GLP-1 drugs show promise in cutting costs but some employers consider dropping coverage

Some employers are considering dropping coverage of GLP-1 drugs for obesity, according to a recent survey from Business Group on Health. Of the employers surveyed, 67% currently cover GLP-1s for weight management but only 72% of these employers said they were likely to continue that coverage in 2027, and 10% said they likely would not, according to the survey. Companies that do not cover GLP-1s for weight management today are unlikely to add coverage in the future.

“Employers will need to make tough decisions about how to sustainably manage the expense of GLP-1s while supporting employee health,” Ellen Kelsay, president and CEO of the Business Group on Health told Managed Healthcare Executive. “As they do so, they will increasingly turn to strategies to help balance cost and care, such as stricter utilization controls and clinical oversight requirements, among other approaches.”

The survey, which examined coverage of GLP-1s specifically for weight management, was completed in February and March 2026 by 105 employer members of the Business Group on Health. It also examined employee support programs and utilization management in the context of an expanding range of options available to workers.

Those employers that do provide coverage of GLP-1 drugs for obesity rely on various strategies to ensure the appropriate use, including validating clinical eligibility via objective biometric data, requiring participation in a weight management program to receive coverage and limiting prescribing to specific providers and excluding certain medications from the formulary.

Although more than half of employers that cover GLP-1s for weight management expect the medications to yield significant clinical benefits, few have yet seen evidence within their aggregated claims.

But some analyses are starting to show a positive impact of GLP-1 therapies on cost growth. Earlier this year, Aon released results of analysis of a representative sample of 192,000 GLP-1 users from commercial medical and pharmacy claims. Among people using GLP-1s for 18 months for weight loss, there was a pattern of reduced medical cost growth, reductions in hospitalizations due to major adverse cardiovascular events (MACE), and lower claims incidence for a range of conditions. Women, in particular, are more likely to see reductions in hospitalizations for MACE, alcohol abuse, bariatric surgery and pancreatic disorders compared with men.

Aon found continuous GLP-1 treatment for both diabetes and weight loss experienced a 7 percentage point improvement in medical spend growth in the second year compared with a matched control group. Those who used GLP-1 drugs experienced a 44% reduction in cardiac events and were also likely to experience fewer diagnoses for pneumonia, inflammatory bowel disease, osteoporosis, and alcohol and substance use disorders.

But Aon's analysis also found that adherence continues to be the main driver of better outcomes and reduced cost growth.

Other findings from the Business Group on Health:

• Fully 87% of employers anticipate that the availability of an oral GLP-1 medication will result in higher demand for the drugs overall, and only 9% of employers anticipate a decrease in price.
• When it comes to how much employees pay for the medications, most employers (83%) use the same standard cost-share arrangement as they do for other medications. This approach far exceeds options such as using a special design or having no out-of-pocket costs.
• Nearly eight in 10 employers involve their executive leadership in GLP-1 coverage decisions.