The weight of wellness: Accelerating GLP-1 utilization

Glucagon-like peptide-1 (GLP-1) medications, such as Ozempic , Wegovy , and Mounjaro are changing the conversation around weight management. Originally developed for diabetes, these drugs can now play a major role in helping people achieve healthier weight goals and manage chronic conditions. As a result, coverage for GLP-1 drugs is expanding in employer-offered health plans, reshaping benefit design, wellness programs, and cost strategies.

The role of GLP-1s in employee health

According to the Employee Benefits Research Institute (EBRI), 55% of employers cover GLP-1s for diabetes and 36% for weight loss, a sharp increase from prior years.

Why the surge? Because obesity remains a major health challenge with significant financial implications. In fact, the U.S. Centers for Disease Control and Prevention (CDC) estimates that about 42% of U.S. adults are obese, contributing to $173 billion in annual medical costs.

GLP-1 medications have been shown to lead to 10–15% body weight reduction, improving overall health and reducing obesity related health conditions and claims.

Source: The New England Journal of Medicine

Integration of GLP-1 utilization into employee wellness plans

Instead of solely relying on step challenges or one-off screenings, many employers are pairing GLP‑1 coverage with programs that reinforce lasting behavior change, such as coaching, nutrition support, behavioral health services, and lifestyle interventions.

This integrated approach is already showing improvements in health conditions among eligible employees. For example, a Cleveland Clinic–affiliated telehealth program combined GLP‑1 therapy with intensive lifestyle coaching for over 2,600 participants. After 12 months, participants achieved an average weight loss of 15.6%, and 73% of those with diabetes or prediabetes reached A1C levels under 5.7%.

FDA-approved GLP-1 coverage criteria for adults 

How broader GLP‑1 use is redefining employer health benefits

Traditionally, weight management programs were considered nice-to-have wellness perks. Today, they’re becoming core components of chronic disease prevention strategies that prioritize outcomes over participation. Instead of rewarding employees for activities like logging steps, plans now incentivize measurable health improvements such as reductions in BMI, A1C, and cardiovascular risk. Employers are also leveraging data-driven eligibility criteria and outcome-based continuation policies to ensure resources are used effectively.

Beyond health metrics, this evolution is impacting talent strategy, as well. Offering access to GLP‑1s signals a commitment to employee wellbeing, which can strengthen recruitment and retention in competitive labor markets, as well as shape company culture.

Financial impact of GLP-1s

However, the popularity of GLP-1 drugs comes with a price tag. According to the American Journal of Health-System Pharmacy (2025), U.S. pharmaceutical spending rose 10.2% in 2024, reaching $806 billion with GLP-1 medications
among the top drivers.

Current monthly costs for GLP-1s range from $617 to $763, according to a recent EBRI report. At these prices, employer health plan premiums could rise 5–14%. A proposed federal pricing agreement, however, could cap costs at $350 per month when purchased through the new TrumpRx, but implementation details are pending at this time.

Nonetheless, employers are responding with cost-control strategies that include:

1. Prior authorization and clinical criteria (BMI or comorbidities) to confirm medical necessity and prevent off-label use
2. Direct-to-consumer partnerships and transparent pharmacy benefit manager (PBM) contracts for better pricing and rebate pass-through
3. Utilization monitoring and adherence programs to track outcomes and avoid waste from early discontinuation
4. Step therapy to ensure appropriate use of lower-cost alternatives before GLP-1 initiation
5. Alternative coverage models such as value-based arrangements or outcomes-based contracts tied to weight-loss results
6. Employee education and lifestyle support to pair medication with nutrition and behavioral programs, improving effectiveness and reducing long-term spend

Compliance and regulatory considerations 

In offering GLP‑1 health plan coverage, employers must navigate a complex regulatory landscape to ensure ethical, effective, implementation that’s in line with federal, state, and legal requirements including:

FDA approval and off‑label use

Plans should align coverage with FDA-approved indications (see chart) and require prior authorization to ensure that any off-label use is supported by medical necessity. This helps mitigate risks tied to low-evidence cosmetic prescribing.

Federal regulatory landscape

Several federal laws shape how GLP‑1 medications can be offered in employer-sponsored health plans, and understanding these rules is key to staying compliant. Among them:

HSA/FSA tax considerations

GLP‑1 medications prescribed for chronic conditions or obesity typically qualify as eligible medical expenses under IRS rules, making them reimbursable through HSAs and FSAs. To stay compliant, employers should require documentation showing medical necessity.

State-level regulations

Some states require GLP‑1 coverage in Medicaid or state employee plans, often with eligibility tied to BMI, prior authorization, and participation in lifestyle programs. Others are introducing or rolling back these mandates, so employers should keep an eye on policy changes in their region.

