Employer health plans are scaling back GLP-1 weight-loss coverage: What alternatives may be available

As open enrollment gets underway, many workers may see a notable change in their benefits: coverage for GLP-1 drugs used for weight loss may no longer be included.

An increasing number of employers are cutting the benefit altogether or making it less generous. In some cases, they are replacing it with a different approach, such as access to a third-party weight-management program.

These medications are expensive for employers, usually costing roughly $500 to $600 per user each month. Still, some companies argue the expense is justified by the health benefits for employees. Bank of America CEO Brian Moynihan told CNBC's Andrew Ross Sorkin in August that the company spends about $250 million or more on GLP-1 drugs, up from nothing four or five years ago. He said the bank sees a strong impact on employee health and continues to push for lower prices while viewing the drugs as a worthwhile long-term investment.

Even so, rising healthcare costs are prompting more employers, including large ones, to rethink GLP-1 coverage for weight loss. A WTW annual health benefits survey, conducted during the summer and set for full release on Wednesday, found that 53% of employers with more than 100 workers cover GLP-1s for weight loss, down from 57% in 2025. That marks the first decline in three years. The survey also found that 16% of employers currently offering the drugs are considering removing them, up from 9% last year.

A recent Marsh survey of more than 1,800 U.S. employers found that healthcare costs per employee are expected to rise 8.2% on average in 2027, the largest jump since 2003, with GLP-1 use accounting for one percentage point of that increase. Marsh experts say those rising costs are one reason employers are weighing cuts to coverage.

“Employers are really balancing empathy with economics,” said Caroline Susie, principal in Marsh’s total health management practice.

For workers in plans that drop the benefit, employers may offer alternatives, though none is likely to fully match standard insurance coverage. Here are the main options.

Direct-to-consumer programs

Some employers are steering workers toward direct-to-consumer purchasing programs such as Novo Nordisk’s NovoCare or Eli Lilly’s LillyDirect. In WTW’s survey, 8% of employers said they were using this approach, while 28% were planning or considering it.

Seth Friedman, pharmacy and health plans practice leader at Gallagher, estimated that 20% to 30% of the firm’s clients have eliminated coverage for 2027 and are sending employees to direct-purchase options. Employers can save significantly by doing so. Gallup said the share of U.S. adults using GLP-1 drugs for weight loss rose to 11% in 2026 from 3% in 2024, and 15% said they had used the medicines for weight loss at some point.

“Many people will choose to pay for this on their own even if it’s not covered by the plan,” said Jeff Levin-Scherz, population health leader at WTW.

The current starting price for self-pay users of Novo Nordisk’s Wegovy is $149 a month for the pill and $199 a month for the shot. Those prices may change later, and Novo Nordisk says its promotional pricing can be modified or ended. Eli Lilly’s Zepbound starts at $299 a month for a single-dose vial or multi-dose KwikPen.

Direct-to-employer programs

Other companies are shifting to a direct-to-employer model. Under this setup, they may drop the drug from their traditional pharmacy program but reimburse part of employees’ out-of-pocket spending instead.

“These 'alternative coverage' models enable employers to access more advantageous pricing and greater control over their contributions, without covering the drug on their PBM formulary,” said a spokesperson for Vida Health, one of several vendors serving employers in this space. Other providers include Noom and GoodRx.

Alysha Fluno, national pharmacy practice leader at Marsh, said employers can often tailor these programs to meet employee needs while still saving substantial amounts compared with buying GLP-1 drugs through a pharmacy benefit manager. A PBM is a third-party administrator that handles prescription drug benefits for health insurers and employers.

WTW’s Levin-Scherz said that based on direct-to-consumer pricing, employers could fully subsidize the medication, pay a vendor fee, and still spend much less than they would to buy Wegovy through a PBM.

Weight-management programs

Some employers are dropping drug coverage and instead contracting with third-party providers such as CVS Weight Management, Noom, Omada Health, UnitedHealthcare, Vida and Virta to offer weight-management programs. Some companies already had these services in place, while others added them only after removing GLP-1 coverage for weight loss.

Marsh data from 2025 show that 25% of employers with 500 or more workers had a vendor partner for lifestyle modification and nutrition support. Employers usually pay for these programs, and the cost is far lower than GLP-1 coverage. Depending on the offering, services often include live or online coaching on behavior change, diet, exercise, nutrition and related health topics. Susie said these programs typically cost about $65 to $100 per employee per month, though employers that choose a vendor offering prescription services may pay $150 or more per month per participating employee.

Program providers say results have been encouraging in recent years. Omada Health data show that 63% of members assessed 12 months after stopping a GLP-1 maintained or continued to lose weight. UnitedHealthcare’s Real Appeal program found that 88% of at-risk participants lost weight during a 52-week program focused on healthy eating, physical activity, better well-being and overall health outlook. CVS Weight Management also reported that 90% of members maintained weight loss up to 10 to 12 months after drug therapy ended.

While programs differ, ongoing professional support is often central to them. “We want to make sure that if they go off GLP-1s for whatever reason, they maintain the behavior changes,” said Cody Fair, chief commercial officer of Noom. “We're able to keep that weight off because they've retrained their brain and changed their habits,” he said.

Still, getting employees to use the programs can be difficult, Friedman said. “It's absolutely a commitment, and that's probably why you don't see a whole lot do it. Especially when they know they can just have their doctor write a script and go directly to Novo or Lilly.”

FSA and HSA funds for medically necessary GLP-1s

Although tax-advantaged accounts are not a substitute for full health coverage, GLP-1 medications can qualify for flexible spending account and health savings account reimbursement when prescribed by a licensed provider for a diagnosed medical condition such as obesity. The downside of paying through an HSA is that the money used no longer has the opportunity to grow tax-free for retirement.

The annual employee contribution limit for an FSA is $3,400 in 2026. For 2026, the IRS set the maximum HSA contribution limits at $4,400 for people with self-only coverage and $8,750 for those with family coverage. Those limits will rise in 2027 to $4,500 for individuals and $9,000 for families. Official 2027 FSA contribution limits have not yet been announced.

“Benefits are there to cover those out-of-pocket costs,” said Andrew Stocker, president of employee benefits at Voya Financial. “Employers need to educate employees about the benefits that do exist.”