GLP-1s: Rewriting the relationship between pharmacy benefits and stop-loss

Pharmacy benefits and stop-loss strategy have always been related. But most self-funded employers and their advisors treat them as separate planning exercises with separate teams and timelines. GLP-1 medications are the drug class that’s forcing those conversations together.

Injectable GLP-1s can cost more than $10,000 per member per year, and adoption is surging. In a KFF survey last fall, 12% of American adults reported taking GLP-1s. The utilization trend began to build in 2024, became a significant cost factor in 2025, and keeps driving claims higher in 2026. When Serena Williams and Charles Barkley appear on billboards across New York City promoting these medications, the demand for them skyrockets.

Lockton’s data shows that allowed per-member, per-month costs rose nearly 840%, from $2.41 to $22.59, between 2022 and 2024 for employers covering GLP-1s for weight management. No previous therapeutic has been this widely adopted despite being so expensive, and the stop-loss market is experiencing both those pressures at once.

What makes GLP-1s unusual in the stop-loss context is where that pressure lands. Most high-cost therapeutics are episodic, such as cancer medication, gene therapy or an organ transplant. They generate large individual claims against specific deductibles, and advisors and carriers know how to price for that. GLP-1s don’t work that way. Individual prescriptions generally sit below typical specific attachment points, but GLP-1s are maintenance drugs. They must be taken indefinitely to remain effective. That sustained utilization across a growing share of the covered population compounds into an aggregate pressure that traditional underwriting models were not built to anticipate from a single drug class.

Let’s say 20% of a 300-person group starts GLP-1 therapy. The additional annual expenditure could reach $600,000. For many smaller groups, that’s enough to breach an aggregate threshold on pharmacy alone.

Adherence complicates things

The picture gets more complicated when you factor in adherence. Discontinuation rates for GLP-1s are high — some studies show that nearly two-thirds of patients stop treatment before reaching the 12-week mark needed for meaningful weight loss. That makes aggregate spending harder to predict, because enrollment in GLP-1 therapy at any given point may not reflect sustained utilization over the full plan year. It also means employers are paying for prescriptions that don’t deliver lasting clinical results, which weakens the long-term cost-benefit case for coverage.

At the same time, GLP-1 complications can lead to inpatient stays that cross specific deductibles. So carriers are under pressure from both directions within the same drug class. That kind of dual exposure from a single therapeutic category has no real precedent in this market.

The structural issue for advisors is that most employers still treat pharmacy benefit decisions and stop-loss strategy as separate exercises. When a client decides to add, restrict or drop GLP-1 weight-loss coverage, that decision has direct consequences for stop-loss attachment points, renewal pricing and claims volatility. But those consequences often don’t get factored in until later.

Advisors who bring pharmacy utilization data into the stop-loss conversation in real time will have more leverage at renewal and fewer surprises. The coverage-design conversation must happen with stop-loss implications in mind from the start.

GLP-1 pricing adds urgency

The pricing environment adds urgency. Multiple oral GLP-1s are now on the market, with self-pay prices starting around $149 per month. Those lower price points will expand the user base, because many people who would not consider a weekly injection will readily take a daily pill. But on the insured side, reimbursement rates for oral and injectable GLP-1s remain comparable, so the per-claim cost relief has not yet arrived for employer plans.

Novo Nordisk announced list-price cuts to $675 per month starting January 2027, and manufacturer competition is intensifying. Relief on per-unit costs is coming, but in the meantime, the more immediate effect is that oral formulations and lower self-pay pricing are pulling more people into GLP-1 therapy. Utilization is growing faster than costs are falling, and aggregate exposure is likely to widen before it narrows.

Employers who react by cutting GLP-1 coverage entirely may reduce their pharmacy trend, but they risk leaving obesity and its associated comorbidities unmanaged. Those costs don’t disappear — they show up as higher medical claims down the road, affecting stop-loss in a different way. The advisors and carriers who recognize that the risk moves rather than disappears will be the ones who manage it best.

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John Thornton is executive vice president, sales and marketing, Amalgamated Life Insurance Company. He may be contacted at [email protected].