GLP-1 medications like Ozempic, Wegovy and Mounjaro have earned a reputation as “miracle drugs” due to their effectiveness in managing type 2 diabetes and weight loss, the latter fueling much of the public’s fascination. As their use expands, researchers are also exploring their potential for treating conditions ranging from Alzheimer’s and substance abuse to cardiovascular disease and more. However, as providers have widened the prescribed uses of GLP-1s, employers and benefits advisors are facing a growing challenge: How to offer access to these high-demand, life-changing therapies without undermining the financial sustainability of their health plans.
For example, let’s take a closer look at the weight-loss phenomenon associated with GLP-1s. These drugs have become powerful tools in the fight against obesity, a condition that affects nearly half of U.S. adults, according to the Centers for Disease Control and Prevention. And while the clinical results are compelling, the financial implications are just as dramatic. GLP-1s are among the fastest-growing cost drivers in employer-sponsored health plans. With the rising utilization of GLP-1s, benefits leaders are under pressure to find the right balance between cost containment and providing meaningful health impacts that improve employee wellbeing. This complex balancing act requires more than reactive cost-cutting — it demands a data-driven strategy, thoughtful benefit design and proactive employee engagement.
The cost challenge: managing coverage without eliminating access
Brown & Brown’s Employer Health and Benefits Strategy Survey reported that 70% of employers now cover GLP-1 medications for weight loss. Yet along with increased coverage and utilization, a sharp uptick in employer-sponsored health care spending has also occurred.
Simply slashing coverage isn’t always a viable solution, as GLP-1s have become a competitive differentiator, especially in industries competing for top talent. Employers offering access to these medications may be perceived as progressive and responsive to employee needs — factors that can influence recruitment and retention. As a result, many employers are turning to utilization controls to curb unsustainable growth while continuing to offer access to GLP-1s.
As employers grapple with balancing cost and access, some are pioneering innovative strategies to manage this tension. One example of an employer taking a unique approach to managing GLP-1 access is Memorial Hermann Health System, which has developed a structured, sustainable approach that could serve as a model for others.
Applying a structured, sustainable approach
Memorial Hermann Health System (MHHS) is one of Texas’s largest not-for-profit health systems. By implementing a structured approach to GLP-1 coverage that combines clinical oversight, behavioral support and shared financial responsibility, MHHS is modeling a unique path forward.
Similar to many employers who cover weight management medications, MHHS’s utilization was significantly impacted by the spike of GLP-1 utilization in 2023. From 2023 to 2024, both utilization and net cost increased by 4x. MHHS knew that they needed to take better control.
Eliminating access to GLP-1s was never on the table. As a health care provider, the organization understood the clinical potential of these medications when used appropriately. While some providers see them as a breakthrough comparable to statins in the late 1990s, others are more cautious. As a large employer, MHHS sought to balance these perspectives to ensure GLP-1 therapy was delivered responsibly and sustainably.
The challenge: How to continue offering GLP-1s responsibly, ensuring that coverage reached patients who would derive the greatest clinical benefit and drive measurable health outcomes while maintaining financial sustainability.
MHHS designed a comprehensive strategy anchored in clinical oversight, engagement and shared accountability to bridge the gap between access and affordability.
1. Utilization management, medical and pharmacy:MHHS implemented prior authorization protocols with their PBM to ensure GLP-1 prescriptions and bariatric surgery align with clinically appropriate use cases. Rather than being prescribed as a first-line treatment for weight loss, these medications are authorized only after careful review, helping to prevent misuse and overprescribing.
2. Clearly defined eligibility criteria:To qualify for GLP-1 coverage, employees must meet the following standards:
- BMI of 30+ with comorbidities, or 33+ without comorbidities
- At least one year of employment with MHHS
- Participation in step therapy, requiring a 90-day trial of other weight-loss medications before moving to GLP-1s
These criteria aim to ensure that GLP-1 medications are reserved for employees with a clinically significant need, who have also demonstrated a commitment to their role within the organization.
These criteria also meant that MHHS was forfeiting the pharmaceutical manufacturer rebates that were negotiated by their PBM. MHHS carefully considered the loss of these rebates and factored this in as a trade-off for the ability to customize and align their criteria to their benefit philosophy.
3. Integration with lifestyle and wellness programs:Coverage is not granted in isolation – GLP-1 coverage is tied to participation in evidence-based wellness initiatives. Employees must actively engage with programs like Noom and MHHS’s internal “Life in Balance” wellness program. Engagement is measured through tangible metrics like Noom Coins (a points system for completed activities) and attendance in wellness sessions, creating a direct tie between medication access and lifestyle changes.
4. Reauthorization and cost-sharing:Initial GLP-1 coverage is granted for three months, with six-month reauthorizations contingent on continued adherence to wellness requirements. Employees also contribute a $150 monthly copay, a significant amount that reinforces shared responsibility and promotes intentional usage.
This thoughtful, tiered approach strives to control cost while, just as importantly, fostering a culture of personal accountability and long-term health improvement.
The results of MHHS’s strategy may provide a template for other employers. While many organizations have seen their GLP-1-related spending rise, MHHS has bucked the trend. Their per-member, per-month (PMPM) spend on GLP-1s has dropped by $15, even as peer organizations have experienced an average increase of $4 PMPM. The number of utilizers has stabilized and has returned close to the levels prior to the 2023 utilization spike.
Importantly, the program has not only curbed unnecessary GLP-1 usage, but has also improved outcomes. By requiring active participation in lifestyle and behavior-change programs, MHHS is helping its workforce build healthier habits that reduce reliance on the medication alone. Employees who stay compliant with the wellness requirements are seeing better, more sustainable results, reinforcing the value of an integrated approach.
As the employer health landscape evolves, the GLP-1 conversation is no longer about whether to cover these medications; it’s about how to do it responsibly. Key considerations and actions include:
A roadmap for sustainable GLP-1 coverage
- Leverage utilization management tools like prior authorization and step therapy to ensure appropriate prescribing
- Align GLP-1 access with evidence-based weight-loss programs, encouraging sustainable lifestyle change rather than medication dependence
- Introduce cost-sharing and engagement requirements to promote accountability and ensure employees are invested in their outcomes
- Monitor utilization and spending carefully and be willing to adjust coverage criteria based on clinical and financial data
With Brown & Brown’s survey showing that 85% of employers that offer GLP-1s are considering additional restrictions for 2026, there’s no doubt that the next year will bring even more scrutiny to GLP-1 coverage. But employers and advisors who take a proactive, holistic approach — marrying medication access with meaningful support — can avoid reactive cost-cutting and build a benefits strategy that’s both generous and sustainable.
Looking ahead, the next phase of this effort focuses on deepening the understanding of long-term outcomes through data analysis. Cohort studies are currently being constructed using a data warehouse to evaluate what happens to individuals who are denied GLP-1 medications compared to those who receive them. Key questions include whether denial leads to costly adverse events — such as strokes or heart attacks — that might have been preventable, and whether those individuals pursue alternative treatments.
For those who do receive GLP-1s, the studies aim to assess whether claims related to diabetes and hypertension decline, and whether these outcomes translate into measurable cost savings when compared to similarly situated members who did not receive the medications. The insights gained from these studies will help inform future coverage decisions and benefit design strategies.
Ultimately, for benefits advisors and employers looking to future-proof their pharmacy benefits strategy, it’s possible to provide access to life-changing medications without breaking the bank. Through smart plan design, thoughtful integration with wellness initiatives and a focus on long-term outcomes, employers can empower their workforce to achieve better health while keeping their benefit budgets intact. In the high-stakes world of employer-sponsored health benefits, that’s a win worth replicating.