What to know about GLP-1 demand, expense and alternatives

• Key insight: Discover how employers like Starbucks and Cigna are changing their GLP-1 coverage.
• What's at stake: Employers risk budget depletion while employees face losing access to critical weight-loss medications.
• Supporting data: 11.5% is the projected increase in prescription drug costs next year.
  Source: Bullets generated by AI with editorial review.

As employers grapple with how to manage growing GLP-1 coverage demands, understanding trends and legislation, related cost considerations, and additional metabolic health options can help them formulate a smart plan.  

The number of U.S. adults taking GLP-1s for weight loss has jumped from 3% to 11% since 2024, according to Gallup. Meanwhile, employers who cover them are reassessing — research from Mercer shows 6% of large employers, Starbucks and Cigna among them, dropped them from their health plan this year.

With prescription drug costs forecasted to climb 11.5% next year, according to the 2027 Segal Health Plan Cost Trend Survey, coverage dilemmas aren't going anywhere anytime soon. 

"Employers aren't facing a temporary spike in pharmacy costs, but instead a consistent, year-over-year growth," Matt Nguyen, vice president and health informatics consultant at Segal, told EBN earlier this month. "We're seeing a structural shift right now, driven by these drugs."

Before deciding the best course of action, benefit leaders should consider short-term and long-term cost and health impacts, as well as how to get the most out of whatever metabolic health benefits they put in place. 

Business ROI vs. growing costs

Nearly 8 in 10 companies say that weight-loss drugs are driving increases in their medical expenses, research by the Business Group on Health found. Of employers that now cover GLP-1s for weight management, only 72% expect to continue doing so in 2027, while 10% expect to drop coverage. 

"Our findings show the tremendous concern employers have regarding these medications from a cost and financial viability perspective," Ellen Kelsay, president and CEO of Business Group on Health, said in a statement. "Against the backdrop of anticipated double-digit health care cost increases, fueled to a large degree by GLP-1s and overall prescription drug costs, companies cannot ignore the reality that GLP-1s have significant implications for healthcare budgets — and overall affordability."

Read the article: As GLP-1 costs climb, more employers weigh dropping coverage in 2027

More about cost concerns: 

• GLP-1s push health plan costs to 15-year high
• GLP-1 drug use surges, along with coverage costs for employers
• How to stabilize your GLP-1 budget amid increasing demand, cost
• Tom Brady's new play: Making GLP-1s affordable for healthcare workers

How Medicare coverage may impact demand

Medicare launched an 18-month pilot program in June called Medicare GLP-1 Bridge, giving eligible participants access to certain GLP-1 medications for $50 per month. While this program is separate from employer-sponsored health plans, benefits that contribute to the long-term success of these prescription drugs may soon be in higher demand. 

"The Medicare news is a signal flare: GLP-1 access is expanding fast, and a lot of those newly covered people are somebody's employee," said Dr. Jeffrey Vogel, founder and CEO of Concorde Health, a behavioral governance platform for employer-sponsored GLP-1 programs. "As usage climbs, the employers who win are the ones who put behavioral and lifestyle support in front of people the day they start the drug, not after they've already drifted." 

Read the article:  What new Medicare GLP-1 coverage means for employers

More about Medicare's GLP-1 Bridge program:

• Inside Medicare's new GLP-1 demonstration

The need for aligned support

The current generation of GLP-1 medications represent a genuine breakthrough, with compelling clinical trial data ranging from 10% to 20% weight loss across the category. In practice, however, many GLP-1s only deliver single-digit weight loss at 12 months. This gap between what medication can achieve in controlled trials vs. what it actually delivers in a real-world setting is not a pharmaceutical or personal failure. It is a support failure," Dr. Linda Anegawa, chief medical officer at Ognomy Sleep, wrote in an article for EBN.

"Members start medications without understanding how to optimize their response through behavioral coaching. They experience side effects without clinical guidance. They lose weight, then plateau and stop the medication and the weight returns – eroding outcomes in the process. Employee health continues to suffer and there's a significant financial concern for employers: a large spend has occurred yet without the promise of lasting results."

Read the article: Is GLP-1 coverage actually delivering value?

More about GLP-1 support

• Women on GLP-1s and hormone therapy seek better clinical support 
• Sustainable strategies for avoiding the GLP-1 cliff
• Bridging the GLP-1 divide: How employers can build more equitable well-being programs
• How employers end up paying for weight gain

Ways to holistically support metabolic health

Benefit leaders are facing big challenges as they figure out how to put impactful, cost-efficient metabolic support in place — especially when it comes to offering GLP-1 medications, said Laura Walmsley, chief commercial officer at metabolic virtual clinic Virta Health. 

"The first conversation we have is where you sit on this continuum," she said. "Once we've determined that, there's really three decisions that an employer needs to make: How they want to get their population healthier, and whether that is going to be inclusive of GLP-1s or not. If the answer is no, there's still great nutritional care from providers like Virta that they can offer. If the answer is yes, the real question behind that is what are going to be your tools to get your population healthier?" 

Read the article: With or without GLP-1s, your business needs a metabolic health strategy

More about metabolic health approaches:

• From ROI to Retention: The Case for Comprehensive Weight Management Benefits
• Improving Lives, Controlling Costs: How To Optimize Your Weight Care Spending
• 'Food as medicine': Meal delivery is covered under HSA and FSA plans
• A new benefit approach to diabetes and weight loss — without a reliance on meds