Credit: K KStock/Adobe stock
The rising popularity of GLP-1 medications like Ozempic, Wegovy, and Zepbound has put benefits leaders in a challenging spot. On one hand, employees are demanding access to these game-changing treatments. On the other hand, insurers are inconsistent, and the financial burden is growing fast, especially for self-insured employers.
In my role advising companies across industries, I’m seeing a surge of questions about how to handle GLP-1 coverage. There’s no one-size-fits-all answer. What’s clear is that this issue isn’t going away, and employers need a strategy that goes beyond just responding to the headlines.
GLP-1s: High demand, uneven coverage
Most major health insurers offer some form of GLP-1 coverage, but only under certain conditions. Coverage for diabetes is more consistent. But when it comes to obesity or weight loss, inconsistency reigns within the industry, forcing employers to make tough decisions: Do they follow the trend and add coverage? Or do they implement restrictions to manage runaway costs?
According to recent survey data, nearly 70% of employers now include GLP-1s in their health plans. However, most are already moving to implement coverage limits—and with good reason. GLP-1s can cost upwards of $1,000 a month per employee. For self-insured employers, those expenses flow straight to the bottom line.
Employers should be making sure their benefits broker is helping weigh the clinical value of GLP-1s against the financial sustainability of their benefits programs. As are all total rewards decisions, this is not just a health decision—it’s a business decision.
The cost curve is bending upward
Employers are worried. Nearly two-thirds have flagged high-cost medications as a top concern. And it’s not just today’s GLP-1s fueling that anxiety; it’s the wave of costly therapies on the horizon. The drug pipeline is packed with treatments that could further strain health care budgets.
To stay ahead, many employers are tightening up their pharmacy benefit strategies. Some are moving to more restrictive formularies. Others are using RFPs to re-evaluate PBMs, sharpen pricing, and ensure fiduciary compliance, especially in self-insured environments.
At the same time, three-quarters of employers are conducting audits on their plans. And there’s a growing focus on telehealth, not just for cost savings but to improve access to primary and behavioral care.
Related: Mark Cuban’s Cost Plus prices often higher than insurers' on neurologic medications
What I’m telling clients
When employers come to me asking if they should cover GLP-1s, here’s what I tell them:
Don’t let demand drive decisions. It’s easy to react to what employees want, especially with the buzz around these medications. But a thoughtful strategy starts with understanding your workforce, your claims trends, and your long-term goals.
Balance access with affordability. Coverage doesn’t have to mean unlimited access. Step therapy, clinical criteria, and prior authorizations can help manage utilization without eliminating access entirely.
Think beyond drugs. GLP-1s are one part of the wellness puzzle. Investing in virtual care, nutrition counseling, mental health access, and even fertility or family benefits can offer more holistic value to employees—often at a lower cost.
Prepare for 2026 now. With 85% of employers considering tighter restrictions in the next plan year, we expect major formulary changes on the horizon. Build in flexibility now so you’re not scrambling later.
The HR-finance tightrope
Perhaps the most overlooked aspect of the GLP-1 conversation is the evolving dynamic between HR and finance. CFOs are more involved in benefits decisions than ever before. And in many cases, they’re the ones calling for restrictions, while HR teams are trying to maintain competitive offerings in a tight labor market.
That tension is real. And it’s reshaping how benefits strategies are being developed. Employers are having to quantify soft ROI, like employee retention and satisfaction, while balancing hard-dollar expenses.
A path forward
The GLP-1 challenge isn’t just about one class of drugs. This is a preview of the future of health care benefits. High-cost, high-demand treatments will continue to emerge. Employers who develop a flexible, cost-aware, employee-centric strategy now will be better positioned for what’s next.
© Arc, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to TMSalesOperations@arc-network.com. For more information visit Asset & Logo Licensing.