GLP-1 Coverage vs. Exclusion: What Employers Need to Know

GLP-1 coverage is one of the most complex and consequential decisions facing U.S. Benefit Leaders today. GLP-1 receptor agonists were originally developed to support type 2 diabetes management, but are now widely used for weight loss. The demand for this medication has surged far faster than most employer-sponsored health plans can absorb.

 

As we step into 2026, employers face a tough challenge. They must balance rising employee expectations and increasing pharmacy costs, as well as the uncertainty about long-term health outcomes. Additionally, there is more focus on fairness and sustainability in employee benefits.

 

The question is not if GLP-1s work in clinical trials, it is whether current GLP-1 coverage can provide lasting health benefits and affordable costs on a large scale.

 

This article explores how employers are approaching GLP-1 coverage versus exclusion in 2026, and how benefit leaders are managing GLP-1 cost pressures. Furthermore, it explores strategies for sustainable, equitable GLP-1 coverage, with insights grounded in recent employer data and Nutrium’s clinical experience.

 

How Are Employers Approaching GLP-1 Coverage or Exclusion in 2026?

As GLP-1 medications continue to dominate headlines, many employers feel pressure to take a definitive stance. However, there is no single “correct” answer to whether GLP-1s should be included in an employee benefits strategy. Coverage decisions depend on an organization’s financial reality, workforce needs, risk tolerance, and long-term health priorities.

 

Employer approaches to GLP-1 coverage are becoming increasingly nuanced. According to a survey conducted by Brown & Brown on The State pf GLP-1 Medication Coverage for Weight Loss, only 37% of self-funded employers currently cover GLP-1 medications for weight loss, with coverage rates increasing among larger employers. Even among those that do offer coverage, restrictions are common. 59% of employers with coverage have utilization controls in place, reflecting growing concern about uncontrolled spend and long-term sustainability.

 

Importantly, employer confidence in GLP-1 coverage appears fragile. Of the employers currently covering GLP-1s for weight loss, 31% report they are either unsure about continuing coverage or are actively considering stopping it within the next 12–24 months. This signals a shift from early enthusiasm to more cautious reassessment as real-world cost and outcomes data emerge.

 

Recent guidance from Mercer highlights three dominant postures that appear to be taking shape across the employee benefits landscape:

 

• GLP-1–friendly employers continue to cover GLP-1 medications broadly, often to remain competitive in tight labor markets. However, many are discovering that access alone does not guarantee stability or return on investment. Medication interruptions, side effects, and inconsistent outcomes are driving interest in added structure and clinical oversight.

 

• GLP-1–selective employers offer coverage with defined eligibility criteria, such as prior authorization, step therapy, or participation in a lifestyle program. These employers aim to balance access with accountability, using guardrails to reduce unnecessary utilization while supporting employees who may benefit most.

 

• Employers that exclude GLP-1 coverage (for now) are often motivated by financial risk rather than philosophical opposition. These organizations are focused on population-wide solutions that improve metabolic health without exposing the plan to high and volatile pharmacy costs. The challenge, however, lies in managing employee expectations as awareness and cash-pay access continue to expand.

 

In reality, many employers operate in a mixed environment, supporting employees who are on GLP-1s through the health plan. Others access them independently, and many prefer or require non-medication approaches. This complexity is shaping the next phase of employee benefits trends and accelerating demand for adaptable, whole-person solutions.

How Are Benefit Leaders Managing GLP-1 Cost Challenges?

The rising GLP-1 cost burden is one of the most pressing concerns for benefits leaders heading into 2026. While list prices remain high, the true cost challenge extends far beyond the price of the medication itself.

 

Employer data shows that cost containment efforts are accelerating. The Brown & Brown survey highlights that prior authorization is now the most common restriction, used by roughly 80% of employers with GLP-1 coverage. Many also require clinical criteria beyond FDA guidelines or limiting coverage to specific GLP-1 drugs. Yet, traditional utilization management tools only address part of the problem.

 

Benefit leaders are grappling with several hidden economic costs associated with GLP-1 use:

 

• High discontinuation rates. Real-world data consistently show that approximately 70% of individuals discontinue GLP-1 medications within the first year. This is often due to side effects, access challenges, or unmet expectations. Discontinuation not only undermines outcomes but also creates wasted spend and repeated restart cycles.

 

• Weight regain and metabolic instability. When GLP-1s are stopped without adequate lifestyle support, two-thirds of individuals regain weight, eroding both clinical progress and employer ROI.

 

• Lean muscle loss. Without nutritional guidance, up to 39% of weight lost on GLP-1s may come from lean muscle mass, which can lower metabolic rate and make long-term maintenance more difficult, a risk often overlooked in benefits planning.

 

• Operational volatility. Fluctuating enrollment, start-stop medication patterns, and multiple access pathways (PBM, direct-to-consumer, compounded medications) create administrative burden and employee confusion, increasing the workload on HR and benefits teams.

