How benefits leaders are approaching GLP-1 costs in 2026

If you're a benefits leader trying to figure out your GLP-1 strategy, you're probably not short on information. What's harder to find is clear, practical guidance from people who are actually working through these decisions every day.

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That's what we were hoping to get at in a recent conversation with Connie Perry, Chief Pharmacy Officer at Ethica Pharmacy Advisors. Connie spends her days helping large employers navigate pharmacy benefit strategy, and GLP-1s are at the center of almost every conversation she's having right now. Here's what stood out.

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It's okay that this feels complicated, but it doesn't have to be binary

One of the most useful reframes from Connie: the cover-or-don't-cover question is the wrong starting point.

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Right now, somewhere between 30–50% of employers cover GLP-1s for weight loss. A lot of the organizations that don't aren't opposed to the idea; they're stuck, largely because they're imagining it as an all-or-nothing commitment. 

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As Connie put it: "It's not ‘do you cover, do you not cover?’ It's how do you best optimize coverage and provide the care that's needed."

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There's a lot of space between full coverage and nothing, and that's where the most thoughtful program design is happening right now.

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Building the internal business case: obesity as a disease

For many benefits leaders, one of the harder parts of this conversation is making the case internally — especially to finance. A framing that helps: obesity isn't a lifestyle issue. It's a disease, recognized as such by the WHO and the AMA, and affecting 42% of U.S. adults.

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That matters because obesity isn't just a standalone condition. It's directly linked to 80–90% of type 2 diabetes cases, and associated with more than 200 documented comorbidities. When you look at plan data through that lens, the costs are already there:

• Outpatient and physician visit costs are 27% higher in populations with higher obesity prevalence
• Hospitalization costs run 46% higher
• Pharmacy costs run 80% higher

(Source: peer-reviewed medical literature, as cited by Ethica Pharmacy Advisors)

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Connie's suggestion: start by pulling your own data: diabetes prevalence, cardiovascular claims, sleep apnea, musculoskeletal spend. "Think about the improvements that occur with weight loss in those conditions," she noted. "Yes, these medications can be expensive. But if we're thoughtful about the program, this can be of great value, from both an economic perspective and a productivity perspective."

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Why weight loss drugs alone aren’t enough, and what to do about it

About half of people who start GLP-1s for weight loss have stopped taking them within a year. Some of that is side effects (nausea and GI discomfort during titration are real barriers). Some of it is people feeling early progress and deciding to try going without. Either way, the data is consistent: most patients who stop regain the weight within two years.

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"These are going to be lifelong medications for the treatment of obesity," Connie said. "It can't just be the drug. You have to understand all the components that go along with it."

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What tends to make a meaningful difference in adherence:

• Side effect education up front: helping employees know what to expect before they start
• Nutritional guidance: protein intake, hydration, practical eating habits
• Strength training and movement support: GLP-1s can cause muscle loss alongside fat loss
• Ongoing behavioral coaching: sustained support, not just onboarding

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A practical path forward: the defined contribution model

For organizations not ready to add GLP-1s as a full pharmacy benefit, there's a middle path worth understanding. 

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A defined contribution approach — typically a specialty HRA — lets employers set a fixed monthly subsidy (say, $100–$200 per employee) for weight management expenses. Employees apply those funds toward GLP-1 medications, often through direct-to-consumer channels like Lilly Direct. The employer pays only for what's actually used.

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There's a visibility benefit here too: right now, employees accessing these medications out of pocket are invisible to the plan — no claims data, no safety tracking, no opportunity to wrap support around them. A subsidy model changes that.

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From what we've seen work well: pairing an HRA for medication costs with an LSA covering healthy food, fitness, and lifestyle support tends to produce the most durable results. 

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As Connie put it, "To have that motivation, and the care, and the cost piece of it… that can make the best solution for an organization that really wants to do this."

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What's worth watching

The landscape is moving fast. Lilly and Novo Nordisk have both developed direct-to-consumer infrastructure that's already influencing employer pricing conversations. And over the last six months, Connie has observed a real wave of direct-to-employer programs emerging: new vendor networks, cash-pay arrangements, and wraparound care models that didn't exist not long ago.

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The organizations best positioned aren't locked into a fixed pharmacy benefit design. They're building flexible subsidy infrastructure that can adapt as the market continues to evolve.

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Where to start

GLP-1 strategy doesn't have to be solved all at once. A reasonable starting point: understand what your current plan data tells you about obesity-related costs, explore what a defined-contribution subsidy model might look like for your population, and think through what wraparound support could be bundled in. From there, you can build toward something more comprehensive over time.

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The organizations getting this right started somewhere modest and iterated. That's a reasonable path for most.

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Want to explore what a GLP-1 and weight management program could look like at your organization?

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This article is for informational purposes. Forma is not engaged in the practice of law. Nothing contained herein is intended as tax or legal advice nor to replace tax or legal advice from counsel. If you need tax or legal advice, please consult with counsel or a certified tax professional.