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In boardrooms and benefits committees across the country, one question is dominating 2026 planning conversations:
Can we afford to cover GLP-1 weight-loss medications — and can we afford not to?
Employers want to support employee health. Employees are increasingly asking for access to medications like semaglutide and tirzepatide. But the cost math is sobering, the legal landscape is shifting, and the operational complexity is real.
This isn’t just a pharmacy line item. It’s shaping healthcare trend projections, compliance discussions, and employee experience strategy in ways that will define benefits leadership this year.
Healthcare costs are projected to rise approximately 6.7% in 2026, bringing the average annual cost per employee to nearly $18,500, according to Mercer. GLP-1 drugs are a meaningful contributor to that trend.
The eligible population alone is staggering. KFF estimates that 34% of non-elderly individuals with employer-sponsored insurance have a BMI that would medically qualify them for a GLP-1. Even if only a fraction of that group initiates treatment, the financial exposure is significant.
EBRI simulations suggest GLP-1 coverage could increase employer premiums anywhere from 5.3% to 13.8%, depending on assumptions around adherence, cost-sharing, and eligibility criteria.
And adherence matters. Data from Prime Therapeutics, cited by Mercer, shows that only about 1 in 12 members remain on GLP-1 treatment after three years, though persistence rates are improving. Employers are left grappling with a paradox: these drugs may offer long-term health benefits, but the upfront and near-term costs are immediate and visible.
GLP-1s aren’t just another specialty drug category. They represent a structural shift in how employers think about chronic condition management, weight, and long-term health investment.
It’s not just about per-script pricing. It’s about premium impact, downstream medical costs, productivity implications, and the ripple effects on workforce strategy.
In 2024, 44% of employers with 500+ employees covered GLP-1s for weight loss, according to Mercer — a sharp increase from prior years. But that upward trajectory may be slowing as cost pressures mount.
At the same time, Brown & Brown reports that nearly half of surveyed employers cover GLP-1s for weight loss, and 89% plan to continue coverage in the near term. This suggests that while cost concerns are real, many organizations are reluctant to pull back once coverage is offered.
However, coverage rarely comes without restrictions.
Among employers that cover GLP-1s:
Employers are tightening prior authorization criteria, requiring documented comorbidities, or mandating engagement in structured wellness programs before approving prescriptions.
The result is a growing patchwork of eligibility rules, clinical criteria, step therapy requirements, and program participation mandates. For HR leaders, this means balancing fiscal responsibility with fairness and clarity.
For employees, it often means confusion.
Employers are responding to the GLP-1 dilemma in markedly different ways. There is no single “standard” approach — and that’s part of the complexity.
Some employers are maintaining traditional coverage through their pharmacy benefit manager, layering on prior authorization, BMI thresholds, and required participation in lifestyle programs. The goal is to control utilization without eliminating access.
Others are excluding GLP-1s for weight loss entirely, while continuing coverage for diabetes. These decisions are often driven by short-term cost containment pressures. But exclusions carry reputational and legal risk, especially as obesity becomes more widely recognized as a chronic disease.
A growing number of employers are exploring alternatives. According to Axios and Ogletree Deakins, some organizations are:
These approaches allow employers to offer some financial support while capping exposure. But they also introduce additional layers of communication complexity and administration.
The GLP-1 debate is no longer about whether to cover. It’s about how to design coverage that aligns with your values, your workforce, and your financial reality.
Beyond cost, employers must also navigate a shifting compliance landscape.
North Dakota recently became the first state to require certain insurance coverage for GLP-1s, and other states are considering similar mandates. This could signal a broader trend toward regulatory intervention.
There’s also the Americans with Disabilities Act (ADA) to consider. Obesity may qualify as a disability under certain circumstances, and blanket exclusions could create legal exposure. Employers who remove or limit coverage must carefully evaluate potential discrimination risks and ensure policies are consistently applied.
The legal question isn’t just “Can we exclude coverage?” It’s “Can we defend that decision if challenged?”
As mandates evolve and case law develops, benefits leaders will need to remain agile.
While the financial and legal considerations are front and center, there’s another cost that’s often overlooked: complexity.
When over 60% of employers apply restrictions and nearly half require criteria beyond FDA guidelines, the employee experience becomes fragmented.
An employee may:
Without clear, personalized guidance, this quickly becomes overwhelming.
At the same time, HR teams are fielding an influx of questions:
Multiply that across hundreds or thousands of employees, and the administrative burden becomes significant.
In the GLP-1 era, complexity is the real enemy. Not just cost. Not just demand. Complexity.
Benefits strategies are increasingly nuanced — but employees often receive static summaries of coverage that don’t reflect their personal eligibility, medical history, or plan design.
The result is frustration, misinformed decisions, and avoidable escalations.
As GLP-1 strategies become more tailored and conditional, the need for dynamic, personalized communication becomes more urgent. It’s no longer sufficient to update a benefits guide once a year and hope for the best.
This story is still unfolding.
Nearly 200 GLP-1 and obesity drugs are currently in development, signaling that the market is far from mature. Increased competition may drive pricing changes over time. New formulations and indications could shift utilization patterns. State mandates may expand. Clinical guidelines may evolve.
The employers that will navigate this most effectively won’t be those who guess right on a single coverage decision. They’ll be the ones who:
GLP-1 coverage is not just a pharmacy benefits decision. It’s a test of how organizations manage rising costs, employee expectations, legal complexity, and operational scale — all at once.
For HR leaders, this is an opportunity to lead strategically.
The conversation isn’t about whether these medications are “worth it.” It’s about how to design a benefits ecosystem that balances innovation with sustainability — and how to ensure employees can actually understand and navigate what’s available to them.
Because in 2026, offering a benefit is only half the equation.
Helping employees make sense of it — in real time, in their real context — is where value is created.
And in a year defined by GLP-1 decisions, clarity may prove to be the most strategic investment of all.
