Employers are increasingly challenged with finding the right balance between providing coverage of GLP-1 medications for weight loss and the financial sustainability of their health plans. Findings from Business Group on Health's 2027 Employer Healthcare Strategy Survey show employers are adopting more aggressive pharmacy cost-management strategies, particularly around GLP-1s, with the percent of organizations covering these medications for weight management falling from 72% in 2025 to 60% in 2026.

Eliminating coverage is only one of several approaches to managing costs, as employers evaluate how to support access through less traditional direct to consumer models and procure the medications through direct to employer channels, to support access but also manage long-term affordability.

Why Have GLP-1s Become a Major Cost Concern for Employers?

Obesity is widely recognized as a complex chronic condition that warrants clinical intervention, and GLP-1s have demonstrated meaningful weight loss results. At the same time, GLP-1s combine several factors that drive healthcare cost pressure: high commercial-market prices, significant and growing demand, and the need for long-term or life-long use.

The issue has evolved over the past several years rather than emerging overnight and continues to influence benefit strategy discussions across organizations and in many cases with C-Suite involvement. As overall healthcare costs rise and coverage decisions become more complex, the conversation has increasingly moved beyond HR and benefits teams to the C-suite, with Business Group on Health survey findings showing that 88% of senior leaders are paying greater attention to health and well-being initiatives and healthcare costs.

Many recognize that obesity can contribute to a range of conditions affecting health, productivity, and quality of life. Consequently, conversations about GLP-1s are increasingly connected to broader strategies focused on prevention, chronic disease management, and whole-person health.

While employers are concerned about rising pharmacy costs, they are equally focused on ensuring that patients within their population using GLP-1s for weight loss receive appropriate clinical support and achieve meaningful health outcomes. There is particular concern about waste when individuals discontinue therapy, use medications inappropriately, or do not receive the behavioral and clinical support needed to reduce and maintain healthy weight. Further, employers have long had other weight management programs in place that may be more beneficial and appropriate for some patients (e.g. other anti-obesity medications, lifestyle and nutrition programs, bariatric centers of excellence).

What GLP-1 Cost-Management Strategies Are Employers Using?

Increasingly, employers acknowledge that there is not one unique solution to managing GLP-1 costs. While many continue to cover these medications for weight management, some employers are choosing to eliminate coverage altogether. According to Business Group on Health's survey, 14% of employers have already eliminated coverage for GLP-1s for weight loss or plan to do so in 2027.

For those employers that continue to offer coverage for weight loss, the focus is on managing utilization with intention, strengthening clinical oversight and supporting appropriate use. For example:

• Aligning Coverage with Clinical Need: Some employers cover GLP-1s only for diabetes, while others continue to cover them for weight management but with more restrictive eligibility criteria. Employers may prioritize individuals with higher cardiometabolic risk or require additional clinical documentation before approving coverage.
• Expanding Utilization Management: Business Group on Health’s survey found that 69% of employers validate eligibility through biometrics and 45% require participation in a weight management program. Employers may also limit prescribing to designated providers, specialists or preferred clinical programs to help ensure appropriate use.
• Evaluating Alternative Procurement and Access Models: Organizations are also exploring whether traditional pharmacy benefit structures provide enough flexibility. Alternative procurement arrangements, direct-to-employer models and other coverage innovations are attracting greater interest as employers seek additional leverage on pricing and program design.
• Measuring Value While Managing Financial Risk: Many employers continue to evaluate whether short-term spending increases will ultimately lead to better long-term health outcomes, productivity, and reduced medical costs. However, the financial pressure remains significant. As a result, employers are simultaneously pursuing better outcomes, greater accountability, and stronger controls around access and utilization.

How Should Employers Manage Employee Expectations and GLP-1 Information Overload?

For many employees, information about GLP-1s does not come from their health plan first. Media coverage, social media platforms, online communities, celebrity endorsements, and direct-to-consumer advertising all contribute to growing awareness and demand.

While increased awareness can encourage individuals to seek care, it can also create confusion about treatment expectations, eligibility requirements, costs, and potential outcomes. Employers need to proactively help their employees navigate an increasingly confusing array of access channels.

• Make Coverage and Access Communication Part of the GLP-1 Strategy: Employees need clear information about what is covered, who may be eligible, how prior authorization works and where they can find support. Consistent messaging can improve the member experience and help employees make informed decisions about their care. If GLP-1s for obesity are not covered, communications can emphasize the other weight loss management programs and treatments that members have access to and emphasize the importance of accessing these medications through qualified providers and clinically appropriate channels.
• Set Expectations About Treatment: Successful treatment may require sustained engagement with healthcare providers, lifestyle modifications and continued monitoring. Clear communication about these realities can help prevent medication abandonment and improve long-term outcomes.
• Equip Managers and Benefits Teams: Employees frequently direct questions to these groups first, making consistent messaging essential. Helping internal stakeholders understand coverage rules and available resources reduces confusion and steers members to trusted sources of information and coverage.

The Bottom Line

The demand for and the cost of GLP-1 medications are challenging traditional approaches to coverage decisions and are impacting healthcare affordability. While employers recognize the promise these medications may hold for improving health outcomes, long-term financial sustainability remains a concern. Business Group on Health survey findings highlight the difficult balancing act employers face as they seek to support employees while managing rising healthcare costs.