Treatment duration, weight regain, and long‑term outcomes: implications for employers

While GLP‑1 and related weight management medications can produce significant initial weight loss and meaningful improvements in cardiometabolic risk factors, emerging research underscores that these benefits may erode quickly when treatment stops. A recent systematic review and meta‑analysis of 37 studies (over 9,000 adults with overweight or obesity) found that, on average, individuals regain about 0.4 kg (0.9 lb) per month after discontinuing weight‑management medications, with weight returning to baseline in roughly 1.7 years. The same analysis projected that improvements in HbA1c, blood pressure, cholesterol, and triglycerides generally return to baseline within about 1.4 years of stopping therapy.

Importantly, the rate of weight regain after discontinuation of medication was faster than after the end of intensive behavioral weight‑management programs, even when the initial weight loss was similar. This suggests that while GLP‑1s and newer incretin therapies are powerful tools for achieving short‑term weight loss and improving health markers, they are not a “quick fix”.

Obesity remains a chronic, relapsing condition that typically requires ongoing management and behavior change support, not time‑limited pharmacotherapy alone.

For employers, this evidence has several implications:

• Short‑term coverage alone may limit long‑term value. Designing benefits around brief “bursts” of GLP‑1 therapy (for example, 6–12 months without a long‑term plan) may generate substantial near‑term pharmacy spend while delivering only temporary clinical gains if medications are stopped and no sustainable lifestyle changes are in place.
• Treatment duration and continuation criteria matter. Coverage strategies should contemplate how long members are likely to remain on therapy, under what conditions treatment continues, and how to respond if members stop—recognizing that discontinuation is common in real‑world settings and typically followed by rapid weight regain.
• Medication should be paired with structured lifestyle support. The data reinforce that pharmacologic approaches work best as part of a comprehensive program that includes nutrition, physical activity, and behavioral support to help sustain weight‑loss behaviors during and after drug therapy.
• Cost projections must reflect likely relapse patterns. When modeling the financial impact of GLP-1 coverage, including potential offsets in cardiometabolic claims, plan sponsors should consider both the high per-member-per-month drug cost and the likelihood that weight and risk factors will revert to baseline after medications are discontinued.

In this context, GLP-1s and other weight‑management medications may be most effective when they are:

• Anchored to clear clinical criteria and outcome-based continuation policies, so that ongoing coverage aligns with demonstrated health improvement and adherence
• Integrated into broader chronic disease and wellness strategies that emphasize long-term behavioral change, rather than positioned as standalone, short-term solutions

By incorporating this emerging evidence into GLP‑1 benefit design, employers can better balance access, outcomes, and sustainability, supporting employee health while setting realistic expectations about the need for ongoing management to maintain results over time.

Innovative strategies for employers

While GLP‑1 medications can deliver meaningful health outcomes, their high cost and growing demand can strain employers’ plan budgets. The key is to design coverage that promotes appropriate use while encouraging lifestyle improvements. If your organization is re-evaluating how to offer employees GLP‑1 access, think guardrails and support, including:

1. Anchor coverage to clinical criteria: Start with FDA-approved indications, BMI thresholds, and comorbidity requirements, plus documented participation in nutrition or activity programs. This ensures resources go to employees most likely to benefit.
2. Pair medication with lifestyle support: GLP‑1s work best when combined with behavior change. Require engagement in coaching or digital wellness programs as a condition for coverage to help improve outcomes and reduce long-term claims.
3. Use outcome-based continuation: Align spend with measurable results. For example, consider initial coverage for three to six months, then renew only if employees meet progress benchmarks (e.g., weight reduction, improved A1C, etc.)
4. Optimize formulary and contract terms: Push for transparent contracting to help understand and control costs without limiting access. Negotiate passthrough pricing and audit rights with PBMs and explore net-cost guarantees and dose optimization to reduce waste.
5. Communicate clearly: Employees need to understand why criteria exist and what support is available. Clearly communicate to build trust and encourage participation in wellness programs.

Expert guidance for GLP-1 benefit design

At The Baldwin Group, we help employers balance expanded access to GLP-1 medications with disciplined cost management. The objective is to design benefit strategies that improve health outcomes, manage pharmacy spend, and support long-term workforce wellbeing.

The rapid acceleration of GLP-1 use:

• Creates both opportunity and financial exposure for employers
• Requires alignment between improved health outcomes and sustainable plan economics
• Calls for tailored strategies informed by experienced benefits and pharmacy advisors
• Demands coordinated resources, transparent pricing, and utilization oversight

That’s where experienced guidance matters. A partnership with our teams bring deep expertise across compliance, pharmacy strategy, and benefit design paired with senior-level access and hands-on support—to help employers implement GLP-1 strategies that are practical, compliant, and financially responsible. Contact us today to get started, or download a printable PDF of this article for easy reference or sharing.