How PBMs are helping patients stay on GLP-1s

Despite a high demand for glucagon-like peptide 1 (GLP-1) drugs for weight loss, patients still struggle to remain on therapy. Insurance coverage restrictions are common for GLP-1 drugs, such as semaglutide (Ozempic for diabetes and Wegovy for weight loss) and tirzepatide (Mounjaro for diabetes and Zepbound for weight loss), as well as the newly approved oral Foundayo (orforglipron).

Most major insurers cover GLP-1s for Type 2 diabetes, but coverage for weight loss is patchy GLP-1 drugs are still costly for many, even though prices are coming down, especially as new therapies become available and competition increases. Approximately half of commercial employers currently cover GLP-1 drugs for weight loss, according to a survey by Navitus Health Solutions released in February 2026. Prior authorization requirements are standard practice, and tier placement — which directly affects patient copays — often varies depending on whether the indication is weight loss or diabetes, with patients with diabetes generally receiving more favorable coverage terms.

Among large employers, 62% provide coverage for weight loss drugs, and more than half have done so for more than two years, according to findings from a survey sponsored by Rightway released in April 2026. Employers, they found, are motivated by goals for wellness and diversity, equity and inclusion, as well as by improving health outcomes.

Approximately one-third of patients stop treatment within the first month, and nearly two-thirds discontinue within three months, said Oron Stenesh, MBA, vice president of product at Optum Rx. He attributed the high dropout rate to people not responding to the drugs and the well-documented gastrointestinal side effects.

One survey published as a preprint in December 2025 found that the side effects were problematic for patients, with 21% of respondents stating this was a barrier to staying on or restarting medication. A 2025 analysis of claims by Prime Therapeutics revealed that only 8.1% of members persisted with treatment for three years, although a separate analysis found an improvement in adherence from 2021 to 2024. Leaders at Prime Therapeutics have speculated that prescribers are getting better at understanding how to manage side effects.

Pharamcy benefit manager clinical programs

Breaking the pattern of patients dropping off medication before reaching their weight loss goals requires behavioral change, which can be daunting for many. Leaders at pharmacy benefit managers now have a better understanding of how to support patients taking weight loss drugs. They are offering clinical programs either alongside their coverage of weight loss and diabetes therapies or as stand-alone products for employers.

“Having these programs in place encourages adherence early on for people who are responding to the drug, and it helps clients get the most bang for the buck for the investment that they’re making on these drugs and for their population,” Stenesh said in an interview with Managed Healthcare Executive (MHE).

Optum Rx’s program, Weight Engage, was piloted in August 2023 and launched in January 2024 as an add-on program that employers can select. It lets members enroll in a virtual obesity management clinic, where they receive their prescription alongside physician-led care, one-on-one coaching, group sessions and ongoing education. Stenesh pointed to early outcome data as a sign that the program is working.

The Rightway survey found that employers want integrated programs, and not just point solutions, that protect rebates and provide clinical support and comprehensive reporting of outcomes. Larger employers also prioritized a return on investment (ROI) for their benefits strategy. Officials with Rightway say that clinical programs that embed pharmacists, nurses and dietitians into core operations will drive better adherence and outcomes.

Rightway’s newly announced program, Care Complete Weight Management, delivers outcomes reporting to employers on medication use patterns, adherence rates and clinical outcomes such as weight loss and improvements in health metrics. This enables employers to evaluate program effectiveness, manage costs and demonstrate ROI on their GLP-1 investment.

MHE survey

The clinical programs offered by PBMs have several commonalities, according to an informal survey of PBMs conducted by MHE. The programs generally include coaching with a pharmacist or nurse who provides nutrition and health information, as well as information on lifestyle and exercise. Many offer access to digital tools and trackers. Some have teamed up with behavioral health companies, such as Virta Health, Omada Health or Noom. The goal of these programs is to provide members with support for long-term success.

“They [GLP-1 drugs] are quite powerful in terms of what they do for diabetes and weight loss,” Arpit Patel, Pharm.D., senior vice president of trade relations and supply chain at MedImpact, said in an interview with MHE. “We wanted to wrap a clinical program around them. In weight loss in particular, one of the things we wanted to emphasize was that there can be an off-ramp.”

MedImpact, Optum Rx and Rightway are just three PBMs that have launched programs around improving outcomes with GLP-1 drugs. In March 2026, MedImpact launched two new programs, including GLP-1 Benefit 360, which aims to provide predictable pricing, integrated clinical support and a clear path off medication. This program includes MedImpact's Med Empower Fuel platform. The app-based tool provides members with a digital scale, access to a registered dietitian and real-time nutritional coaching, including the ability to snap a photo of a meal and receive instant dietary feedback.

Patel emphasized that the clinical program isn’t an add-on; it's central to the product's value. “We wanted a holistic solution and not a separate add-on,” he said.

Med Empower Fuel is a behavioral health platform that launched in late 2025 and has enrolled approximately 5,000 members to date. Early results show 90% engagement among enrolled members, with 84% achieving their weight goals after 12 months, and one-third of participants reaching a healthy body mass index within the same time frame.

GLP-1 therapies, Patel said, can boost a member’s weight loss, “but there have to be lifestyle changes to sustain it.”

Separately, MedImpact has launched GLP Direct Fund, a program that allows plan sponsors to subsidize a portion of costs for patients who want to access GLP-1 drugs through the direct-to-consumer channels. Employers can contribute any amount toward the drug’s cash price. The program is open to any client, not just those using MedImpact as their PBM.

Both Optum Rx and MedImpact are already eyeing the next wave of GLP-1 indications, including sleep disorders and metabolic dysfunction-associated steatohepatitis, with plans to evaluate each new drug and indication on their clinical and financial merits.

“GLP-1 success depends on how well the therapy is managed,” Kristin Devlin, Pharm.D., chief pharmacy officer at Rightway, said in a news release. Rightway’s program provides members with on-demand access to a dedicated nurse, pharmacist and registered dietitian, as well as ongoing guidance and real-time intervention when needed.