GLP-1 access in Belize: WHO's essential list and chronic-drug costs

Semaglutide and tirzepatide are now on the World Health Organization's list of the medicines every health system should have. Belize, where one in six people lives with diabetes⁶, is deciding how to pay for chronic-disease care. On 21 October 2025 Cabinet asked the Ministry of Health and Wellness to work with the Ministry of Finance "to explore ways to reduce the cost of certain classes of drugs used in the management of noncommunicable diseases"⁴. The San Pedro Sun reported the plan as an effort to lower prices by regulating the supply chain and working with pharmaceutical companies⁵. Cabinet did not name drug classes⁴. This is what the international benchmarks say about the newest and most expensive class, the GLP-1 receptor agonists.

What WHO's Essential Medicines List says about GLP-1 drugs

WHO's 2025 update added 20 medicines for adults, bringing the list to 523¹. It included the GLP-1 receptor agonists semaglutide, dulaglutide and liraglutide and the dual GLP-1/GIP agonist tirzepatide as glucose-lowering therapy for adults with type 2 diabetes and established cardiovascular disease or chronic kidney disease who also have obesity¹. That is narrower than common use. WHO warned that "High prices of medicines like semaglutide and tirzepatide are limiting access to these medicines" and recommended prioritising patients who benefit most, encouraging generic competition and offering the drugs in primary care¹. The narrow listing tracks the outcome evidence: in patients with type 2 diabetes and chronic kidney disease, semaglutide reduced major kidney events (hazard ratio 0.76) and death from any cause¹³.

WHO's first obesity guideline for GLP-1 therapies

On 1 December 2025 WHO issued its first guideline on GLP-1 therapies for obesity². It says they "may be used by adults, but excluding pregnant women, for the long-term treatment of obesity," and that intensive behavioural programmes may be offered alongside them on low-certainty evidence². The recommendation is conditional because of "limited data on their long-term efficacy and safety, maintenance and discontinuation" and because of "their current costs, inadequate health-system preparedness, and potential equity implications"². WHO suggested pooled procurement, tiered pricing and voluntary licensing to widen access². PAHO, for its part, asked countries in March 2026 to keep use within "indications approved by the national regulatory authority" and warned of sales through the internet and social media³.

Belize's formulary, tenders and pooled purchasing

Belize's public sector buys from a national list. The 10th edition of the Belize Drug Formulary and Therapeutic Manual, launched in October 2020 for 2020–2023 with PAHO's help, classes each drug as "vital, essential, or necessary for the country" and guides procurement and inventory⁷. That edition predates WHO's 2025 GLP-1 listing¹⁷. The Ministry tenders by generic name: "When we do our tender process we do not put any brand to the product," the Director of Health Services said in 2019¹². Pooled purchasing is another lever. The PAHO Strategic Fund buys medicines on the WHO Essential Medicines List for its members and "pools demand, thus achieving better value for money"⁹. Dr. Javier Zuniga said in July 2026 that Belize's full WHO drug-monitoring membership lets it buy "directly through PAHO from WHO-certified suppliers"⁸. Diabetes care is also being reorganised: in October 2025 PAHO, the World Diabetes Foundation and the Ministry launched a project to integrate diabetes services into primary health care¹⁰.

Where the price gap lies

The gap between what GLP-1 drugs cost to make and what they sell for is large. A 2024 economic evaluation combined trade data on active-ingredient costs with formulation and operating costs and a profit margin, and estimated sustainable cost-based prices of $0.75 to $72.49 a month for GLP-1 agonists, "substantially lower than current prices" in the 13 countries surveyed¹¹. The authors concluded that "robust generic and biosimilar competition could reduce prices"¹¹. WHO's own projection is that, despite fast-growing production, fewer than 10 % of those who could benefit will get GLP-1 therapy by 2030². For a small market like Belize, that is the context for Cabinet's request: any lower-cost GLP-1 supply would have to come through registered products and the tender and pooled-buying routes above⁴⁹.