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The demand for GLP-1 employer coverage is climbing, prices aren’t getting any lower, and the decision about what to cover has landed squarely on benefits leaders.
Nearly 8 in 10 large employers now say GLP-1s are driving up their healthcare costs.¹ With more and more brands advertising GLP-1 medications for weight loss, it’s going to remain top of mind for employees. But how can your company realistically manage these costs in your benefits budget?
There’s no version of this where you make everyone happy. But there are ways to make a decision you can defend to your CFO and your employees. Here’s the current landscape and a practical framework for navigating the GLP-1 dilemma.
The math is unlike anything else in your plan. GLP-1s approved for weight loss are listed at over $1,000 a month before rebates, and unlike a surgery or an ER visit, this isn’t a one-time claim.
It’s a recurring monthly cost that, clinically, may need to continue for years to sustain results. Multiply that by demand. In 2023, GLP-1s accounted for 6.9% of annual prescription drug claims. By 2026, that figure hit 11.4%.² One drug class now eats more than a tenth of the pharmacy budget for many plans.
And the pressure is about to increase. About 87% of employers anticipate that the availability of oral GLP-1 medications will result in higher demand, and only 9% expect a price decrease.¹
We don’t recommend betting on relief from the market anytime soon.
Many employers feel stuck right now. The market has essentially frozen in place:
Almost nobody is expanding coverage, and a meaningful minority is gradually moving away from it. The employers keeping coverage are doing it with far more conditions attached than they had in 2023 or 2024.
One more shift worth knowing: 27% of employers now point employees toward direct-to-consumer (DTC) pharmacy programs like NovoCare and LillyDirect, where self-pay prices run well below list price. That option didn’t exist at scale two years ago.
It’s important to keep in mind that only about 1 in 12 members are still on GLP-1 therapy three years after starting.³
The vast majority of members discontinue use before the medication gets a chance to deliver the long-term outcomes (fewer cardiac events, lower diabetes incidence, reduced joint and musculoskeletal claims) that justify the spend in the first place.
That’s a missed opportunity for everyone involved. A key question for you as an employer this year isn’t just “should we cover GLP-1s?” It’s “how do we make sure every dollar we spend on GLP-1s goes to members who are set up to stay on therapy and see results?” That reframing leads to much better plan design.
Most employers land in one of four camps. There is no universally right answer — it’ll depend on what works best for your workforce, your funding model, and your budget.
83% of employers who exclude weight loss GLP-1s do it through a formal carve-out from the medical or pharmacy plan.² If you go with model four, make sure the exclusion is explicit in plan documents, not just an unwritten PBM setting an employee discovers at the pharmacy counter.
If you’re covering GLP-1s for weight loss (or want to keep covering them in 2027), these are the steps employers are taking this year:
Leading plans confirm BMI and comorbidities through biometric screening or claims history before approving therapy.
Requiring participation in a clinical weight management or lifestyle program helps employees stay on track. Members with coaching and nutrition support stay on therapy longer and keep results if they taper off.
Some employers limit GLP-1 prescriptions to designated providers or a contracted vendor. That way, you can make sure the medications are medically necessary.
Ask your PBM for net-of-rebate GLP-1 costs and compare them to DTC self-pay pricing. In some cases, the “uncovered” path costs employees less than their coinsurance would under traditional coverage.
Many oral GLP-1 options are already available by prescription in the United States. Set formulary criteria now so you’re not rushing to make a new policy in the middle of a demand spike.
Whatever you decide, don’t let your employees learn about it at the worst possible moment. At the pharmacy counter, or in a denial letter, with no context.
Your plan design might be perfectly reasonable, but employees need to know what’s available to them: the prior authorization steps, the required program that comes with coverage, the DTC option that costs half of what they assumed, the free nutrition counseling. Otherwise, you’ll risk upsetting your workforce and decreasing morale.
Healthee excels at handling these situations. When an employee asks Zoe, our AI benefits assistant, “Is Wegovy covered?”, they get an answer specific to their plan — including what conditions apply, what the prior authorization requires, what alternatives exist, and which in-network providers can help.
Zoe will also steer employees toward more affordable care, explain confusing terms, and proactively remind them about their available benefits. All the while, your benefits team gets time back and better data on what employees are actually looking for or struggling with.
If you want employees to understand exactly what their plan covers (GLP-1s included) without your team fielding every question manually, you should connect with our team.
1. Business Group Health. “GLP-1 Costs Loom Large for Employers, Forcing Challenging Coverage Decisions.” 2026. https://www.businessgrouphealth.org/newsroom/news-and-press-releases/press-releases/2026-glp-1-survey
2. International Foundation of Employee Benefit Plans. “GLP-1 Drugs Survey Report: What Employers Are—and Aren’t—Covering.” 2026. https://blog.ifebp.org/glp-1-drugs-survey-report-what-employers-are-and-arent-covering-in-2026/
3. Mercer (Marsh). “GLP-1 considerations for 2026: Your questions answered!” 2026. https://www.mercer.com/en-us/insights/us-health-news/glp-1-considerations-for-2026-your-questions-answered/
Mostly no, but they're not adding it either. Coverage for both diabetes and weight loss held flat at 36% of employers year over year, and among large employers that cover weight management, about 10% say they're likely to discontinue in 2027. The bigger trend is adding conditions to existing coverage rather than dropping it outright.
List prices for weight loss GLP-1s exceed $1,000 per member per month before rebates, and the category grew from 6.9% of prescription drug claims in 2023 to 11.4% in 2026. Your real number depends on rebates, utilization management, and persistence, which is why a net-of-rebate analysis from your PBM is essential.
Yes, and it's increasingly common. Employers often require verified clinical eligibility plus active participation in a lifestyle or clinical program as a condition of initial and continued coverage.
Be direct about the why, and lead with what you do offer: diabetes coverage where clinically indicated, direct-to-consumer self-pay options (often far below list price), HSA/FSA eligibility, nutrition counseling, and any bariatric or lifestyle benefits.
AI in HR doesn’t have to feel overwhelming. Learn how to choose a first use case, protect employee data, and build confidence with AI.
Reduce benefit renewal costs by reviewing claims data, plan design, employee decision support, and year-round guidance.
AI in HR doesn’t have to feel overwhelming. Learn how to choose a first use case, protect employee data, and build confidence with AI.
