By Simon Leung, PharmD, RPh and Jill Ambrose, MBA, BSN, RN
The weight loss trend isn’t going away any time soon. In a 2025 West Health-Gallup poll, 52% of adults in the U.S. said they would like to lose weight. With so many Americans looking to lose weight, the demand for weight loss drugs like GLP-1s continues to rise. According to Gallup, the use of weight loss injectables by U.S. adults more than doubled from 5.8% to 12.4% between early 2024 and late 2025. And more than 170,000 people are already taking the Wegovy pill that maker Novo Nordisk just launched in the U.S. in January 2026.
While the employee benefits talk had focused mainly on the high cost of these drugs, increased utilization is now compounding the GLP-1 conundrum. Both issues pose a great challenge for employers as they look to support employees in bettering their health while balancing the short and long term expenditures. With the arrival of GLP-1 generics for weight loss not expected in the U.S. until late 2031 at the earliest – and the Food and Drug Administration’s recent actions to limit compounded drug production – there are no lower-cost options on the market.
While there is no “silver bullet” for the GLP-1 conundrum there are new access pathways emerging, beyond traditional pharmacy benefit managers (PBMs), that could prove effective for plan sponsors depending on their budget and goals.
At the end of 2025 manufacturers Eli Lilly and Novo Nordisk launched direct-to-consumer programs that allow patients with prescriptions to purchase GLP-1s for weight loss directly from the manufacturers at lower prices. Through these programs cash-paying patients can purchase Eli Lilly’s Zepbound (tirzepatide) injectables for as low as $299 for the starting dose, Novo Nordisk’s Wegovy (semaglutide) injectable for $349 per month at the lowest dose and the Wegovy pill for $149-$299 per month. When accessed through the employer PBM these same medications can cost the employer anywhere from $700 to $1,000 per month.
The direct-to-consumer pathway does not coordinate with insurance and is designed for individuals without GLP-1 coverage, meaning employers can’t tap into these lower prices directly. However, if they completely remove GLP-1 coverage from their PBM, employees might turn to the direct-to-consumer pathway to access these drugs. While that approach might offer significant savings for employers, it puts the cost burden directly on employees – and the price might end up being higher for them than an insurance co-pay would have been – which could potentially dampen employee satisfaction with their benefits. Plan sponsors will have to weigh the savings with their recruitment and retention goals.
In January 2026 Eli Lilly and Novo Nordisk began testing direct-to-employer models that allow employers with self-funded plans to bypass traditional PBMs and work directly with vendors or specialty pharmacies to include GLP-1s in their health plans. By working directly with the vendors or specialty pharmacies instead of a PBM, employers get improved transparency which helps them forecast drug spending, as well as pricing as much as 30-40% lower than PBM pricing. These vendors will also manage eligibility, prescription fulfillment and ongoing care – lightening the administrative burden on employers. Direct-to-employer programs can help employers access GLP-1s at a lower cost, however, the utilization challenge driving up overall costs remains and is likely to increase as the costs to employees go down.
Some direct-to-employer vendors help control utilization through a wellness management component. For example, the vendor might have their own network of obesity specialists who clinically evaluate each case for eligibility and work with approved patients on an ongoing basis. While these wellness programs can help control utilization, they come at an additional cost that could negate much of the net savings over PBMs. There’s also the option to add wellness programs through the PBM model. It comes down to a numbers game and plan sponsors will need to evaluate what’s best for them based on their budget, employee population and health plan goals.
Another option that allows employers to move GLP-1s out of their pharmacy benefit is the use of a health reimbursement arrangement (HRA) specifically targeted for GLP-1s. An HRA is an employer-funded benefit that reimburses employees tax-free for qualified medical expenses. Through this set up, employees would access GLP-1s through the direct-to-consumer programs and the employer would be able to subsidize some of the cost – delivering a more supportive arrangement.
Employers using an HRA need to be explicit that it only covers expenses for GLP-1s for weight loss. The HRA allows employers to have greater control over utilization, by dictating who qualifies through eligibility requirements, such as a body mass index (BMI) threshold or diagnosis of certain comorbidities. While this arrangement isn’t a “silver bullet,” it does allow employers to set contribution limits and rollover unused funds. Plan sponsors might want to consider out-of-the-box arrangements like HRAs to control costs and utilization while keeping employees feeling supported.
Outside of GLP-1s for weight loss, there’s also a growing market for non-pharmaceutical weight management products. In August 2025 the U.S. Food and Drug Administration approved the first over-the-counter continuous glucose monitor (CGM) indicated for weight management. The product is designed to help users build healthy habits by better understanding how their body reacts to certain foods.
An advantage of non-pharmaceutical weight management vendors is that these programs can be utilized by all employees, helping to improve overall population health and lower medical spending. Plan sponsors can also use them as a utilization management tool, requiring employees to participate in a structured lifestyle or nutrition program from a chosen vendor before they can become eligible for GLP-1s under the pharmacy benefit. Again, these programs would be an additional cost – but employers should weigh the payoff of a healthier employee population in their decisions.
As the GLP-1 landscape evolves new strategies to contain spending and utilization continue to emerge. While there is no perfect solution that’s right for every employee population, a good benefits consulting partner will work with you to determine an approach that fits for your organization. At Conner Strong & Buckelew our consultants, population health and pharmacy practice groups are working on the frontlines — developing data-driven strategic solutions that help organizations manage the GLP-1 conundrum. We can help your company stay up to date in the rapidly changing landscape and work with you to build custom solutions for your business. Contact us to learn more.
Jill Ambrose, MBA, BSN, RN
Partner, Head of Population Health
Simon Leung, PharmD, RPh
Vice President, Head of Pharmacy
