Why holistic GLP-1 strategies are needed now

Employers evaluating GLP-1 strategies must take a holistic view of the forces influencing utilization, cost, and outcomes.

GLP-1s have quickly become one of the most important employee health and benefit considerations for employers. Rapidly growing consumer awareness, combined with high unit costs and expanding clinical eligibility, has increased the complexity and financial implications for employer-sponsored health plans.

As GLP-1 costs rise, utilization increases, and new formulations and indications enter the market, employers are also making key decisions against a backdrop of broader health plan cost pressures and worsening population health.

As these pressures intensify, employers need a coordinated, long-term approach now that moves beyond access and cost alone to focus on real outcomes, sustained engagement, and financial sustainability.

• GLP-1 cost is accelerating, including 2X higher brand prescription trend among plans that cover GLP-1s for weight management.

• New formulations and expanding indications are adding to the pressure, with direct-to-consumer marketing also influencing employee expectations and demand.

• High discontinuation rates are a real risk for weight loss GLP-1s, with significant downstream clinical and cost consequences when therapy is stopped.

• There is no demonstrable ROI within the pharmacy benefit for employer health plans covering GLP-1s for weight loss at current prices.

GLP-1s are a substantial and growing driver of health plan cost

• Nearly 840% cost increase: Allowed PMPMs rose from $2.41 to $22.59, an almost 840% per member per month (PMPM) increase, from 2022 to 2024 for employers covering GLP-1s for weight management.

• 2X higher brand Rx trend: Employers who covered GLP-1s had 2X higher brand Rx trend rates in 2024 than they would have if they hadn’t covered GLP-1s for weight management.

Given how these medications are currently used, there is currently no demonstrable return on investment (ROI) for employer health plans that cover GLP-1s for weight loss at the current price.

GLP-1s FOR WEIGHT MANAGEMENT: PMPM QUARTERLY GROWTH

BRAND RX PMPM

New formulations and expanding indications are adding to the pressure

New indications and formulations entering the market are also increasing pressure on employer health plans to revisit strategy and oversight.

The introduction of oral GLP-1 formulations has removed the injection barrier but doesn’t change underlying cost dynamics. Oral Wegovy, the first FDA-approved oral GLP-1 for weight management, is priced similarly to injectable formulations. As a result, there is no clinical or economic basis to expect lower unit costs or improved outcomes for plans that already include weight-loss GLP-1s.

And Lilly’s oral GLP-1, orforglipron, is expected to launch soon, signaling broader class expansion. By removing the injection barrier, oral formulations are likely to increase utilization, but not reduce cost. For employers that include GLP-1s for weight loss, this is expected to translate into higher overall cost exposure.

THE GLP-1 PIPELINE: 2026 UPDATES

The growing GLP-1 approval pipeline has significant implications for employers in terms of cost, coverage, and employee access. Read more on expanding indications: GLP-1 Indications Continue to Expand: Potential approvals expected through 2026 | Lockton (opens a new window)

High GLP-1 discontinuation rates signal a broader problem

Lockton data shows that discontinuation is common among members using GLP-1s, particularly for weight management. Nearly half of members taking GLP-1s for weight loss discontinued use, compared to about one-third of members taking GLP-1s for diabetes.

• 48% discontinuation among weight-loss GLP-1 users

• 33% discontinuation among diabetes GLP-1 users

Discontinuation of GLP-1 therapy is associated with metabolic rebound, including weight regain, rising blood pressure, and worsening glycemic control, undermining both clinical outcomes and the value of initial investment.

While the effectiveness of GLP-1s in diabetes management is well established, coverage for weight loss presents a more complex challenge. For weight management, successful and durable outcomes depend on sustained lifestyle changes alongside medication use.

GLP-1s are intended to function as an addition to lifestyle intervention, not a standalone solution, and are most effective when used as part of a comprehensive approach that includes dietary modification, physical activity, and behavioral support. Long-term success relies on embedding these changes over time. Although the goal may be to eventually taper medication, de-prescribing should only occur after durable lifestyle modifications are in place.

Emerging alternative funding and direct-to-consumer (DTC) strategies could offer some relief

As employers evaluate GLP-1 coverage and cost containment options, many are exploring options beyond the traditional medical or pharmacy benefit. These approaches can include cash-pay pathways, manufacturer programs, or employer-funded reimbursement arrangements.

While such strategies may offer some cost relief or expanded access, they also introduce important compliance, data visibility, and employee considerations.

And DTC platforms do offer choices to patients without insurance but may increase costs for insured patients if they pay outside of plan benefits. While DTC models may improve access and shift employer prescription costs, there’s no evidence that they will solve the obesity burden or reduce total healthcare costs long-term.

Why GLP-1 strategy has become an immediate employer priority

While GLP-1s play a meaningful role in addressing obesity and metabolic health, they are not a standalone solution. Their impact depends on how they are used, how long they are used, and what surrounds them. 
 
When deployed without supporting lifestyle interventions, clinical oversight, and coordination across benefits, GLP-1s risk delivering short-term results without long-term health improvement. Weight regain following discontinuation, uneven outcomes, and rising costs all highlight the limits of relying on medication alone to address a complex, chronic condition.

Employers should view these medications as one component of a broader obesity and metabolic health strategy, pairing medication use with lifestyle support, benefit coordination, and clear expectations around duration and outcomes. This approach recognizes both the clinical promise of GLP-1s and the practical realities of cost, sustainability, and long-term population health. 

Lockton expertise across medical management, pharmacy, population health, and total costs allows employers to move beyond single-lever decisions and toward a more balanced, sustainable approach. Speak to an expert to learn more. (opens a new window)