Few benefit decisions generate as much debate as whether to cover GLP-1 drugs for weight loss. Employees ask for them, the clinical results are significant, and the costs can be substantial. With 2027 renewals starting, here's a framework for helping clients make a decision they can defend and sustain.
What the data shows
KFF's 2025 Employer Health Benefits Survey found that among firms with 200 or more workers that offer health benefits, coverage of GLP-1s primarily for weight loss was:
- 16% of firms with 200 to 999 workers
- 30% of firms with 1,000 to 4,999 workers
- 43% of firms with 5,000 or more workers, up from 28% in 2024
The cost side is just as clear. Among the largest firms that cover these drugs for weight loss, 59% said use was higher than expected and 66% said coverage had a "significant" impact on prescription drug spending. KFF also reported that some employers have stopped covering GLP-1s for weight loss, and 34% of covering firms require participants to meet with a dietitian, case manager, or therapist, or join a lifestyle program, to get coverage.
What changed in the last year
Supply
The FDA determined that the shortages of tirzepatide (December 2024) and semaglutide (February 2025) had been resolved. That ended the shortage-based allowance for mass compounding of copies of these drugs, and FDA continues to warn about unapproved GLP-1 products. Employees who relied on cheaper compounded versions may be looking to their health plan instead.
Federal pricing agreements
On November 6, 2025, the White House announced agreements with Eli Lilly and Novo Nordisk. Under those agreements:
- Medicare and Medicaid prices for Ozempic, Wegovy, Mounjaro, and Zepbound will be $245 per month, and Medicare is expected to cover Wegovy and Zepbound for certain patients with obesity, with a $50 monthly copay. Mercer noted the timing wasn't settled but said the coverage was expected to be in place by 2027.
- Direct-to-consumer prices through TrumpRx were announced at $350 per month for Ozempic and Wegovy, and an average of $346 for Zepbound. Mercer's summary noted the White House said average prices would trend down toward $245 over 24 months.
TrumpRx.gov launched in February 2026, giving cash-paying consumers another channel for these drugs.
Importantly, these agreements don't set prices for employer plans. As Mercer pointed out, PBMs say they've generally negotiated net costs for group plans close to direct-to-consumer levels, so lower DTC prices may eventually flow through, but that depends on each plan's PBM contract.
PBM transparency
The Consolidated Appropriations Act, 2026, signed in February, will require PBMs to report detailed drug spending data to employer plans and pass through 100% of rebates, though most requirements won't apply until plan years beginning in 2028 or 2029. In the meantime, employers can ask for GLP-1 utilization and net cost data at renewal.
Options to put in front of clients
1. Don't cover for weight loss
Many employers still exclude GLP-1s for weight loss while covering them for diabetes. If a client chooses this path, make sure the plan documents and communications are clear, and that coverage for other indications is administered consistently.
2. Cover with guardrails
Common guardrails include:
- Prior authorization with BMI and comorbidity criteria
- Lifestyle program participation as a condition of coverage
- Step therapy or preferred-product requirements
- Reauthorization tied to adherence or results
- Higher cost sharing for the weight-loss indication
Guardrails control costs but add friction. Ask the PBM how many members typically meet criteria and what the projected cost per member is.
3. Support direct-to-consumer purchases through an HRA
Mercer described another option for employers that don't cover weight-loss GLP-1s in the plan: providing financial support through a health reimbursement arrangement for drugs purchased through TrumpRx or other DTC channels. That can make a fixed-dollar benefit possible.
The trade-offs Mercer flagged are important: drugs purchased outside the pharmacy benefit bypass the clinical checks PBMs perform (such as drug interaction screening), and employers that currently cover GLP-1s through the PBM need to assess the effect on rebates. Any HRA approach also needs to be designed to comply with the rules that apply to HRAs, so involve benefits counsel.
4. Revisit the decision annually
Prices, products, and PBM terms are changing quickly. Lock in a review date rather than treating the decision as permanent.
Questions to ask the PBM or carrier
- How many members are using GLP-1s today, by indication?
- What's the net cost per prescription after rebates for our plan?
- What prior authorization criteria apply, and how many requests are approved?
- What would adding (or removing) weight-loss coverage cost per member per month?
- How will lower direct-to-consumer prices affect our net cost, and when?
A note on smaller groups
For fully insured small groups, carriers typically make these coverage decisions at the product level, so the employer's choice is often limited to which plan to offer. For level-funded groups, GLP-1 coverage choices can affect claims and renewal pricing, so review the stop-loss contract and pharmacy terms together. For ICHRA participants, coverage depends on the individual plan each employee selects.
The takeaway
There's no single right answer on weight-loss GLP-1 coverage. The right answer for each client depends on budget, workforce, and the plan's pharmacy contract. Your role is to bring data, lay out the options, and make sure the decision is deliberate and documented.