The evolution of the current use of the newer GLP-1s, however, makes it vital that these medications follow the latest FDA guidelines. For example, GLP-1s prescribed for weight loss should match the current FDA clinical guidelines for patients who are clinically obese and have a body mass index (BMI) of 30 or greater (or 27 when select co-morbidities are present).

Following FDA guidelines – while discouraging off-label use – will help protect the health of the individual and employers' investments in their pharmacy benefit offering. Though these drugs may offer a cost benefit, off-label usage may expose employees to a series of known and unknown health risks.

Balancing act: Where benefits outweigh costs

GLP-1 medications, on average, can cost individuals $1,000 per month if their employers do not provide insurance coverage.

While this presents some initial sticker shock, jumpstarting weight loss and staving off conditions that are more likely due to obesity can motivate employees in their journey to a healthier lifestyle. If utilizing GLP-1s to combat obesity is successful, in the long term, employers may reap the benefits of lower health care costs overall for employers.

GLP-1 coverage has employee satisfaction and retention benefits, too. A 2023 study found that companies that include GLP-1 medications in benefit plans have seen higher employee satisfaction. As a result, 99% of the employers currently covering GLP-1 drugs plan to keep covering them next year to demonstrate their commitment to employee wellbeing.

A comprehensive three-step approach

Covering GLP-1 medications under a pharmacy benefits plan requires a holistic approach.

The first step is to conduct thorough due diligence to ensure interested employees are GLP-1 eligible. This can be done through prior authorization programs that use BMI and a physician assessment to gauge other risk factors. If employees are not eligible, this provides an opportunity to refer them to other wellness benefits, including lifestyle, nutrition, and behavioral health support. Many third-party programs offer these programs in addition to GLP-1 prescribing. In fact, many programs offer mandatory engagement in the above programs before using a GLP-1, and studies show a higher rate of success when a member stops treatment.

Next, employers need to closely monitor employees' use of GLP-1 medications to determine whether they are being taken as prescribed, having the intended weight loss impact, and employees are not experiencing untoward side effects. GLP-1s are generally well tolerated, although severe side effects have been reported and need to be considered and reviewed carefully with the patient and clinician prior to and during treatment.

One way in which employers can support education and monitoring of GLP-1 utilization is through third-party vendors or pharmacy benefit managers. These offerings enhance all aspects of treatment with GLP-1s to help employers mitigate unnecessary spending while creating a supportive and caring environment for the employee-patient.

Finally, understand that current FDA guidelines define GLP-1s for weight loss as a maintenance drug. Employees may reach the point in treatment, however, where they may want to stop taking GLP-1 drugs and/or the clinician may determine it may be time to consider discontinuing or weaning the individual off the medication. As such, this does not mean the care journey is over; it's the beginning of a new phase and what should be considered the most important phase.

Related: Low-income patients struggle to afford high-priced GLP-1 diabetes drugs

This is where a comprehensive wellness and lifestyle program with continued engagement is even more critical to educate employees on how to keep weight off. Unfortunately, studies have shown that, on average, patients regain most of their lost weight within a year of stopping treatment.

By adopting the comprehensive approach outlined above, employers have an opportunity to combat obesity and bolster their employees' health via GLP-1 coverage. By covering these drugs and providing educational and clinical support through vendor programs, employers can help foster employee satisfaction and retention while promoting a healthier lifestyle and wellness journey.

Andrea Grande R.Ph. is a principal at Brown & Brown.