Some employers steer workers toward cash platforms for GLP-1 obesity drugs

Employers are beginning to encourage their employees to obtain GLP-1 receptor agonists for weight loss through direct-to-consumer platforms and use their health savings/flexible savings accounts to pay for those medications, according to a new survey from the International Foundation of Employee Benefit Plans (IFEBP). In fact, 27% of those surveyed encourage the direct-to-consumer platforms, and 21% encourage employees to use their savings accounts.

“One of the things that we’ve seen is, instead of covering the drug within the plan, companies give employees some seed money in the flexible spending account,” Justin Held, director of educational programs at the International Foundation of Employee Benefit Plans, said in an interview. “The FSAs or HSAs can help reduce the cost burden for employees if they have a monthly subscription service on a direct-to-consumer platform. As more of these drugs are going the direct-to-consumer route, this will continue going forward.”

The IFEBP is a nonprofit membership organization that provides benefits professionals with information and research about employee benefits and compensation. This survey, conducted from June 2, 2026, to June 12, 2026, captures U.S. employers’ coverage and considerations surrounding GLP-1 drugs.

Cost remains a primary driver in employer decisions about GLP-1 coverage for diabetes, weight loss, and other indications, the survey found. Of those surveyed by IFEBP, 60% of employers provide coverage for diabetes only compared with 55% in 2025, 57% in 2024, and 49% in 2023.

But just 36% provide coverage for both diabetes and weight loss, an increase from 34% in 2024 and 26% in 2023. And 45% cover GLP-1 drugs for other FDA-approved conditions, such as sleep apnea or cardiovascular disease.

When asked if they would consider coverage of GLP-1 for weight loss, 9% of those who already provide coverage for diabetes said they might consider it, but 62% said they wouldn’t. Another 19% said they would not cover weight loss indications even though they did provide this coverage in the past. “We think they’ve dipped their toe into the space, and then they were not getting the results they expected, so they pulled back on coverage,” Held said. He said it might still be too early to know what the cost benefit is for GLP-1 drugs for indications other than diabetes.

But evidence is beginning to emerge. Earlier this year, Aon released results of analysis that showed 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. This analysis was from a representative sample of 192,000 GLP-1 users from commercial medical and pharmacy claims.

Held said that of those employers that do provide coverage for weight loss, 20% go through a dedicated weight management vendor solution.

The IFEBP survey found that there were 10 factors that employers consider when assessing GLP-1 coverage for weight loss:

• Broker/consultant/PBM recommendations—58%
• Obesity as a risk factor for chronic diseases and associated costs—46%
• Impact/effectiveness of cost-control mechanisms on health insurance premiums—44%
• Long-term costs and difficulty measuring outcomes—41%
• Availability of direct-to-consumer options—39%
• Oral pill forms available—34%
• Selecting and monitoring vendor point solutions—32%
• Medication adherence factors—30%
• Immediate/short-term costs—29%
• Expanded price transparency and flat-fee pricing—26%

The findings from the IFEBP survey show a continuing trend of payers being concerned about the high cost and affordability of GLP-1 drugs for obesity. Last month, Pharmaceutical Strategies Group (PSG) released its Trends in Drug Benefit Design report, which found that payers are also questioning patients’ lack of adherence and the impact of that on overall spend. Nearly two-thirds of patients without Type 2 diabetes who take GLP-1s discontinue treatment within one year.