With open enrollment season in swing, many employees may notice something conspicuously missing from their benefits menu — coverage of GLP-1 drugs for weight loss.
More companies are dropping coverage completely or offering employees less generous payouts. In some cases, they're shifting to a different model altogether — offering employees a consolation prize of sorts — access to a weight management program through a third party.
Coverage of these drugs for weight loss is pricey for employers — typically costing in the mid-$500s to mid-$600s per user monthly. Some companies say whatever the price, covering the drugs is worth it based on employee health. "We spend about $250 million or more on GLPs, and that's up from zero" four or five years ago, Bank of America CEO Brian Moynihan told CNBC's Andrew Ross Sorkin in August. "We see a great impact on the employees. ... Believe me, we're pounding everybody on price and trying to get as cheap [as possible]. But our view is that [because of] the long-term health benefits, plus there may be more short-term health benefits ... it's a good investment."
Nevertheless, as healthcare costs continue to climb, more employers have been looking for an exit ramp on GLP-1 coverage for weight loss, and that includes bigger companies. A WTW annual health benefits survey fielded over the summer and being released in full on Wednesday found that 53% of employers with more than 100 employees cover GLP-1s for weight loss, down from 57% in 2025. That's the first decline in three years. What's more, 16% of employers said they cover the drugs now but are considering removing them, up from 9% last year.
According to a recent Marsh survey of over 1,800 US employers, health insurance cost per employee is expected to rise 8.2% on average in 2027, the biggest increase since 2003, with GLP-1 use accounting for a full percentage point of the overall cost growth. Its experts have cited the soaring costs among reasons employers are considering dropping coverage for 2027.
"Employers are really balancing empathy with economics," said Caroline Susie, principal in Marsh's total health management practice.
Some workers who use employer-sponsored health plans are being provided with options in the event of GLP-1 coverage being dropped, though nothing may match full health insurance coverage. Here are alternatives to expect.
Direct-to-consumer programs
Some employers are directing workers to buy GLP-1s through direct-to-consumer options like Novo Nordisk's NovoCare or Eli Lilly's LillyDirect. WTW's survey showed that 8% of employers have gone this route, and 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 dropped coverage for 2027 and are sending employees the direct route. For employers, this move can mean significant savings. The percentage of U.S. adults who take GLP-1 medications for weight loss purposes climbed to 11% in 2026, up significantly from 3% in 2024, according to Gallup. What's more, 15% report having used the medicine for weight loss at some point, a nine-percentage-point boost.
"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 starting price for the lowest dose of Novo's Wegovy for self-pay individuals is currently $149 a month for the pill and $199 a month for the shot. Those prices are subject to change in 2027; Novo Nordisk says current promotional pricing may be modified or canceled. Lilly's Zepbound starts at $299 a month for a single-dose vial or multi-dose KwikPen.
Direct-to-employer programs
Some companies are moving to a direct-to-employer model, where they drop coverage through their traditional pharmacy program, but offer to reimburse some portion of an employee's out-of-pocket costs.
"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 multiple vendors that works with employers in this area. Others include Noom and GoodRx.
Employers can often design the program that works for their employees' needs, at a significant savings from paying for GLP-1 drugs through a pharmacy benefit manager, said Alysha Fluno, national pharmacy practice leader at Marsh. A PBM is a third-party administrator that manages prescription drug benefits for health insurers and employers.
Based on direct-to-consumer prices, employers could fully subsidize, pay a vendor fee, and still spend much less than they would to purchase Wegovy, for example, through a PBM, according to WTW's Levin-Scherz.
Weight-management programs
Some employers are dropping coverage and contracting with third parties like CVS Weight Management, Noom, Omada Health, UnitedHealthcare, Vida and Virta, to offer weight-management programs to employees. Some employers offered these types of programs before, while others made them available only after dropping GLP-1 coverage for weight loss.
According to 2025 data from Marsh, 25% of employers of 500 or more employees had a vendor partner for lifestyle modification and nutrition support. Employers, not employees, typically foot the bill for these programs, at a significant savings compared with GLP-1 coverage. Services can vary by member, but offerings generally include live or online coaching on behavior change, diet, exercise, nutrition and other health topics. Costs for these programs can run about $65 to $100 per employee per month, depending on what's offered, according to Marsh's Susie. Employers who choose a vendor that offers prescription services as well could pay $150 or more per month per participating employee.
Service providers cite good results from their programs in recent years. Data from Omada Health show that 63% of members evaluated at 12 months after stopping a GLP-1 maintained or continued to lose weight. UnitedHealthcare's Real Appeal program data show that 88% of at-risk participants lost weight during the 52-week program designed to promote healthy eating, physical activity, improved well-being and a better health outlook. What's more, 37% of participants lost 5% or more in body weight. Meanwhile, initial program results reported by CVS Weight Management showed 90% weight loss maintenance for members up to 10–12 months after ending drug therapy.
Provider offerings vary somewhat, but professional support is often a hallmark. "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.
Employee utilization, however, can be a challenge, said Gallagher's Friedman. "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, HSA money for medically necessary GLP-1s
While these tax-advantaged accounts are not alone a replacement for a comprehensive health plan, GLP-1 medications are eligible for flexible spending account (FSA) and health savings account (HSA) reimbursement when prescribed by a licensed provider to treat a diagnosed medical condition, such as obesity. The disadvantage of using an HSA to pay for GLP-1s is that the dollars invested don't have a chance to grow tax-free for use later on in retirement.
The annual employee contribution limit for an FSA is $3,400 in 2026. For 2026, the maximum annual HSA contribution limits set by the IRS are $4,400 for individuals with self-only coverage and $8,750 for those with family coverage. That will rise in 2027 to $4,500 for individuals and $9,000 for families. Official 2027 IRS contribution limits for FSAs 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."