How Employers Can Reduce, Stabilize GLP-1 Costs

It is no secret that plan sponsors’ health care budgets are stretched thin covering rising costs, including weight loss drugs, but providers are offering new tools to help rein in the spend.

Glucagon-like peptide-1 medications, widely known as GLP-1s, were originally developed to help control blood glucose levels in people with type 2 diabetes but have since gained Food and Drug Administration approval for treating a variety of conditions—perhaps most notably, obesity.

More than 40% of U.S. adults were classified as obese between 2021 and 2023, with the highest prevalence among working-age adults, according to data from the Center for Disease Control. A study from health science journal Nutrition & Diabetes revealed the cost of excess body weight is steep: In 2023, a 30% obesity rate and 34% overweight rate among 158 million civilian non-farm employees cost employers an estimated $425.5 billion, a product of higher medical claims, disability payments, workers’ compensation costs, absenteeism and presenteeism

In 2025, 36% of employers provided coverage for employees using GLP-1s for both diabetes and weight loss, while 57% provided coverage for diabetes only, according to an International Foundation of Employee Benefit Plans survey. GLP-1s used for weight loss comprised an average of 10.5% of employers’ annual claims in 2025, an increase over the 2024 average of 8.9% and the 2023 average of 6.9%, the data showed. More than one-quarter (27%) of respondents reported GLP-1 costs to be more than 15% of their annual claims.

While a much larger share of companies with at least 5,000 employees covered GLP-1s for weight loss last year (43%) than in 2024 (28%), employers may not be able to sustain that coverage due to cost concerns. Strategies to mitigate those costs include offering direct-to-employer pricing; holistic wellness programs either as a condition of or a supplement to GLP-1 coverage; utilization management; and eligibility requirements.

Direct-to-Employer Pricing

One GLP-1 cost-control strategy employers might explore is partnering with a pharmacy benefit manager that offers direct-to-employer pricing. For example, True Rx Health Strategists, a PBM, and Waltz Heath, a digital technology company, recently launched a collaboration to embed direct-to-employer GLP-1 pricing within employers’ existing pharmacy benefits.

Adrienne Williams LaBorwit, CEO of True Rx, explains that the medications, offered at lower-than-usual cost, would run through an employee’s prescription insurance and count toward their deductible and out-of-pocket costs. The exact amount an employer saves depends on the employer’s plan design, LaBorwit says.

In addition, on Thursday, Eli Lilly and Co. announced the launch of a platform designed to connect employers with more than 15 independent program administrators offering obesity coverage options.

Through the platform, Lilly’s Zepbound KwikPen is available to network pharmacies at a price of $449 for all doses. The list price for Zepbound is $1,086.37 each time the prescription is filled, according to Lilly’s pricing page. The final cost to the employer may vary based on its choice of pharmacy and program administrator, according to Lilly’s announcement.

Holistic Management

In addition to offering a direct-to-employer model like True Rx’s, LaBorwit recommends employers adopt a holistic wellness program for employees taking GLP-1s.

“Employers are concerned about their rising health care costs, but our health care costs are never going to go down if people, at the end of the day, aren’t actually healthier,” LaBorwit says.

Organizations such as Peterson Health Technology Institute have recommended requiring employees to participate in behavior-, nutrition- or lifestyle-change programs as a condition of their GLP-1 coverage. According to Brown & Brown Co.’s “State of GLP-1 Medication Coverage for Weight Loss: Employer Survey Results,” 20% of employers covering GLP-1s for weight loss required employees receiving the drugs to participate in a lifestyle program in 2025. Even more (28%) were considering requiring participation for 2026.

Gabrielle Boisvert, head of solution strategy at telemedicine and virtual health care company Teladoc Health, wrote in a recent article that employers can set guardrails that require a person on a GLP-1 to meet with a health coach and weigh themselves regularly, among other “engagement thresholds” to maintain coverage.

“In our conversations with employers, we emphasize the value of healthy behaviors, such as proper nutrition, physical activity, sleep and stress management, whether or not GLPs are part of the plan,” Boisvert wrote. “Providing access to evidence-based interventions that support meaningful, long-term behavior change is critical to the success of GLP-1 management.”

Among respondents to Brown & Brown’s employer survey, 13% required step therapy—either nonmedication weight loss programs or non-GLP-1 weight loss medications—as an alternative to, or prior to, taking GLP-1s. An additional 15% said they were considering implementing a step-therapy requirement in 2026.

Weight Watchers for Business, a division of WW International Inc., suggested employers look for a weight management provider that offers “personalized coaching (by obesity-trained specialists) to help overcome social challenges, nutritional guidance for mitigating side effects, education on strength training to maintain muscle mass and behavior modification strategies for long-term success.”

“Prevention is key to long-term cost containment,” Weight Watchers’ article stated. “You can address the factors that contribute to weight gain by investing in proactive benefits.”

Setting More Limits

Plan sponsors are also limiting coverage through utilization management strategies and eligibility requirements:

• 80% of respondents required employees to receive prior authorization;
• 54% required employees to meet clinical criteria beyond FDA guidelines;
• 43% limited coverage to a specific GLP-1;
• 15% limited coverage to a specific duration or number of refills;
• 13% limited prescribing physicians to certain specialist types; and
• 9% limited prescribing to one source or a sole provider.

Employers can also consider implementing cost-sharing structures to incentivize participation in comprehensive weight management programs. Weight Watchers recommended offering lower cost-sharing rates for employees who actively engage in holistic weight management programs and demonstrate adherence to their treatment plans.

Marsh McLennan Agency recently published an article that echoed the cost-sharing sentiment.

“With growing employee interest, introducing higher cost sharing through copays or coinsurance can help offset employer expenses and ensure members have a stake in the process,” the Marsh article stated. “This tactic not only discourages unnecessary use but also signals that these drugs are not a first-line solution.”

IFEBP’s survey was conducted between April 25 and May 7, 2025. Brown & Brown completed a benchmarking survey among 237 employers in early June 2025.