The question is no longer whether your employees are asking about GLP-1 medications. They are. The question is what your organization is going to do about it, and whether you’ve thought through all the implications before your next open enrollment season.
As employee benefits consultants, we’ve spent the last several months in room after room with HR leaders facing versions of the same pressure: employees want access to Ozempic, Wegovy, Mounjaro, and Zepbound; CFOs want to know what it will cost; and everyone is waiting for HR to make a recommendation. Here’s what we’re telling them.
The Numbers Are Too Big to Ignore
Let’s start with the financial reality. Prescription drug costs are rising 13–15% annually, and GLP-1 medications are a primary driver, currently accounting for roughly 20% of total prescription drug spend. Total GLP-1 spend increased approximately 50% in 2025 alone. Health costs are projected to reach an average of $18,500 per employee in 2026.
Even if 10% of eligible employees begin using GLP-1 medications for weight loss, employer costs can increase by $30 or more per employee per month, across your entire workforce, not just users. With these medications listed at over $1,000 per month before rebates, the math is unforgiving for any organization without a deliberate management strategy in place.
The Coverage Landscape Is Shifting — Fast
Currently, about 23% of U.S. employers cover GLP-1 drugs for diabetes and/or weight management, according to the 2025 SHRM Employee Benefits Survey. Among large employers, those with 20,000 or more employees, nearly 64% covered weight loss medications in 2024. Larger organizations have more bargaining power and broader risk pools, which makes coverage more sustainable.
What’s notable is that the trend toward expanding coverage may be slowing. Some employers who added GLP-1 coverage in recent years are now reconsidering. At the same time, walking coverage back carries its own risks. In a competitive talent market, benefits packages are scrutinized during hiring and open enrollment.
What Smart Employers Are Actually Doing
Rather than making a hard cover-or-don’t-cover decision, the most effective HR leaders we work with are building structured, managed approaches:
- Prior Authorization and Clinical Criteria. Among employers who do cover GLP-1s for weight loss, more than six in ten have restrictions in place. A significant percentage require members to meet clinical criteria beyond FDA guidelines, such as documented lifestyle intervention history, BMI thresholds, or comorbid conditions.
- Whole-Person Program Wrapping. Clinical evidence increasingly supports pairing medication access with nutrition counseling, behavioral health support, and fitness resources. Employers who take this approach see better outcomes and better justify the investment.
- Alternative Funding Mechanisms. Some employers are exploring health reimbursement arrangements (HRAs) as a middle path, offering employees a monthly subsidy (typically $100–$200) toward direct-to-consumer GLP-1 access rather than covering the drugs as a plan benefit. An excepted benefit HRA can be up to $2,200 in 2026.
The Long View
Here’s the part that often gets lost in the cost conversation: there is emerging evidence that covering GLP-1s for weight loss may reduce downstream health costs over time, fewer cardiovascular events, lower rates of type 2 diabetes, reduced joint replacements and sleep apnea treatment. The employers who build a managed approach, by implementing clinical criteria, whole-person support, defined formulary rules, are better positioned to realize the long-term value proposition.
Greater competition in the weight-loss drug market over the next several years is also expected to give pharmacy benefit managers more negotiating power. More than 100 drugs are currently in clinical development for obesity. The landscape will look very different in 2028 than it does today.
Questions Every HR Leader Should Be Asking
- Do we have a current, documented GLP-1 coverage position that reflects where we want to be in 2026?
- If we cover these medications, do we have meaningful utilization management tools in place?
- Are we evaluating our PBM contract with GLP-1 spend in mind?
- Do we have a whole-person wellness infrastructure that makes GLP-1 coverage more effective and defensible?
- Have we modeled what happens to our plan costs if 10%, 15%, or 20% of eligible employees seek coverage?
GLP-1 medications are not a trend that will fade. Obesity affects more than 40% of U.S. adults, and employees are paying close attention to whether their employer offers access to the most effective treatments available. Your response to this challenge will define your benefits strategy for years to come.