The FDA approved the first semaglutide drug for weight loss more than a decade ago, but the so-called GLP-1 market exploded more recently, after the 2021 greenlighting of the GLP-1 drug Wegovy for weight management. Employer uptake may be slow—Kaiser Family Foundation estimates that less than one-fifth of organizations with more than 200 employers covered GLP-1 drugs for weight management last year—but demand is high. KFF found that almost half of Americans are interested in an effective weight-loss medication, while a J.P. Morgan study estimates that 30 million Americans could have such drugs prescribed for weight loss in the next five years.

That interest could influence whether workers jump ship—or stay on board—for employers that cover GLP-1s for weight management: Cardiometabolic care tool 9amHealth found that more than two-thirds of the 1,300 Americans it surveyed would stay at a job they didn’t like because of its GLP-1 coverage. Twenty percent would be likely to take a new job if it offered such coverage.

“If the employee is paying for the GLP-1 drugs out-of-pocket now but another employer covers it at 50%, then that can be as much as $675 added to their monthly budget,” says Tom Tran, senior vice president of the pharmacy practice at consulting firm Gallagher.

However, the hefty price tag of GLP-1 drugs is among the factors complicating decisions about employer coverage.

“Employers are already facing pressure to balance rising healthcare costs with workforce wellbeing, and GLP-1s present both an opportunity and a challenge,” says Kristin Hall, vice president of clinical programs at health navigation platform apree health.

“While these medications can be highly effective for weight management and metabolic health, their long-term affordability, sustainability and appropriate utilization remain key concerns.”

Cost and other GLP-1 coverage concerns

As Hall references, employer healthcare costs already are soaring: Late last year, Mercer estimated that employers would see a 5.8% hike in healthcare costs in 2025, the third consecutive year of record-high increases. The firm cites prescription drug costs as the fastest-growing component of benefit cost increases.

GLP-1s are poised to keep those numbers rising.

KFF estimates that GLP-1 prescriptions cost nearly $1,350 per employee, per month, while a proprietary projection model from pharmacy benefits optimizer RxBenefits found, that for an employer plan with 1,200 members, GLP-1 coverage could add between $73,000-$184,000 in plan ingredient costs in the first year.

Yet, the potential ROI from effective weight management could be significant: Improved health outcomes, increased productivity and potential reductions in obesity-related conditions—from cardiovascular disease to diabetes—all should be considered, says Hall.

Patient adherence and employers

However, one vexing challenge to employers realizing that positive return will be employees themselves, as patient adherence will play a significant role in long-term ROI for employers that decide to cover GLP-1s.

“Research shows that GLP-1 discontinuation rates are high—up to 50%—with many patients stopping within the first year due to cost, side effects or lack of comprehensive support,” says Hall of apree health. This could become an increasing problem as reports of side effects surface, particularly GI symptoms.

For HR and benefits leaders weighing employee interest with potential cost impact, “ensuring the right patient gets the right drug at the right time is more critical than ever,” says Mark Campbell, chief pharmacy officer at RxBenefits.

Employee health data can be critical to informing the safest path forward for the employee—and the most cost-effective for the employer, adds Hall.

“For example, some members may benefit more from being placed on a medication management plan, while others may be better suited for a lifestyle management path that focuses more on nutrition, behavior change and exercise,” she says.

Employees’ primary care providers, she adds, should serve as the “quarterback” at the helm of their weight management experience. “It’s important that we don’t have people taking GLP-1s or weight loss medication without primary care,” she says.

Cost-saving strategies for GLP-1 coverage

Broad and blanket GLP-1 coverage isn’t sustainable; rather, forward-thinking employers, Hall says, are prioritizing integrated, cost-effective strategies that leverage medication where appropriate alongside behavioral, nutritional and lifestyle support.

“Without a holistic weight management strategy,” Hall says, “employers risk significant pharmacy spend without achieving long-term success.”

To yield both cost savings and sustainable health impacts, Hall says, weight management programs need to take a “comprehensive approach.”

