The high cost of GLP-1s is leading some employers to reconsider their coverage, a new investigation from the Business Group on Health found.
The survey received responses from 105 self-funded employers. It specifically looked at the coverage of GLP-1 for weight management. The Business Group on Health is an employer advocacy organization.
The study found that eight in 10 employers say GLP-1s increase their company’s healthcare costs. About 67% currently cover GLP-1s for weight management, while most cover them for diabetes. However, that could change next year, as only 72% of those with current coverage say they are likely to continue into 2027. Meanwhile, 10% said they are unlikely to continue coverage for weight loss in 2027.
“Our findings show the enormous concern employers have about these medications from a cost and financial viability perspective,” Ellen Kelsay, president and CEO of the Business Group on Health, said in a statement. “Against the backdrop of anticipated double-digit increases in health care costs, fueled in large part by GLP-1 and the overall cost of prescription drugs, companies cannot ignore the reality that GLP-1 has significant implications on health care budgets – and overall affordability.
However, according to the survey, employers are implementing strategies to mitigate GLP-1 costs. This includes validating clinical eligibility with objective biometric data, limiting prescribing to certain providers, excluding certain medications from the formulary, and requiring participation in a weight management program.
The survey also found that more than half of employers who cover GLP-1 for weight management anticipate it will result in significant clinical benefits, such as reduced obesity rates and fewer employees requiring bariatric surgery. However, few have seen this evidence yet.
Additionally, 87% of employers believe that oral GLP-1 medications will lead to higher demand for these medications. However, only 9% of employers expect prices to fall.
According to the survey, most employers (83%) require employees to pay for GLP-1 medications through the same cost-sharing structure used for other prescriptions, rather than through special benefits or free coverage.
The Business Group on Health also found that nearly 80% of employers include management in decisions about GLP-1 coverage.
Several major health plans have also dropped GLP-1 coverage for weight management, including Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of Michigan and Harvard Pilgrim Health Care. Additionally, some state Medicaid programs have ended coverage, such as California, New Hampshire, Pennsylvania, and South Carolina.
Photo: Jason Dean, Getty Images