 

In response, benefit leaders are exploring alternatives beyond traditional PBM management. Notably, 71% of employers surveyed by Brown & Brown are actively exploring or open to alternative access arrangements, such as direct-to-consumer programs or complementary support models. This reflects a broader shift in employee benefits trends: moving from reactive cost controls toward proactive care models that stabilize outcomes. 

 

What Are the Best Strategies for Sustainable GLP-1 Coverage?

  As employers look ahead to 2026, a clear consensus is emerging: GLP-1s should not stand alone. This aligns with the World Health Organization’s guidelines for GLP-1 medication use. WHO states that GLP-1 use should always be combined with nutrition and lifestyle support for healthy usage. 

 

Furthermore, sustainable GLP-1 coverage requires a framework that supports both medication users and non-users while aligning clinical outcomes with financial predictability. This is where many early GLP-1 strategies have struggled. Coverage decisions alone do not determine success; outcomes depend on the care structure that surrounds the medication. 

 

Anchor GLP-1 coverage within a lifestyle-based care model

  Lifestyle interventions are the clinical foundation that makes GLP-1 use safer and more durable. Nutrition guidance helps employees meet protein and micronutrient needs despite appetite suppression. It reduces gastrointestinal side effects, preserves lean muscle mass, and supports metabolic stability over time.

 

At Nutrium, GLP-1 support is built on a lifestyle-first model, where every employee works with a registered dietitian to establish sustainable eating patterns and metabolic foundations. When GLP-1s are embedded within this type of structured lifestyle care, employers see more consistent outcomes and fewer costly disruptions related to discontinuation, side effects, or rebound weight gain.

 

Provide continuous support before, during, and after GLP-1 use

    Sustainability requires planning beyond the prescription itself. Employees may start, stop, adjust doses, or discontinue GLP-1s entirely over time. Benefit strategies must support these transitions by helping employees manage appetite changes, maintain eating structure, and sustain progress even as medication use evolves.

 

Nutrium Care's care model is designed to support employees throughout the full GLP-1 journey. This includes preparation, active use, and eventual dose changes or discontinuation. By planning for transitions upfront, employers reduce rebound risk, protect long-term health outcomes, and avoid repeated cycles of reset that drive both clinical and financial instability.

 

Ensure equity across medication and non-medication users

  Not all employees will use GLP-1s due to need, eligibility, preference, tolerance, or cost. Sustainable strategies ensure that employees who are not on medication still have access to the same lifestyle-based foundation and clinical support.

  Nutrium Care addresses this by delivering one unified care framework, where lifestyle-based nutrition and behavior change are the baseline for all employees. GLP-1 users receive additional, medication-specific support layered on top, not a separate or privileged pathway. This approach reduces perceived inequity, prevents GLP-1s from becoming the sole pathway to health improvement, and reinforces trust in the benefits program.

 

Focus on durability, not short-term weight loss

  Effective GLP-1 strategies shift success metrics away from rapid weight loss alone and toward outcomes that reflect long-term health. Metrics such as weight maintenance at 6 and 12 months, metabolic improvements, preserved muscle mass, energy levels, and functional wellbeing.

 

Nutrium Care emphasizes these durability-focused outcomes by combining clinical oversight with ongoing lifestyle support, helping employees build habits that persist beyond the initial weight-loss phase. For employers, this aligns GLP-1 investments with goals around productivity, engagement, and sustainable healthcare cost containment.

 

Integrate human clinical support with digital tools

Technology can scale access and engagement, but human clinical guidance remains essential for managing the complexity of GLP-1 use. Employers are increasingly prioritizing models that combine digital tools with licensed clinician support, ensuring care adapts as employee needs change.

 

Nutrium Care integrates 1:1 registered dietitian care with digital tracking and feedback, allowing employees to receive personalized guidance while giving employers a scalable, consistent framework to support their workforce.

 

Ultimately, sustainable GLP-1 coverage is not about choosing between medication and lifestyle-based care. It is about recognizing that GLP-1s are most effective when they are supported by structured lifestyle interventions, delivered consistently and equitably across the workforce. Employers that adopt this integrated approach are better positioned to manage cost, improve outcomes, and meet rising employee expectations in the years ahead.

Nutrium Care: A Solution That Adapts to Employee Needs

  Nutrium Care was designed specifically for this evolving reality. Rather than taking a medication-first approach, Nutrium provides a unified, nutrition-driven care framework that adapts to employees, whether they are using GLP-1s, considering them, tapering off, or choosing lifestyle-only support.

 

At the core of Nutrium Care is clinician-led support. Every participant works 1:1 with a licensed registered dietitian, combining human expertise with daily digital guidance through the Nutrium platform. This ensures care is personalized, evidence-based, and responsive over time.