The high cost of GLP-1s is causing some employers to reconsider their coverage, a new survey from the Business Group on Health found.
The survey received responses from 105 self-funded employers. It specifically examined GLP-1 coverage for weight management. The Business Group on Health is an advocacy organization for employers.
It found that eight in 10 employers say that GLP-1s are increasing their company’s healthcare costs. About 67% currently cover GLP-1s for weight management, while most cover them for diabetes. However, this may change next year, with only 72% of those currently covering them saying they’re likely to continue in 2027. Meanwhile, 10% said they likely will not continue coverage for weight loss in 2027.
“Our findings show the tremendous concern employers have regarding these medications from a cost and financial viability perspective,” said Ellen Kelsay, president and CEO of Business Group on Health, in a statement. “Against the backdrop of anticipated double-digit health care cost increases, fueled to a large degree by GLP-1s and overall prescription drug costs, companies cannot ignore the reality that GLP-1s have significant implications for health care budgets – and overall affordability.”
However, employers are implementing strategies to mitigate GLP-1 costs, according to the survey. This includes validating clinical eligibility with objective biometric data, limiting prescribing to certain providers, excluding some medications from the formulary and requiring participation in a weight management program.
The survey also found that more than half of employers that cover GLP-1s for weight management anticipate that it will lead to significant clinical benefits, like a reduction in obesity rates and fewer employees requiring bariatric surgery. However, few have seen this evidence yet.
In addition, 87% of employers believe that the oral GLP-1 medication will lead to higher demand for the drugs. Just 9% of employers expect there to be a decrease in price, however.
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 benefit designs or zero-cost coverage, according to the survey.
The Business Group on Health also found that nearly 80% of employers include executive leadership in decisions about GLP-1 coverage.
Several major health plans have also dropped coverage of GLP-1s for weight management, including Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of Michigan and Harvard Pilgrim Health Care. In addition, some state Medicaid programs have ended coverage, like California, New Hampshire, Pennsylvania and South Carolina.
Photo: Jason Dean, Getty Images
