New report provides practical guidance for designing sustainable benefit programs as employers face unprecedented demand and rising costs

NEW YORK —

The Peterson Health Technology Institute (PHTI) released Employer Approaches to GLP-1 Coverage, a market trend report that serves as a purchasing guide for employers managing coverage of Glucagon-Like Peptide-1s (GLP-1s) amid mounting pressure to provide access while controlling escalating costs. Designed to provide timely insights in a rapidly evolving field, this analysis draws on expert interviews, Purchaser Advisory Council member insights, and published data to help employers evaluate virtual weight management solutions and design clinically effective, financially sustainable benefit programs.

Employers say GLP-1s for obesity present unprecedented challenges: While these medications deliver clinically meaningful weight loss and cardiometabolic benefits, employers providing coverage report utilization far exceeding projections, with weight management drugs accounting for almost half of drug spending growth in 2024. Nearly 58 million commercially insured adults meet criteria for coverage, creating budget impacts many employers say they cannot sustain. As oral formulations enter development and U.S. Food and Drug Administration indications potentially expand into cardiovascular disease prevention and other conditions, pressure on pharmacy budgets is expected to intensify. In response, employers report turning to virtual weight management solutions to structure GLP-1 benefit design, guide utilization, and improve clinical outcomes.

“Employers are caught between employee demand for highly effective medications and the financial reality of covering them for potentially large portions of their workforce,” said Caroline Pearson, executive director of PHTI. “The market for GLP-1s is evolving faster than traditional benefits planning cycles, with new pricing models, direct-to-consumer options, and virtual solutions emerging rapidly. This report provides employers with an evidence-based approach to make informed decisions that balance access with sustainability.”

The report identifies three critical phases where virtual solutions can support employers in managing GLP-1 coverage:

  • Initiation: Providing targeted GLP-1 coverage using clinical criteria, behavioral or AI-based screening, narrow prescribing networks, or step-therapy pathways that include lower-cost alternatives or lifestyle change programs.
  • Maintenance: Providing lifestyle coaching, nutritional guidance, symptom management, and proactive engagement to improve medication adherence and mitigate the discontinuation rates observed in real-world settings, where only 30% of patients remain on therapy after two years.
  • Supported Discontinuation: Offering structured behavior, diet, and coaching to help individuals who choose to taper or discontinue therapy to maintain weight loss and prevent the rapid rebound that typically follows medication cessation.

Based on analysis of employer experiences, vendor data, and expert interviews, the report outlines five key recommendations for employers:

  1. Establish clear, clinically driven eligibility pathways for GLP-1 coverage
  2. Require participation in behavior, nutrition, or lifestyle change programs as a condition of coverage
  3. Provide structured support for employees who choose to taper or discontinue GLP-1 therapy
  4. Review existing vendor capabilities before adding additional point solutions
  5. Contract with vendors to drive outcomes while examining overall program costs

The market trend report is available at https://phti.org/employer-approaches-to-glp1-coverage.

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About the Peterson Health Technology Institute

The Peterson Health Technology Institute (PHTI) provides independent evaluations of innovative healthcare technologies to improve health and lower costs. Through its rigorous, evidence-based research, PHTI analyzes the clinical benefits and economic impact of digital health solutions. These evaluations inform decisions for providers, patients, payers, and investors, accelerating the adoption of high-value technology in healthcare. PHTI was founded in 2023 by the Peterson Center on Healthcare. For more information, please visit PHTI.org