Key Takeaways

• GLP-1 drugs are effective but complex, with high demand and many potentially eligible employees.
• Falling prices are increasing access, but cost control still depends on strategy, not availability alone.
• Targeting high-risk populations and understanding emerging concerns helps improve outcomes and better align healthcare spend.
• Combining medication with clinical support and flexible plan design leads to more sustainable results.

The Growing Impact of GLP-1s on Employee Benefits Strategy

Weight loss medications, especially GLP-1 drugs like Wegovy, Ozempic, and Zepbound, are delivering meaningful clinical outcomes, but they’re also introducing new complexity around cost, access, and long-term strategy.

In a Holmes Murphy webinar covering GLP-1s and employer health plans, we walked through what we’re seeing in the evolving GLP-1 market and how employers can approach coverage in a more intentional way. For benefits leaders trying to balance supporting employees and an ever-increasing health plan spend, these takeaways can help you evaluate if GLP-1 coverage fits your needs.

A Breakthrough Therapy with Real Impact

GLP-1 medications are reshaping how we think about obesity management, metabolic health, and chronic condition prevention. The clinical results are strong, and we continue to see new research emerge around additional use cases.

From a population health standpoint, the opportunity is significant. A large portion of the workforce may qualify for treatment, many individuals have underlying conditions tied to obesity, and effective intervention has the potential to reduce downstream medical costs.

But GLP-1s are not a simple solution. Patients often need ongoing support to manage side effects, stay adherent, and adapt to lifestyle changes. That’s where things become more complex for employers designing benefits programs.

GLP-1 Drug Costs Are Evolving, But Strategy Still Matters

For most employers we work with, GLP-1 drug costs have been the biggest barrier to coverage.

Historically, these medications can cost around $1,000 to $1,200 per member per month. Even when factoring in pharmacy benefits manager (PBM) rebates, the net cost is still high, especially when a large percentage of employees qualify.

We’re starting to see meaningful shifts in the market in response to the cost barrier:

• Expansion of direct-to-consumer GLP-1 programs.
• Monthly pricing moving into the $350 to $450 range.
• Increased regulation and enforcement around compounding pharmacies.

This shift is important because it improves accessibility and creates new options for employers. But lower pricing does not automatically make broad coverage sustainable.

Why Traditional GLP-1 Coverage Models Fall Short

Many traditional coverage approaches rely on basic clinical criteria, like BMI thresholds. While that’s straightforward, it can create challenges for employer-sponsored health plans.

In our experience, when employers take an open-access approach to GLP-1 coverage, they often lose visibility into who is benefiting most and how that investment is impacting overall spend. That’s when things start to feel unpredictable and difficult to manage.

A Better Approach: Targeted, Data-Driven GLP-1 Strategies

One of the biggest shifts we’re seeing in the market is toward risk-based, population health-driven strategies.

Instead of offering GLP-1 coverage broadly, employers are taking a more targeted approach by identifying individuals with the highest clinical and financial risk, focusing on those most likely to benefit, and aligning access with measurable outcomes and ROI.

When we analyze the data, it’s common to find that a relatively small portion of the population drives a large share of total healthcare spend. Prioritizing that group first often allows employers to improve clinical outcomes in high-risk populations, better align spend with measurable results, and maintain greater control over long-term cost trends.

Medication Alone Isn’t Enough for Long-Term Success

GLP‑1 access alone does not guarantee results. People need to stay on therapy through titration and early treatment phases, manage side effects effectively, and build sustainable lifestyle habits that support long-term health.

Without the right support, many patients discontinue treatment early, creating a gap between expected outcomes and actual results. That’s why we strongly advocate for solutions that combine medication with clinical engagement and care management. In practice, that often includes:

• Ongoing access to prescribing providers.
• Health coaching and nutrition support.
• Continuous monitoring and follow-up.

When these elements work together, we consistently see better adherence, stronger outcomes, and more meaningful value from the investment.

Flexibility Is Critical in GLP-1 Program Design

Every employer’s population is different, which means there is no “right” way to approach GLP-1 benefits coverage.

What we’re seeing work best are flexible models that allow employers to:

• Set a defined budget for obesity-related spend.
• Customize employee cost-sharing and copays.
• Adjust eligibility criteria over time.
• Monitor utilization, engagement, and outcomes.

This level of flexibility gives benefits leaders more control and helps reduce surprises at renewal.

Growing Scrutiny Around GLP‑1 Safety and Long-Term Value

From a benefits perspective, understanding concerns about GLP-1 use helps you know what to look for and how it may influence your long-term plan performance. These therapies remain highly effective, but like any fast-growing category, they’re being evaluated closely as use scales.

Emerging Side Effects

As more people use GLP‑1s, the volume of reported side effects naturally increases, and not all of those signals are straightforward. For example, a single reported liver failure case tied to a new oral GLP‑1 briefly raised the alarm, but further review suggested it was likely not drug-related, highlighting how difficult it can be to separate coincidence from causation in large populations. At the same time, it’s important to recognize that the safety profile extends beyond the commonly discussed GI side effects, with potential risks such as pancreatitis, gallbladder issues, and kidney injury more likely to surface for certain populations.

Research Into Rare Outcomes

We’re also starting to see early research explore rarer outcomes that may not have been fully visible in clinical trials. One analysis found a potential association between some semaglutide therapies, particularly Wegovy, and rare vision-related events, though this type of data is directional and doesn’t establish causality. Additionally, the creation of new GLP-1 therapies remains highly sensitive to safety signals like Pfizer’s decision to discontinue an oral GLP‑1 candidate after a single potential liver-related event during development.

Long-Term Value and Adherence

Where this becomes most relevant for employers is in thinking about sustained value over time. We know these medications can drive meaningful results, but we’re also seeing patterns around early discontinuation and weight regain once therapy stops. That dynamic can create a scenario where maintaining outcomes requires longer-term use, which in turn impacts overall cost exposure.

From a planning standpoint, this reinforces the importance of thinking beyond access alone and focusing on how these therapies are supported, targeted, and managed to deliver consistent, measurable results.

What This Means for Employee Benefits Leaders

GLP-1 medications are now a central part of the overall conversation around employee health, pharmacy benefits, and population health management, plus more employees are asking about the use and coverage of GLP-1s beyond diabetes and weight loss. From our perspective, the discussion is no longer whether to engage with GLP-1s. It’s how to do it thoughtfully.

That starts by asking:

• Who should we prioritize for coverage?
• How do we ensure meaningful health outcomes?
• What level of investment aligns with our long-term strategy?

Employers who take a data-driven, intentional approach tend to feel more confident in their decisions and are better positioned to manage both cost and care quality.

Providing Care Beyond Coverage

The GLP-1 landscape is evolving quickly, creating both new opportunities and new challenges for employers. While improving affordability is an important step, the real differentiator is how these medications are integrated into a holistic employee benefits strategy.

This is where we’ve seen Holmes Murphy’s Employee Benefits team bring real value. We help clients look beyond the headlines and evaluate what will actually work for your population. From pharmacy benefits manager strategy and vendor evaluation to data insights and cost management, our goal is to build solutions that are practical, sustainable, and outcomes-driven.

If you’re evaluating GLP-1 coverage or want to take a closer look at your current approach, we’d encourage you to reach out. We’d be happy to connect and help you find the right path forward.