“A holistic, integrated approach that balances medication use with behavioral change and structured clinical support is the key to delivering real health outcomes while maintaining financial responsibility,” she advises.

The role of plan design in reducing employer costs

Such strategies should speak to the socioeconomic factors impacting employee health, and include lifestyle support—from access to health coaches and dietitians to behavioral interventions—as well as mechanisms for proper prescribing and oversight.

“Ultimately, these solutions will promote lasting behavior change to help employees maintain a healthy weight for life,” Hall says.

Keeping employer costs down, adds Campbell, will hinge on basing plan design and coverage decisions around plan goals and member needs. To that end, he suggests, implement a prior authorization process—supported by diagnosis, lab results and other documentation—and leverage a human-led review process for approvals. Decisions should be “specific to each member’s unique needs and circumstances,” rather than “one-size-fits-all automated processes.”

Utilization management tools like step therapy can also ensure that “lower-cost, clinically appropriate first-line therapies are being tried first when applicable,” he says. Hall also suggests that employers consider tiered cost-sharing to manage pharmacy costs.

It’s imperative that HR and benefits leaders continuously monitor health outcomes related to GLP-1 coverage for weight management—biometrics, medication adherence, lifestyle engagement and metabolic health improvements, suggests Hall. Keeping a finger on the pulse of this data will help leaders “measure the program’s ROI while ensuring employees receive the care and support they need.”

A benefits landscape in flux

This is shaping up to be a “pivotal year” for the GLP-1 drug class, says Campbell, as a number of macro trends will influence the landscape in which HR and benefits leaders are considering plan design and implementation.

For instance, the scope of GLP-1s is expanding: Zepbound by Eli Lilly was recently approved by the FDA for treatment of sleep apnea in patients with obesity, while Ozempic was greenlit to reduce risk for kidney disease and other conditions. Meanwhile, Campbell says, there are other trials in progress that could continue to broaden the use of GLP-1s for other chronic conditions.

“If approved, the expanded indications will not only increase utilization for those conditions, they may also give manufacturers greater access to more of the obesity market,” he says, as many of these conditions are considered comorbidities of diabetes and obesity. “In many cases, this would circumvent a payer’s plan design restricting coverage for weight loss and increasing plan costs.”

At the same time, new market entrants like pill-form GLP-1 drugs “could potentially lower prices” for employers, Campbell says; however, those savings may be canceled out by increased utilization. Increasingly, the drugs are being offered in compounded alternatives, he adds, which also “could offer lower-cost alternatives, but once again increase demand and utilization.”

How will Trump affect GLP-1s?

The new Trump administration’s influence over the GLP-1 market is also a significant question mark for employers. The Biden administration proposed that the Centers for Medicare and Medicaid Services (CMS) cover GLP-1s for obesity and, if this proposal were to move forward, Campbell says, “it could profoundly influence the commercial marketplace. It is not uncommon for the commercial market to follow CMS’ lead.”

Tran notes that Trump’s early actions include efforts to roll back Biden-era policies aimed at lowering prescription drug costs, such as through expanding Medicare’s ability to negotiate drug prices. Ozempic and Wegovy were among 15 drugs the Biden administration added to the list that the CMS will negotiate prices for by 2027; since Trump took office, CMS officials have stated the agency is proceeding with negotiations but is looking to “improve” the program. 

“It will be interesting to see what price the government is able to negotiate with the drug makers as this might help to lower the price of these medications for all Americans,” he says.

As employers keep an eye on changing regulations, the growing scientific recognition of obesity as a chronic disease is also likely to influence how GLP-1 drug coverage is addressed, Tran says.

HR and benefits professionals have to take a measured, strategic approach to benefits decision-making, given the breadth and complexity of the changing GLP-1 landscape.

“By framing the case with a balance of financial, clinical and cultural considerations,” Tran says, “HR and benefits leaders can address hesitations while aligning coverage decisions with organizational goals.”

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