Why GLP-1 coverage alone isn't enough

As the obesity epidemic accelerates, employers are facing mounting pressure to address weight management in their benefit strategies. The World Health Organization predicts that overweight and obese populations worldwide will reach $3 trillion per year in U.S. dollars by 2030 and more than $18 trillion by 2060. 

GLP-1 medications, such as Semaglutide and Tirzepatide, have emerged as powerful tools that deliver significant weight loss and also reduce the risk of diabetes and cardiovascular disease. But as brokers and consultants know, these drugs come with a steep price tag and the real value to employers and employees depends on more than just coverage. 

Obesity is now recognized as a precursor to a host of serious health conditions, including diabetes, heart disease, cancer, sleep apnea and mental health challenges. Nearly three in four U.S. adults are overweight or obese and by 2030, one in two American workers may be obese, threatening not only individual health but also workforce productivity. 

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GLP-1 drugs have proven clinical effectiveness, with studies showing sustained weight loss over three years, reduced progression to type 2 diabetes and fewer cardiovascular events in at-risk populations. However, these benefits come at a cost: U.S. employers covering GLP-1s are seeing pharmacy spend trends spike by 10% to 20%.

The evidence is clear: GLP-1s are most effective when paired with lifestyle management, specifically, nutrition and physical activity programs. When patients stop GLP-1s, most regain weight, but those who maintain healthy eating and exercise habits experience far less rebound.  

Side effects from these medications include nausea, vomiting, diarrhea, constipation, hypoglycemia, injection site reactions and pancreatitis (which may have serious consequences). Adherence, therefore, is another challenge. Up to 50% of patients discontinue GLP-1s within the first year, but adherence improves significantly when medication is part of a comprehensive program that includes coaching, specialist support and behavioral health resources.

International models reinforce this approach. In countries like France, Germany and Denmark, GLP-1s are only prescribed alongside nutritional counseling and require specialist oversight. This ensures that expensive treatments are delivered within a framework that maximizes outcomes and minimizes waste.

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Blueprint for value-driven benefit design

For brokers and consultants advising employer clients, it is clear that simply covering GLP-1 medications is not enough to ensure meaningful outcomes or justify the significant investment. Instead, a value-driven approach requires integrating GLP-1 coverage within a comprehensive, evidence-based weight management program.

Our global group practice of clinical and executive leadership experts from Europe and Latin America recommends the following best practices:

• Mandatory participation in comprehensive nutrition and physical activity programs.
• At least one consultation with an obesity management specialist, ideally within a center of excellence.
• Access to behavioral health, wellness coaching and care management resources.

This wrap-around model is not only clinically sound but also cost-effective. The incremental investment in these services is far less than the cost of the medications themselves and is essential to achieving the outcomes that justify the expense.

In addition to a holistic nutrition and physical activity regime, we recommend that employers consider GLP-1 coverage for those with Type 2 diabetes or other FDA-approved diagnoses, such as obesity (BMI > 30) with hypertension or dyslipidemia and those with established cardiovascular disease at risk for major events. Over time, as affordability improves, employers also may consider extending coverage to those with obesity (BMI > 27) and additional comorbidities or even based on BMI alone.

It is also important to recognize that while GLP-1s are currently the most talked-about option, they are not the only FDA-approved medications for weight loss. Many obesity specialists will initiate treatment with less expensive, well-established medications before prescribing GLP-1s, a practice known as step therapy. This approach can help manage costs while still providing effective treatment options for employees.

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The landscape is evolving rapidly: More GLP-1 options are coming to market, prices are expected to moderate and oral formulations are on the horizon. As coverage expands, the need for integrated, holistic programs will only grow. 

Any expensive treatment, GLP-1s included, requires not only high adherence but also meaningful, sustained outcomes to justify its cost. The most effective way to achieve this is by integrating medication coverage with required participation in lifestyle and educational programs and ensuring access to leading specialists and centers of excellence. Equally important is fostering social support: Encouragement from family, friends and peers facing similar health challenges can significantly boost motivation and resilience throughout the weight management journey. 

For employers, these elements are not merely added expenses — they represent a strategic investment that yields lasting health improvements, greater employee engagement and better value for every healthcare dollar spent.