How to protect access and manage GLP-1 costs

Surveys of employers and health benefit leaders consistently find that for most pharmacy plan sponsors today, the number one concern is the financial impact of GLP-1 medications, particularly for obesity treatment.¹

And yet, obesity is associated with many health conditions, ranging from cardiovascular diseases to cancers, so effective medications to help people control their weight could have substantial health benefits.²

So much is riding on determining how to gain the clear health advantages of GLP-1s without straining the health system. For employers and plan sponsors, the question is no longer whether GLP-1s matter — it is how to provide access while maintaining long-term affordability.

This information can help plan sponsors benchmark their approach and prepare for future coverage decisions.

The answer depends on the indication.

GLP-1 coverage refers to a plan sponsor's decision to include GLP-1 medications within its pharmacy benefit for specific indications such as diabetes or obesity.

For type 2 diabetes, GLP-1 coverage remains widespread and relatively stable. A 2024 survey of large employers found that 97% covered GLP-1 medications for diabetes treatment.³

For obesity and weight management, coverage expanded substantially between 2023 and 2025. Business Group on Health reported that 67% of surveyed large employers covered GLP-1s for weight management in 2024. An additional 3% planned to add coverage in 2025, with others considering future adoption.⁴

At the same time, newer data indicates that growth may be slowing. Only 72% of employers currently covering weight management GLP-1s expect that they will continue coverage through 2027, while 10% indicated they likely would not.⁵

Other analyses have found commercial coverage rates for obesity GLP-1s in the range of 30%-40%, illustrating the significant variation across segments of the market.⁶

Source: Brown & Brown. State of GLP-1 Medication Coverage for Weight Loss: Employer Survey Results (2025).

These developments suggest that while the number of plans offering some degree of coverage has increased, the average covered member is more likely to face clinical review and adherence requirements than in prior years.

Yes. One of the clearest patterns in the market is that larger employers are more likely to cover GLP-1s for obesity than smaller employers.

ICER has also noted that commercial coverage is generally more generous among larger employers, wealthier industries and organizations with more stable employee populations.⁸

KFF and Peterson Center analyses found substantial variation by employer size. In 2025, approximately 43% of firms with 5,000 or more employees covered GLP-1 drugs for weight loss, while only 19% of employers with 200+ employees did so.⁹

Increasingly, yes.

Although there is no single national standard, employers, PBMs and health plans are converging around several common principles for obesity-related GLP-1 coverage. These include:

a)  Objective obesity criteria, usually based on BMI thresholds and FDA-labeled indications.¹⁰

b)  Documentation of obesity-related comorbidities such as diabetes, cardiovascular disease, sleep apnea or other metabolic conditions.¹¹

c)  Prior authorization review before therapy initiation.¹²

d)  Lifestyle intervention requirements such as participation in coaching or weight-management programs.¹³

e)  Ongoing monitoring and adherence review to justify continued coverage.¹⁴

Thus, while benefit designs still vary, there is growing alignment around the idea that coverage should be tied to documented clinical need and structured obesity-management programs. 

Across the market, the prevailing model is shifting from simply paying for a drug toward supporting a broader obesity-management journey. 

Many employers require participation in structured weight-management services that include nutritional counseling, exercise guidance and behavior-change support.¹⁶

Leading organizations are increasingly adopting integrated models that combine clinical criteria, coaching and benefit navigation. The Optum Rx Weight Engage program reflects this broader market trend.

Weight Engage combines medication management with lifestyle and behavioral support. The program can connect members with obesity management specialists who develop individualized treatment plans and coordinate clinically appropriate care.

Members also have access to health coaching focused on nutrition, physical activity, behavior change, motivation and long-term weight-loss maintenance. Optum Rx supplements these services with benefit navigation, patient monitoring and digital health partnerships that support adherence and healthy habit formation.

Weight Engage incorporates behavioral coaching and support services through partners such as Calibrate,® Omada Health® and Virta Health®, reinforcing sustained lifestyle changes alongside GLP-1 therapy.¹⁷

Employers can tailor eligibility and support requirements, including participation in weight management programs, to encourage appropriate GLP-1 use while improving outcomes and managing costs.

Scenario 1: Continued coverage with tight guardrails

This may be the most likely near-term outcome. Employers maintain coverage but require prior authorization, clinical eligibility verification and participation in weight management programs.¹⁸

Scenario 2: Broader coverage driven by lower prices

If competition from new injectable and oral GLP-1 products substantially reduces net prices, employers may expand eligibility and reduce utilization management restrictions. Several analyses suggest that affordability, rather than clinical skepticism, is the primary barrier to broader coverage.^{19, 20}

Scenario 3: Coverage retrenchment among some employers

Rising pharmacy spending could lead some employers to eliminate obesity coverage entirely or restrict access to high-risk populations. Surveys already show that some employers are considering reducing benefits because of budget pressure.²¹

The most recent evidence suggests that GLP-1 coverage for obesity has expanded meaningfully but is entering a new phase characterized by cost management and clinical oversight. Most importantly, plan sponsors appear to be converging around common evidence-based standards for determining who receives therapy.

The emerging industry consensus around structured clinical criteria and lifestyle support aligns directly with our Weight Engage approach.