"A combination of medication (if deemed appropriate by your prescriber), healthy diet and increased physical activity are all pieces of the puzzle."
Updated May 2026. Original article written March 11, 2024. Clinical contributions from Melisa Horton, PharmD and Strategic Pharmacy Consultant, and the Rx Solutions team. Cost and coverage insights from Rich Fahn, SVP, Benefits, and Cam Kennedy, Managing Director, Benefits.
GLP-1 (glucagon-like peptide) medications like Ozempic and Wegovy have grown in popularity over the last several years. This class of brand-name medications is U.S. Food and Drug Administration (FDA)-approved for the treatment of type 2 diabetes and for long-term weight management. This article provides context and information for employers as they evaluate their own plans, along with an informational section that can be shared with employees.
A Rapidly Changing Landscape
While many health plans cover GLP-1 drugs for type 2 diabetes, coverage for weight management varies significantly. In a study by KFF of large companies, less than one in five offered coverage for GLP-1 medications for weight loss. Among those who do, one-third reported that offering coverage contributes significantly to their healthcare spend.
Coverage for weight loss is changing rapidly. Cost, demand, supply, new information and new products – including oral GLP-1 pills and research regarding usage and side effects – are all factors at play that continue to transform the situation.
There have also been updates regarding the products that are available. In addition to the typical injection-style administration of the GLP-1 drugs, there has recently been a second GLP-1 pill that has been approved by the FDA from Eli Lilly. On April 1, 2026, the FDA approved the new pill, Foundayo. This pill is taken once a day and will compete with the pill form of Wegovy, made by Novo Nordisk, which was approved by the FDA in December.
These new GLP-1 pills offer a lower-cost option for those looking for GLP-1 medications. The starting dose for Foundayo, per the Eli Lilly website, is $149 a month for customers going outside their insurance and paying cash, whereas the cash price for Zepbound, the company’s obesity injection, is $299 a month.
What This Means
The situation continues to rapidly change — new medications are emerging on the market and gaining attention and interest from consumers looking to lose weight. You’ve likely experienced this directly: many employees are asking for coverage and don’t understand why it’s not offered or who will pay cash for the medications if they aren’t covered. Ultimately, this has made it a challenge for decision-makers at businesses in the U.S. – regardless of their size and location – to know if they should offer their employees coverage.
While it is a complex and ever-evolving situation for both employees navigating coverage and employers determining whether to offer it, the right solution can be found by examining the whole picture. This includes not only understanding the current data and information and staying up to date, but it also means staying true to, as well as understanding, your organization’s goals, culture and values.
Expanded Indications and Emerging Uses For GLP-1 Receptor Agonists
As of April 2025, GLP-1 receptor agonists continue to evolve beyond their original use in type 2 diabetes and obesity management. Most notably, the FDA recently approved semaglutide (Ozempic) for reducing the risk of kidney disease progression, kidney failure and cardiovascular death in adults with type 2 diabetes and chronic kidney disease — making it the first GLP-1 to receive this indication. The approval was based on results from the FLOW trial, which showed significant risk reduction in major kidney and cardiovascular outcomes.
Eli Lilly’s oral GLP-1, orforglipron, is also generating significant attention. In Phase 3 trials, it demonstrated substantial weight loss and improved glycemic control in patients with type 2 diabetes. Unlike earlier oral agents, orforglipron does not require fasting and was approved by the FDA in April 2026 for weight loss, becoming Lilly's second FDA-approved obesity medicine and first GLP-1 pill, Foundayo. Lilly touts that “with Foundayo, we now have an oral option that delivered an average of 12.4% weight loss at the highest dose in clinical trials.” Though in clinical trials, the GLP-1 pill appeared to be potentially less effective than its competition. However, these new GLP-1 pills may change the market for those who previously could not afford the weight loss injection.
GLP-1s are also in development for several novel therapeutic areas. Clinical trials are evaluating their efficacy in treating nonalcoholic steatohepatitis (NASH), polycystic ovary syndrome (PCOS) and neurodegenerative conditions such as Alzheimer’s disease. Preliminary research even suggests a potential role in reducing addictive behaviors related to alcohol and substance use. In addition to expanded indications, pharmaceutical companies are developing next-generation therapies that combine GLP-1 activity with other mechanisms. For example, CagriSema – a combination of semaglutide and cagrilintide – has shown enhanced weight loss efficacy in clinical trials. These advances indicate a broadening scope for GLP-1 therapies across metabolic, renal, neurological and behavioral health domains.
GLP-1 Information for Employees
Is GLP-1 The Same as Ozempic?
Ozempic is a brand name of the prescription drug semaglutide. Semaglutide belongs to the drug class called GLP-1 receptor agonists. There are many different brand names and uses within the drug class. See the table below for the approved uses of each one.
GLP-1 Medications Approved for Type 2 Diabetes: |
GLP-1 Medications Approved for Weight Management: |
|---|---|
Bydureon Byetta Mounjaro Ozempic Rybelsus Trulicity Victoza |
Foundayo Saxenda Wegovy Zepbound |
Understanding Your Current Coverage
If you are interested in accessing GLP-1 medications for weight management, you will need to investigate their status under your employer-sponsored health plan. Start by checking your insurance benefit guide materials or contacting your insurer directly using the customer service number on the back of your insurance card to inquire about coverage qualifications. Key questions to ask:
- Is GLP-1 therapy a covered pharmacy benefit if prescribed for chronic weight management?
- What prior authorization rules or quantity limits apply for these medications?
- Are there step therapy requirements to try other medications first?
