Employers blend GLP-1 drugs with wellness to curb long-term costs

Even as use of glucagon-like peptide-1 (GLP-1) receptor agonists for weight loss increases, evidence suggests GLP-1s won’t mark the end of lifestyle management programs offered alongside prescriptions from physicians or as part of employee wellness initiatives. In fact, organizations such as the American Institute for Preventive Medicine have said in no uncertain terms “lifestyle coaching must be an integral part of the program.”  

The organization noted coaching can help build healthy habits and provide ongoing support, which can help maximize the long-term effectiveness of GLP-1s. That matters for employers beyond the intrinsic value of helping employees achieve weight-loss goals and improve quality of life.  

One reason is the documented medication adherence for popular GLP-1s. The Journal of Managed Care & Specialty Pharmacy reported less than one-third of patients stayed on GLP-1s for a full year, and only 27% took their medications as intended. While shortages and side effects are common causes of non-adherence, study authors also noted the importance of “understanding obesity care management program needs.” 

Employers must also grapple with the cost of GLP-1s. A Nomi Health analysis found GLP-1s made up nearly 10% of prescription drug spending in 2023, with an annual growth rate of 2%. If that trend continues, the company said GLP-1 medications will likely be the costliest prescription category by 2027.  

Given the cost, many employers simply choose not to cover GLP-1s. Estimates vary from 48% of companies not covering the drugs for weight loss (WTW) to 66% (International Foundation of Employee Benefit Plans) to 82% (Kaiser Family Foundation), though the figure from KFF decreases to 72% for firms with 5,000 or more workers. Without coverage, employees are on the hook for the drugs’ full list price, which KFF estimated can approach $1,350 per month. 

For companies that do cover the drugs, plan design strategies are often necessary to keep costs in check. In particular, HR service provider Sequioa pointed to price negotiation with pharmacy benefit managers or drug manufacturers themselves, prior authorization to verify medical necessity prior to prescribing, and step therapy. The latter requires employees to start with less expensive treatment options – which may include a lifestyle management program. 

Such programs can be a mechanism to help manage financial and clinical outcomes for those on GLP-1s. Among employers that do cover the drugs: 

• KFF found 24% require employees to schedule an appointment with a dietitian, while 10% require enrollment in a weight-loss or lifestyle management program.  

• WTW found 14% require participation in lifestyle management, with another 26% considering it for 2026.  

• Sequioa reported 19% require documentation of body mass index (BMI). 

Tying drug coverage to program participation offers three primary benefits. First, it offers employees long-term holistic support that can range from symptom tracking to custom nutrition plans. Support is especially valuable for weight loss maintenance after discontinuing GLP-1 use, which a Health Affairs Scholar paper said may be necessary to manage long-term spending on the drugs. 

Second, it enables a shift to preventive care. Successful lifestyle management and behavior change can delay (or outright prevent) the onset of a comorbidity commonly linked to obesity.  

Third, it helps employers find a balance between enhancing employee engagement and placing guardrails on GLP-1 coverage eligibility. This can ensure the right employees are granted access to weight-loss drugs, which can contribute to downstream improvements to health and well-being along with reduced healthcare spending. 

Brian Eastwood is a Boston-based writer with more than 10 years of experience covering healthcare IT and healthcare delivery. He also writes about enterprise IT, consumer technology, and corporate leadership.