Four novel prescription weight-loss agents have launched in the United States since 2012: Vivus’s Qsymia (phentermine/topiramate ER), Arena Pharmaceuticals/Eisai’s Belviq (lorcaserin), Orexigen Therapeutic/Takeda Pharmaceutical’s Contrave (naltrexone SR/bupropion SR), and Novo Nordisk’s Saxenda (liraglutide 3 mg). However, therapeutic options remain limited, despite the high prevalence of overweight and obesity in the United States and increasing awareness of this public health issue. The reimbursement environment for pharmaceutical obesity treatments is challenging; the high prevalence of obesity has restricted access to medical treatments because healthcare budgets cannot afford widespread use of expensive new medications. In time though, the increase in weight-related comorbidities and complications, particularly type 2 diabetes, will pressure insurers’ healthcare resources. Consequently, the market opportunity for a safe and well-tolerated pharmaceutical agent that can induce satisfactory weight loss is considerable, but drug developers will need to be aware of the unique dynamics of the of the obesity market to ensure access, secure reimbursement, maximize uptake, and realize the commercial potential.