Exploring the most effective ways to integrate GLP-1s into your benefits plan

Understanding GLP-1s

GLP-1 medications for treating diabetes have been widely available for decades. However, GLP-1 medications specifically for weight loss are much newer, drawing significant scrutiny while gaining recognition for their effectiveness in treating Type 2 diabetes and facilitating weight loss.Beyond these applications, ongoing research is exploring their potential to address conditions like rare metabolic disorders, cardiovascular diseases1 and even substance use disorders 2. This expanding scope underscores the importance for employers to stay informed about the evolving clinical benefits of these medications.

Employer coverage trends: GLP-1s for weight loss

Despite the clinical advantages, employer adoption of GLP-1 coverage remains limited for weight loss. Many employers are hesitant to include these medications in their health plans due to concerns about long-term efficacy, their ability to reduce related medical costs and the substantial costs associated with these treatments. This cautious approach reflects the need for a thorough evaluation of both the health benefits and financial implications.

When incorporating GLP-1s into health plans, effective strategy involves a comprehensive approach that ensures every plan member receives the right level of care at the right time. This includes but is not limited to:

• Conducting financial analyses: Employers should meticulously review Pharmacy Benefit Manager contracts with their pharmacy consulting expert to identify potential cost-saving opportunities and mitigate financial risks. Understanding the financial landscape is crucial for making informed decisions about coverage.
• Aligning with organizational culture: Decisions regarding GLP-1 coverage should reflect the company's commitment to employee health, aligning with its cultural values and long-term health objectives. This alignment ensures that health benefits resonate with the workforce and support overall organizational goals.

Integrating treatment with lifestyle modification programs

One of the most important aspects of an effective approach to GLP-1s usage is coupling treatment with lifestyle and behavioral interventions. Relying solely on medication without addressing underlying habits may lead to rebound weight gain and diminished long-term effectiveness. Combining usage with behavioral and nutritional support addresses the root causes of obesity and promotes better long-term health outcomes.

Educating employees about the benefits and potential risks of taking the medication without other interventions — while also providing robust support systems — is essential for sustained health improvements.

Addressing employer challenges

The rising demand for GLP-1 coverage presents challenges, including employee retention concerns, budgetary constraints and the proliferation of non-FDA-approved compounded versions of these medications. Employers must navigate these complexities by staying informed about regulatory developments3 and ensuring their health plans provide as safe, effective, and affordable options as possible.

The role of independent healthcare navigation

Some employers are partnering with independent healthcare navigation platforms to provide a more effective approach to weight loss management. Successful navigation solutions help ensure members receive clinically appropriate care, along with education and guidance about the importance of adopting healthy lifestyle behaviors.

These solutions can also help employers manage the complexities associated with high-cost medications, including GLP-1s. With clinical expertise and proactive engagement, healthcare navigation directs members to cost-effective medication alternatives aimed at maintaining quality care while controlling costs.

Author: Janice Rosenthal, clinical consultant at Marsh McLennan Agency, is a seasoned health care consultant and registered nurse. She offers a comprehensive perspective on managing the integration of GLP-1s into employer-sponsored health plans. Her approach emphasizes balancing clinical efficacy with financial sustainability, ensuring that both employee health outcomes and employer cost structures are optimized.

1 American Heart Association (AHA) & American Stroke Association (ASA). GLP-1 Receptor Agonists and Cardiovascular Outcomes: Current Evidence and Future Directions. December 2022.

2 Multidisciplinary Digital Publishing Institute. Investigating the Expanding Role of GLP-1 in Treating Metabolic and Neurological Disorders. November 2024.

3 U.S. Food & Drug Administration (FDA). FDA Warns Against Non-Approved Compounded GLP-1 Medications. December 2024.