- Is there a weight management GLP-1 medication that is preferred on my plan?
Seeking Medication Approval
If coverage is in place for GLP-1 therapy for nondiabetic weight loss purposes, gaining authorization often still requires multiple approval steps beyond just having coverage.
Partner closely with your prescribing physician throughout the documentation and prior authorization to streamline the process.
If your prior authorization is denied, you will receive notification from your insurer on the next steps.
Standard Prior Authorization Criteria Requirements
Prior authorization criteria can vary by insurer, but some standard guidelines are listed below:
Diabetes |
Weight Loss Management |
|---|---|
Physician confirmation of diabetes diagnosis or Prior anti-diabetic medication use |
Physician confirmation of BMI > 30 kg/m2 or BMI greater than 27 kg/mg2 with a comorbidity (e.g., hypertension, type 2 diabetes, dyslipidemia) and Behavioral modifications |
BMI = Body Mass Index
Important Things to Keep in Mind
As with any medication, the GLP-1 drug class comes with a list of pros and cons.
While these medications can be highly effective in both helping control blood sugar for diabetic patients and weight reduction for overweight or obese patients, they are not without side effects. The potential side effects include nausea, vomiting, constipation, abdominal pain and diarrhea.
These medications also come at a significant cost (with the average being $1,200 to $1,400 per month) and have experienced shortages, making access difficult at times. Your insurer can help you determine your expected out-of-pocket cost and copay amounts, and reaching out to your preferred pharmacy ahead of time to determine availability of your prescribed medication is always recommended.
From a pharmacist and clinician standpoint, there is clear value in GLP-1 medications for both treating diabetes as well as weight management, but it is important to remember that these medications, as a class, are relatively new. We still do not know the long-term effects, good or bad.
For those seeking a GLP-1 to help with weight loss, it is important to remember that medication alone is not the key to success but it is instead a tool to be used to help you achieve your weight loss goals. A combination of medication (if deemed appropriate by your prescriber), healthy diet and increased physical activity are all pieces of the puzzle in helping to not only achieve your goals but to maintain them long term. It truly is about lifestyle change for lifelong success.
The employee information portion of the article was written by Melisa Horton, PharmD and Strategic Pharmacy Consultant.
For Employers Considering Coverage
Cost Coverage Factors
When deciding whether to offer coverage for GLP-1 drugs for weight loss, it is impossible not to consider the cost of this drug, both short-term and long-term. In October 2024, the Congressional Budget Office estimated that enrollees could potentially save $650 per year per medication by 2034 (at least for Medicare). Over time, however, they expect better ROI for federal healthcare spending. Due to the nature of these medications as intended to be used long term, many employers have found the commitment to the current high price tag and uncertain future for the unit cost of the drug to be daunting or simply untenable.
Some insurance carriers are increasing coverage for GLP-1 drugs for obesity or changing requirements for coverage to only include individuals who meet certain criteria, while others are removing it entirely or offering coverage for an increased fee.
However, some others have taken on this cost as a risk mitigation tool, as obesity is a risk factor for chronic diseases and their associated costs. Beyond reduced heart disease risk that comes with weight loss, there's growing evidence that these drugs yield health benefits beyond diabetes and weight loss. Researchers from Loyola University Chicago suggest GLP-1 and GIP drugs may provide innovative treatment strategies for opioid and alcohol use disorders. In a new study released by the scientific journal Addiction, there was a 40% lower rate of opioid overdose in those taking GLP-1s compared with those who didn’t take the weight-loss drugs.
Rx Rebate Impact
Utilization management programs can be a good way for self-insured plans that offer GLP-1 coverage to save on costs while still offering coverage. However, some employers have found that suppliers have withdrawn, or have threatened to withdraw, drug manufacturer rebates, meaning the per-unit cost of coverage would increase dramatically.
GLP-1 Medicare Drug Negotiation Price List
In January 2025, the Centers for Medicare and Medicaid Services (CMS) announced the inclusion of GLP-1 receptor agonists in the second cycle of the Medicare Drug Price Negotiation Program, as per the Inflation Reduction Act. Specifically, semaglutide-based medications Ozempic, Wegovy and Rybelsus were included.
Negotiations with manufacturers were scheduled throughout 2025, with the newly negotiated prices set to take effect in 2027. This initiative aims to reduce out-of-pocket costs for Medicare beneficiaries and address the high expenditures associated with these medications. Notably, CMS will treat all formulations of semaglutide as a single product for negotiation purposes (regardless of brand name, dosage form or approved indication), potentially leading to more uniform and substantial price reductions across these therapies.
GLP-1 receptor agonists, widely used for managing type 2 diabetes and obesity, represented over $14 billion in Medicare Part D spending from November 2023 to October 2024, underscoring their significant financial impact on the program.
Attraction and Retention Tool
While the cost and commitment of covering GLP-1 drugs for weight loss are steep, some employers find it to be a tool for attracting and retaining top employees. This largely depends on how it aligns with your company’s culture and what your people value. For some organizations with relatively high turnover – where benefits are not a value add to employees – it may not be an advantage. Some companies may not be able to offer GLP-1 drugs for weight loss even if they would like to. For others, finding a way to cover GLP-1s at a time when employer coverage is not commonplace could be a differentiator in the job market.
A Comprehensive Analysis, Not a Single Solution
In this rapidly changing environment, you need a partner that can help you make the best decisions for your business. NFP’s experts have knowledge of the current market, stay up to date with the evolving situation, and are deeply committed to understanding your business to help you solve your toughest problems.
