Sustainable strategies for avoiding the GLP-1 cliff

Employers are facing one of the fastest-rising costs in healthcare today: GLP-1 medications prescribed now account for 17% of U.S. employer pharmacy claims, in large part due to the increased demand for weight-loss medications. Beyond cost, there are additional GLP-1 challenges that employers are experiencing, including growing demand, emerging indications and adherence issues.

All this being said, it's worth noting that more employers are facing the risks of the "GLP-1 cliff" — a sharp drop in engagement and outcomes that can occur when employees lose access to medications due to cost, coverage limits or lack of long-term support. Fortunately, employers don't need to start from scratch. There's already a foundation of trusted, proven strategies to turn early wins into lasting health.

Employees with obesity are more likely to face serious chronic conditions like type 2 diabetes, hypertension and heart disease. Obesity is also linked to double the medical claims of peers, higher absenteeism and nearly twice the short-term disability claims. The impact isn't just financial. These employees also face stigma, fatigue and mental health struggles that make it harder to stay engaged.

Originally developed for type 2 diabetes, GLP-1s are now a breakthrough treatment for obesity and obesity-related chronic conditions such as diabetes, heart disease, liver disease, MSK, kidney disease, sleep apnea and more. The issue is the unique nature of taking GLP-1s for weight loss. People on these medications need an enormous amount of guidance and support. Just look at the staggering discontinuation rates: research found that as many as 30% of people stop taking GLP-1s within the first six months. This is why expert, individualized care – built on a foundation of behavior change – is what drives sustainable health. 

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Red flags not to ignore

The pressure to offer coverage is intense — 44% of employees say they'd consider leaving a job to gain access to obesity treatment, yet only 28% of larger-sized organizations offer GLP-1s for weight loss. Given this backdrop, it's easy to get caught up in vendor pitches that sound good in the moment. But the difference between short-term hype and long-term value comes down to spotting key red flags. Here are a few employers and their broker-adviser partners should be aware of:

• An overemphasis on participation. Some vendors highlight sign-ups or prescription fills as proof of a successful program. That may look good on paper, but it doesn't tell you whether health outcomes improved or claims went down. 
• Accessibility isn't enough. Behavior change isn't a nice-to-have — it's what makes results stick. When employees build healthier habits, they're more resilient, more engaged and more likely to keep progress going after the medication. That pays off in both health and costs.
• Broad solutions that can't adapt. No two employees are the same. Programs that don't adapt to different health risks, cultures or preferences leave people behind — and employers paying for short-term progress that doesn't last.
• Watch for hidden costs. What looks simple up front can balloon later. Uncertainty around compounded drugs, extra navigation fees or unsupported self-pay models can quietly drive up spend.
• Be cautious of another silo. Employers already juggle multiple vendors. If a program doesn't connect with your client's existing pharmacy, wellness or care management benefits, it adds more confusion for employees and more work for HR and benefit teams.

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Similarly, these four questions will quickly show whether a vendor can deliver outcomes that last or the risk will be inherited:

1. How will employers measure outcomes that actually matter?
Look for signs of staying power such as long-term weight loss and lowered risk or prevalence of chronic conditions like blood pressure or type 2 diabetes. If the only number they can give is participation or enrollment, that's potentially a sign to walk away. 

2. What happens when employees stop or shift their treatment?
GLP-1s may not be needed forever for everyone. Some will stop because of side effects or preference, others because they've hit their goals and some may transition to a lower-dose or oral version for weight maintenance. Ask vendors how they'll support employees when they've hit the weight maintenance stage or their GLP-1 needs change.

3. How will this fit into what we already offer?
Employers don't need another silo. If a vendor can't explain how their program connects to your client's care management, pharmacy and wellness benefits, it means more complexity and  confusion for employees. Integration isn't nice to have — it's what makes the whole system work.

4. What risk are you willing to share?
If a vendor is confident that they'll deliver, they should be willing to financially guarantee outcomes. That could mean improved health measures, lower claims or less reliance on costly medication. If they aren't willing to share the risk, the odds are your client will be carrying it alone.

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The GLP-1 cliff isn't about the drugs. It's about durability. GLP-1s can be a life-changing tool but need the right support for sustainability. By building a better benefits foundation, employers can avoid the GLP-1 cliff. This not only protects dollars but gives employees a fair shot at long-lasting health.