GLP-1 medications have changed the conversation around weight and chronic condition management faster than almost anything employers have dealt with in recent years. Demand is real. Outcomes matter. And for many employees, these medications can be life changing. At the same time, benefits leaders are staring down rising costs, unpredictable utilization, and pressure to make decisions that will be sustainable over the long term.
The challenge most employers are running into isn’t whether GLP-1s work. It’s whether today’s coverage decisions will still make sense as interest grows, pricing evolves, and expectations change. What looks manageable at a small scale can become far more complicated when applied across an entire workforce.
That’s where many GLP-1 strategies start to break down.
Why yes-or-no GLP-1 decisions fall short
In practice, many employers feel pushed toward a binary choice: cover GLP-1s broadly or exclude them altogether. Both approaches can appear straightforward on paper. But each of these choices has their own potential drawbacks.
Broad coverage often brings rapid uptake and budget volatility, especially as awareness and prescribing increase. Even employers prepared for higher utilization can struggle to forecast what demand looks like, particularly as new indications and medications enter the market.
On the other end of the spectrum, full exclusion doesn’t eliminate demand. It shifts it. Employees may pursue self-pay options without clinical oversight, look for workarounds, or consider changing jobs to gain access to coverage. That creates a different set of risks for employers, including missed opportunities to support long-term health.
Industry data reflects this tension. Business Group on Health reports that nearly 80% of employers are already seeing increased utilization of obesity treatments. Many organizations are responding by tightening eligibility criteria or adding participation requirements rather than making all-or-nothing coverage decisions. That trend suggests employers aren’t looking for a single answer. They’re looking for a more durable approach.
The real issue employers are navigating: scale
What’s often underestimated in the GLP-1 conversation is how quickly scale changes the equation. A strategy that works for a limited number of high-risk members won’t translate to a broader population, especially with increasing accessibility at play. With oral GLP-1s on the horizon, more indications being considered, and media attention heightened, demand is only expected to rise.
Without a plan for managing that growth, employers can find themselves reacting instead of leading. The question employers are increasingly asking isn’t “Should we cover GLP-1s?” It’s “How do we design a strategy that still works when demand doubles?”
To dig deeper into what this looks like in practice, we recently sat down with our Chief Medical Officer Dr. Tim Church for a candid Q&A on GLP-1 pricing, utilization risk, and what employers should be thinking about next. To view that conversation, click here.
A more durable framework: designing for coexistence
Employers that seem to be navigating this moment most effectively aren’t treating GLP-1s as a standalone decision. They’re designing strategies that allow different approaches to coexist within a broader framework that addresses weight and chronic conditions.
That starts with targeted access. Rather than open-ended coverage, many employers are aligning GLP-1 access with clinical appropriateness, readiness, and structured support. According to BGH, prior authorization, participation in a weight management program, and defined clinical criteria are now common requirements. The intent isn’t restriction, but stewardship.
The second shift is looking at affordability beyond the pharmacy line item. Pharmacy trend matters, but it’s only one part of the picture. Employers are increasingly evaluating how GLP-1 strategies interact with existing programs, long-term engagement, and overall population health. Focusing exclusively on per-script cost can obscure whether a strategy is actually sustainable as utilization grows.
The third, and often overlooked, component is a strong foundation that supports everyone, not just employees on medication. GLP-1s don’t replace the need for nutrition support, behavior change, mental health resources, and ongoing engagement. In fact, they tend to work best when those foundational elements are already in place.
This matters because no employer population is the same. Some employees will qualify for GLP-1s. Some will pursue them through self-pay. Many others will never use them at all. Strategies that acknowledge and support that mix tend to be more resilient over time.
What leading employers are doing differently
Across employer surveys and industry conversations, a few patterns are becoming clear.
Coverage decisions are becoming more nuanced Many of our clients are pairing access with guardrails rather than defaulting to blanket policies. Weight management programs are increasingly viewed as infrastructure rather than optional add-ons. And there is growing recognition that unmanaged demand, not just drug price, is one of the biggest long-term risks.
A recent survey found that while roughly two-thirds of employers are covering or considering GLP-1s, many are also prioritizing vendor oversight, data transparency, and integrated support models. That suggests a shift away from reactive decisions and toward strategies designed to hold up over time.
Importantly, these changes aren’t about doing less for employees. They’re about doing things in a way that remains viable as the landscape continues to evolve.
Practical considerations for benefits leaders
As employers revisit their GLP-1 strategies, a few questions are proving useful:
- What problem are we trying to solve with GLP-1 coverage, and for whom?
- How will we manage demand as awareness and interest continue to grow?
- What foundation supports long-term behavior change, not just short-term utilization?
- How do employees on GLP-1s and those not using medication coexist within our benefits strategy?
- How often should we reassess this approach as pricing, evidence, and workforce needs change?
There isn’t a single right answer. But employers who ask these questions early tend to avoid more disruptive course corrections later.
Where Wondr Health fits
At Wondr Health, we partner with employers across the spectrum, from those that cover GLP‑1s to those supporting employees through self‑pay and alternative pathways, to build obesity strategies on a foundation of sustainable behavior change and population‑wide support. By implementing a proven behavior‑change program, tailoring medications so the right person receives the right drug and dose at the right time, and choosing configurable benefit designs that flex to budget and organizational needs, we help our clients meet employees where they are today while staying ready for what’s next. If you’re rethinking your obesity benefits approach, contact our team to schedule a strategy session here today.
