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In 2026 the picture is more complicated than ever: employer coverage has plateaued and in some cases reversed, Medicare has launched its first-ever weight loss drug program, and several states have eliminated Medicaid coverage

The dual mechanism is why Eli Lilly positions tirzepatide as a distinct therapeutic option and why some patients specifically need it rather than a single-agonist alternative

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Dulaglutide exploits this property of the Fc fragment to extend the half-life by linking the amino acid-substituted GLP-1 molecule to the N-terminal end of the Fc fragment via a 16-amino acid junction (Figure 2)

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