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The coverage debate is over. Forty-three percent of employers with 5,000+ workers now cover GLP-1s for weight loss — nearly double last year's number. Of those covering, 89 percent plan to keep doing so. Your clients aren't asking "should we cover this?" anymore.
They're asking "how do we cover this without blowing up our budget?"
That makes this a plan design conversation — and it's one brokers are uniquely positioned to lead.
Employers are splitting into camps. Knowing which one fits your client is the conversation that matters at renewal.
The most common play. GLP-1s stay in the plan, but with prior authorization, BMI thresholds, or mandatory coaching programs alongside the medication. Over 60 percent of employers covering GLP-1s already have restrictions in place.
The logic works: these drugs perform best paired with lifestyle changes, so requiring program participation improves outcomes and gives the employer a defensible framework for maintaining coverage.
Some employers are going a level deeper — renegotiating PBM contracts, carving out specialty pharmacy, or rethinking how GLP-1s flow through benefits entirely. Fifty-eight percent say evaluating new PBM contracting models is a top priority. When one drug category is consuming this much of the pharmacy budget, the standard arrangement deserves a second look.
A growing number of employers are sidestepping plan coverage altogether. Instead, they're contributing $100–$200/month toward employees' direct-to-consumer purchases through HRAs or lifestyle spending accounts. Programs like WeightWatchers' RxFlexFund formalize this — combining manufacturer pricing with a flexible employer subsidy.
The appeal: predictable cost exposure without the open-ended liability of plan coverage.
Each of these carries different cost, compliance, and administrative tradeoffs. Helping clients navigate those tradeoffs — not just pick a yes or no on coverage — is the advisory work that defines this renewal cycle.
EBRI's October 2025 simulation put real numbers to the conversation: premium increases from GLP-1 coverage range from 5.3 percent to 13.8 percent depending on eligibility, cost-sharing, and adherence assumptions.
That range is the point. The difference between 5 percent and 14 percent isn't luck — it's plan design. Who qualifies, what the copay looks like, how tightly utilization is managed. Those are levers your client controls, and walking them through the scenarios is how you turn a cost conversation into a strategy conversation.
State mandates are starting. North Dakota became the first state to require GLP-1 coverage in its ACA benchmark plan, effective January 2025. It applies to individual and small-group plans — not large employers yet — but the precedent is set.
ADA risk is emerging. Employers who cover GLP-1s for diabetes but exclude obesity face growing litigation exposure. Most federal courts say obesity alone isn't an ADA disability, but the EEOC and some courts disagree, and lawsuits are already in play. Clients limiting coverage should document their rationale, align with FDA-approved indications, and apply rules consistently.
Neither of these requires panic. Both require awareness.
Two shifts are reshaping the GLP-1 landscape heading into renewals — and both affect how employers think about coverage.
Direct-to-consumer pricing is now a real alternative. Lilly offers Zepbound starting at $299/month through LillyDirect, with Walmart pickup nationwide. Novo Nordisk launched NovoCare Pharmacy with Wegovy at $199/month for new patients. More than a third of new Zepbound prescriptions already come through the DTC channel. When employees can access GLP-1s for $200–$500/month out of pocket, it changes the pressure dynamic on employer plans — but also fragments utilization data and raises equity concerns for lower-wage workers who can't front the cash.
TrumpRx is adding another layer. The administration's November 2025 agreements with Lilly and Novo established prices of roughly $350/month for Ozempic and Wegovy and $346 for Zepbound through the TrumpRx platform, which launched in early 2026. Medicare will cover GLP-1s for obesity for the first time. There will be significant pressure on PBMs to bring employer plan pricing in line with these numbers. Some employers may start reimbursing employees who purchase through DTC channels via HRAs instead of covering through the plan at all.
The assumptions baked into last year's plan design may no longer hold. That's worth revisiting before renewal season, not during it.
The clients who navigate this well will be the ones whose brokers help them do four things:
Model scenarios. Use the EBRI framework. Run the numbers for different eligibility, copay, and adherence assumptions. Show clients the range and let them choose where to land.
Challenge utilization assumptions. Over 40 percent of insured adults are clinically eligible for GLP-1s, but two in three patients quit before 12 weeks. The gap between potential demand and real demand is where plan design meets reality.
Match coverage to the workforce. A manufacturing employer with an older, higher-BMI population has a different calculus than a tech company. Coverage strategy should reflect the population, not a generic benchmark.
Connect it to the bigger picture. GLP-1 strategy isn't a standalone pharmacy decision. It ties into wellness programming, chronic condition management, and how well benefits are personalized to the people who use them. Employers who use data to match the right benefits to the right employees will find this manageable. The ones who treat it as an isolated line item won't.
Sources: KFF 2025 Employer Health Benefits Survey; Brown & Brown 2025 Strategy Report; EBRI Issue Brief No. 644 (October 2025); Mercer; IFEBP; Morgan Lewis; North Dakota Insurance Department; White House; WTW; Eli Lilly; FDA.
