With open enrollment season in full swing, many employees may notice something conspicuously missing from their benefits menu: coverage for GLP-1 weight loss medications.
More and more companies are dropping coverage altogether or offering their employees less generous benefits. In some cases, they’re moving to a completely different model — offering employees a sort of consolation prize — access to a weight management program through a third party.
Coverage for these weight loss medications is expensive for employers – typically costing between $500 and $600 per user per month. Some companies say that, regardless of the price, drug coverage is worth it, depending on the health of employees. “We’re spending about $250 million or more on GLP, and that’s an increase from zero” four or five years ago, Bank of America CEO Brian Moynihan told CNBC’s Andrew Ross Sorkin in August. “We see a big impact on employees…Believe me, we pressure everyone on price and try to get as cheap (as possible). But our view is that (because of) the long-term health benefits, and there may be more short-term health benefits…it’s a good investment.”
Still, as health care costs continue to climb, more employers are looking for an off-ramp from GLP-1 coverage for weight loss, and that includes large corporations. An annual WTW health benefits survey conducted over the summer and released in full Wednesday found that 53% of employers with more than 100 employees cover GLP-1s for weight loss, up from 57% in 2025. That’s the first decline in three years. Additionally, 16% of employers said they now cover medications but are considering removing them, up from 9% last year.
According to a recent Marsh survey of more than 1,800 U.S. employers, the cost of health insurance per employee is expected to increase by 8.2% on average in 2027, the largest increase since 2003, with GLP-1 reliance accounting for one percentage point of overall cost growth. Its experts cited soaring costs among the reasons employers are considering dropping coverage for 2027.
“Employers are really balancing empathy and economics,” said Caroline Susie, director of Marsh’s global health management department.
Some workers who use employer-sponsored health plans are offered options for dropping GLP-1 coverage, although nothing can match comprehensive health insurance coverage. Here are alternatives to consider.
Direct-to-consumer programs
Some employers are incentivizing their workers to purchase GLP-1 through direct-to-consumer options, such as Novo Nordisk’s NovoCare or Eli Lilly’s LillyDirect. The WTW survey showed that 8% of employers chose this route and 28% were considering it or considering it.
Seth Friedman, head of Gallagher’s pharmacy and health plans practice, estimated that 20% to 30% of the company’s clients have dropped their coverage for 2027 and are sending their employees the direct route. For employers, this move can mean significant savings. The percentage of U.S. adults taking GLP-1 medications for weight loss purposes climbed to 11% in 2026, up significantly from 3% in 2024, according to Gallup. Additionally, 15% say they have used the drug for weight loss at some point, an increase of nine percentage points.
“Many people will choose to pay for this themselves, even if it’s not covered by the plan,” said Jeff Levin-Scherz, population health manager at WTW.
The starting price for the lowest dose of Novo’s Wegovy for self-pays is currently $149 per month for the pill and $199 per month for the injection. These prices are subject to change in 2027; Novo Nordisk indicates that current promotional prices are subject to change or cancellation. Lilly’s Zepbound starts at $299 per month for a single-dose bottle or multi-dose KwikPen.
Programs aimed directly at employers
Some companies are moving to a direct-employer contact model, in which they drop coverage through their traditional pharmacy program but offer to reimburse a portion of an employee’s out-of-pocket expenses.
“These ‘alternative coverage’ models allow employers to access lower rates and greater control over their contributions, without covering the drug on their PBM formulary,” said a spokesperson for Vida Health, one of several providers working with employers in this area. Others include Noom and GoodRx.
Employers can often design a program that meets the needs of their employees, realizing significant savings by paying for GLP-1 medications through a pharmacy benefit manager, said Alysha Fluno, national pharmacy practice leader at Marsh. A PBM is a third-party administrator that manages prescription drug benefits for health insurers and employers.
According to WTW’s Levin-Scherz, based on direct-to-consumer pricing, employers could fully subsidize, pay vendor fees, and spend much less than buying Wegovy, for example, through a PBM.
Weight management programs
Some employers are dropping their coverage and contracting with third parties, such as CVS Weight Management, Noom, Omada Health, UnitedHealthcare, Vida and Virta, to offer weight management programs to their employees. Some employers offered these types of programs before, while others only made them available after dropping GLP-1 coverage for weight loss.
According to Marsh data from 2025, 25% of employers with 500 or more employees had a vendor partner for lifestyle modification and nutritional support. Employers, not employees, typically foot the bill for these programs, with significant savings compared to GLP-1 coverage. Services may vary among members, but offerings typically include live or online coaching on behavior change, diet, exercise, nutrition, and other health topics. Costs for these programs can run between $65 and $100 per employee per month, depending on what is offered, according to Marsh’s Susie. Employers who choose a provider that also offers prescription services could pay $150 or more per month per participating employee.
Service providers cite good results from their programs in recent years. Data from Omada Health shows that 63% of members assessed 12 months after stopping GLP-1 maintained or continued to lose weight. Data from UnitedHealthcare’s Real Appeal program shows that 88% of at-risk participants lost weight during the 52-week program. designed to promote healthy eating, physical activity, improved well-being and improved health prospects. Additionally, 37% of participants lost 5% or more of their weight. Meanwhile, initial program results reported by CVS Weight Management showed 90% weight loss maintenance for members up to 10 to 12 months after drug treatment ended.
Vendor offerings vary somewhat, but professional support is often a feature. “We want to make sure that if they drop GLP-1 for any reason, they maintain the behavior changes,” said Cody Fair, Noom’s chief business officer. “We are able to maintain this weight because they have retrained their brain and changed their habits,” he said.
Employee utilization, however, can be a challenge, said Gallagher’s Friedman. “It’s absolutely a commitment, and that’s probably why you don’t see a lot of people doing it. Especially when they know they can just have their doctor write a script and go straight to Novo or Lilly.”
FSA and HSA money for medically necessary GLP-1
Although these tax-advantaged accounts alone are not a substitute for a comprehensive health plan, GLP-1 medications are eligible for Flexible Spending Account (FSA) and Health Savings Account (HSA) reimbursement when prescribed by an approved provider to treat a diagnosed medical condition, such as obesity. The downside to using an HSA to pay for GLP-1s is that the invested dollars do not have the opportunity to grow tax-free for use later in retirement.
The annual employee contribution limit for an FSA is $3,400 in 2026. For 2026, the maximum annual HSA contribution limits set by the IRS are $4,400 for individuals with individual coverage and $8,750 for those with family coverage. This amount will increase in 2027 to $4,500 for individuals and $9,000 for families. Official IRS contribution limits for 2027 for FSAs have not yet been announced.
“Employee benefits are there to cover those expenses,” said Andrew Stocker, president of employee benefits at Voya Financial. “Employers must inform their employees of the benefits that exist.”
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