3 paths for employers to retain GLP-1 coverage in 2027

How employers can retain coverage of GLP-1 drugs (AI-generated image)

By William G. (Bill) Stuart

The dominoes keep falling. Insurer after insurer is restricting GLP-1 access to patients with a Food and Drug Administration-approved indication – diabetes, sleep apnea, cardiovascular disease – rather than weight loss alone. Employers and employees are scrambling for answers as these changes arrive ahead of the 2027 renewal season.

Why the alarm? As of September 2025, 1 in 14 U.S. prescriptions filled was for a GLP-1. Total 2025 U.S. sales approached $50 billion. Eli Lilly's Mounjaro and Zepbound alone generated roughly $25 billion in U.S. sales – more than the entire $20.7 billion in global sales of Eliquis, one of the world's best-selling drugs. Insurers see this trajectory as unsustainable, especially since only about 1 in 6 Americans reports having used a GLP-1, in a nation where 40% of adults are obese and roughly a quarter of those meet the threshold for severe/morbid obesity.

Compounding the concern: Much of this spending may not deliver lasting value. Roughly one-third of GLP-1 patients abandon the drug within six months, and about half abandon it within a year, often before achieving durable weight loss.

What can employers do to retain or restore GLP-1 coverage for weight loss in 2027? Here are three distinct paths.

Insurance rider. Most insurers restricting GLP-1 coverage for weight loss alone offer a rider to buy it back. Cost varies with plan design, but 6% to 9% of premium is a common surcharge. This is the least disruptive option for current users and the least administrative burden for employers – no new plan or vendor to sponsor.

The tradeoff is control: The insurer sets formulary and program rules, and most employers have little influence over cost or design (although large self-insured groups have somewhat more leverage). Some insurers bundle nutrition counseling or coaching into the rider, but these supports haven't prevented the high abandonment rates cited previously, since insurer-covered patients already reflect those numbers.

Advantages: Least administrative burden; least disruptive to current users.
Disadvantage: Minimal employer control over cost or design.

Health reimbursement arrangement. Employers can offer an integrated HRA (available only to employees enrolled in the medical plan, health savings account-compatible, with employer-set annual and/or per-script caps) or a GLP-1 excepted benefit HRA, or EBHRA (open to all benefits-eligible employees regardless of medical enrollment, capped at $2,200 in 2026; the 2027 limit isn't yet set). Employees pay cash price and submit for reimbursement.

The EBHRA's low ceiling covers roughly six months of a GLP-1 at today's roughly $350 monthly cash price. A per-script cap without an annual limit increases exposure if multiple family members are reimbursed; an annual cap controls total spending more tightly. An HRA limits employer dollars spent but includes no medical management.

Advantage: Employer controls costs directly.
Disadvantage: Requires sponsoring and administering another plan, although a third-party administrator can absorb much of that burden.

Point solution. A comprehensive patient-management and distribution partner enrolls employees and applies employer-defined medical management – behavioral programs, nutrition counseling, coaching, periodic evaluation.

It's the most expensive option, driven by the administrative intensity and support needed to keep patients engaged long term. But it gives employers the most control over program design and often includes manufacturer-negotiated drug discounts. For employers balancing cost against outcomes, this option stands out.

Advantage: Most supportive for employees; often lower drug prices.
Disadvantage: Highest cost.

Forward-thinking benefits advisors can offer clients three distinct paths to sustain GLP-1 coverage in 2027 – each a different trade-off between cost control, administrative burden and employee support – as part of a broader retention, recruitment and population-health strategy.