Drugs like Ozempic®, Wegovy®, and Zepbound® are delivering meaningful results. Patients are losing weight, improving diabetes management, and better controlling chronic conditions. Yet, they are not the right solution for all patients, and drug costs are piling up for employers. As a result, employers are conflicted over whether or not to cover GLP-1s for weight management. Most of those decisions stop there.
Whether an organization covers GLP-1 medications fully, partially, or not at all, the coverage decision is only one part of the equation. The employers seeing the strongest outcomes, regardless of where they landed on coverage, are the ones who paired their decision with a broader workforcehealth strategy.
For those who do cover GLP-1s, clinical support, nutrition guidance, and long-term accountability significantly improve the likelihood of sustainable results. For those who do not, structured weight management programs offer an alternative path to the same goal.
The question is not whether to cover GLP-1 medications. It is whether your organization has a strategy built around the answer.
The growing demand for GLP-1s
Today, approximately 40% of U.S. adults are obese, and 1 in 8 adults report taking GLP-1 medications for diabetes, weight loss, or another chronic condition. Employee demand continues to rise because these medications are producing meaningful clinical results. Employees are experiencing weight loss, improved energy, better blood sugar control, and improved quality of life. Employers are also recognizing that obesity is a complex medical condition that requires more than a simple, yes-or-no coverage decision.
For many employers, these GLP-1s at a cost of $10,000 to $17,000 per patient annually, are now among the largest drivers of pharmacy spend, sometimes outpacing traditional specialty medications. As utilization grows, employers are taking a closer look at clinical appropriateness, prior authorization requirements, benefit design, and long-term cost sustainability.
Tailoring your GLP-1 strategy to your business needs: 4 common strategies
The most effective GLP-1 approach is simply the one that fits your organization, and employers have a range of options. The right path depends on your workforce goals, financial priorities, and the level of clinical support you want to provide.
Here are four potential strategies for your business:
- Do not cover GLP-1s for weight management: Coverage may simply not be right for your organization, and you are not alone. In fact, only 35% of employers choose to cover GLP-1s for weight management, mainly due to cost. If you do not cover GLP-1s, consider other ways to promote a healthier lifestyle for obese employees – ranging from bringing in healthier snacks to the office to implementing a weight management program that provides access to dieticians. Later this year, True Rx will be expanding our True Outcomes: Weight Management program to patients without GLP-1 coverage, allowing them to benefit from the same nutritional coaching and lifestyle skills.
- Increase your GLP-1 employee copay: For those who are choosing to cover GLP-1s for weight management, employer strategy and benefit design is becoming a much larger part of the conversation. Cost-sharing models can help preserve employee access while increasing member participation in costs.
- Leverage alternative pricing models: For high-cost medications like GLP-1s, employers are increasingly looking for greater transparency into the true net cost of treatment. That is why many employers are shifting toward more transparent PBM relationships focused on straightforward pricing. At the same time, employers are searching for new ways to balance affordability with access.
True Rx Employer Access, powered by Waltz Health, embeds direct-to-employer GLP-1 pricing within employers’ existing pharmacy benefits through an integrated, in-network solution. Under this new model, employers will be able to provide access to select GLP-1 weight loss medications, including Wegovy® and Zepbound®, at select pharmacies at significantly reduced prices. The prices will be seamlessly integrated into each member’s experience and applied to their deductible and out-of-pocket max. This represents a true net-price reduction strategy for payers -- free from rebate pressures.
Clinically guided weight management programs that pair GLP-1 therapy with clinician support: Sustainable weight management is rarely solved through medication alone. GLP-1 discontinuation rates at one year range from 37% to 81%, a signal that coverage alone may not be enough to sustain results over time. With the cost of GLP-1s alone costing employers an average of $25 per member per month, a weight management program that supports measurable and sustainable weight loss is a smart option. Coverage gets employees to the pharmacy. Clinical support programs get them the rest of the way.
Employers using more structured weight management strategies are already seeing measurable outcomes: not only in weight loss, but in stronger engagement, improved productivity, and a reduction in absenteeism.
For employers seeking a more clinically guided approach, True Rx, Health Strategists True Outcomes: Weight Management combines GLP-1 therapy with registered dietitian coaching, nutrition education, and long-term lifestyle guidance designed to help employees build healthier, and more sustainable habits over time. The program is offered at $3 PMPM and can be bundled with diabetes and pharmacogenomics programs as part of the $5 PMPM Healthier You bundle.
Some employers are exploring a combination of strategies to lower net costs while still maintaining access, an approach increasingly attractive to employers looking to balance affordability, retention, and employee experience.
Preparing for the future of GLP-1 management
GLP-1 medications are expanding into additional chronic disease categories including: cardiovascular disease, chronic kidney disease, sleep apnea, and metabolic health management. As the category continues to grow, employers will need strategies designed not only for today’s utilization, but for long-term expansion across multiple conditions.
As Health Strategists, True Rx helps employers stay ahead of what's next with proactive, pharmacist-led guidance designed to improve health outcomes while managing costs. We act in the best interest of our clients and patients, helping employers navigate a rapidly evolving pharmacy landscape with confidence and a long-term view of employee health.
