GLP-1s: What Employers Should Know About Cost, Coverage, and Care

Woman self-administering a GLP-1 weight-loss medication injection at home for diabetes or obesity treatment

The buzz about GLP-1s is everywhere—on the news, in Super Bowl commercials, in doctors’ offices, and increasingly, in benefits conversations.

As demand and employer costs continue to rise, it’s helpful to understand exactly what these medications are, why they’re so expensive, and how you should think about their role in helping your employees with their overall health and long-term weight management.

Not sure where to start? This guide has the skinny on GLP-1s, so you can make informed decisions about your benefits and your workers’ well-being.

What are GLP-1s (and how do they work)?

GLP-1 agonists (commonly called “GLP-1s”) are a class of medications that manage blood sugar (glucose) levels. Because of that, they’re commonly used to treat people with Type 2 diabetes and obesity.

Ozempic has gotten outsized attention, but it’s not the only GLP-1 available. Remember, GLP-1 is a class of medications, not a single drug. There are a variety of GLP-1s on the market, including:

  • Semaglutide injections (Ozempic and Wegovy)
  • Semaglutide tablets (Rybelsus)
  • Tirzepatide (Mounjaro and Zepound)
  • Dulaglutide (Trulicity)
  • Liraglutide (Victoza and Saxenda)
  • Exenatide (Byetta and Bydureon)

Currently, Wegovy, Saxenda, and Zepbound are the only three GLP-1s that are FDA-approved for weight loss. The others are FDA-approved only for Type 2 diabetes.

How do GLP-1s work?

Exactly how a GLP-1 works depends on the specific one a person is using. But here’s the gist of what’s happening in the body: GLP-1s mimic a natural hormone produced in the gut. This hormone tells the pancreas to release insulin, which moves glucose out of your bloodstream and into your cells, where it can be used for energy and nutrition.

Insulin is a big part of it, but GLP-1s also slow the movement of food through the stomach (this is called “delayed gastric emptying”) and activate satiety signals in the brain, helping people feel full sooner and stay full longer. That’s why many people say GLP-1s help turn down the “food noise” in their brains.

Why are GLP-1s getting so much attention now?

GLP-1s aren’t new. The first one (Byetta) was FDA-approved for Type 2 diabetes more than 20 years ago. Using GLP-1s specifically for weight loss is a slightly newer concept, though, with the first (Saxenda) approved by the FDA in 2014.

Even so, the real “Ozempic craze” (the term often used for the celebrity- and media-fueled excitement about the drug) didn’t start in earnest until 2022.

So, why the sudden spike in interest? There isn’t a pinnacle moment or driving factor. Rather, there are several forces at play shaping the enthusiasm for and interest in GLP-1s, including:

  • Impressive results: Newer GLP-1s (like semaglutide and tirzepatide) delivered significantly greater and more consistent weight loss than earlier medications. That made the results much harder for people to ignore.
  • Clinical and regulatory momentum: FDA approvals for obesity treatment (not just diabetes) helped legitimize GLP-1s as an effective medical weight-loss option rather than an off-label workaround. FDA approvals happened in:
    • Saxenda: December 2014
    • Wegovy: June 2021
    • Zepbound: November 2023
  • Increased focus on metabolic health: Rising rates of obesity, diabetes, and cardiac diseases—combined with more awareness of obesity as a chronic condition as opposed to a moral failing—shifted the conversation from just willpower to effective treatment options.
  • Media attention: Media coverage and high-profile stories from celebrities accelerated awareness and drove patient demand way faster than what medications typically see.
  • Easier access: Telehealth, employer-sponsored coverage, and direct-to-consumer programs made access easier for patients who wanted prescriptions.

Now, one in eight adults is currently taking a GLP-1 to either lose weight or treat a chronic condition. Nearly one in five say they have taken one at some point.

How much do GLP-1s cost?

GLP-1s are effective, but they’re also expensive. Much like with any type of medication, prices vary. But the average annual list price of GLP-1s is $12,000. That means, without any insurance coverage, adults pay roughly $1,000 per month for these medications. Other estimates say they cost closer to $700 to $800 per month.

Either way, it’s an expense many people can’t afford, and 54% of adults who have taken GLP-1s admit the cost was difficult to manage. That’s true even when insurance chips in, with 53% of insured adults saying it was still tough to stomach the cost.

Fortunately, many employers cover GLP-1s—especially for diabetes management. Coverage for weight loss is less common but quickly growing. 55% of employers say they currently cover GLP-1s for diabetes, and 36% cover them for both diabetes and weight loss.

While a decent percentage of plans do provide coverage, people often still feel uninformed or out of the loop. 51% of Americans admit they’re unsure if their plan covers these medications. And, even when they do, getting approved for coverage often involves jumping through a lot of hoops.

Are GLP-1s a standalone weight loss solution?

GLP-1s can absolutely drive meaningful weight loss (some research indicates an average weight loss of 15-20%), especially in the first six to 12 months. But these medications aren’t without their downsides, including:

  • Weight regain: Once the medication is stopped, weight regain is common (with many people gaining back up to three-quarters of what they lost).
  • Bone density loss: Rapid weight loss and reduced intake of nutrients can often lead to a loss in bone density, but there is some conflicting evidence of the impact of GLP-1s themselves on bone density. Some experts say they’re harmful, while others say they actually increase bone formation.
  • Decreased muscle mass: Rapid weight loss (and not necessarily the GLP-1 itself) can also potentially cause loss of muscle mass.

This doesn’t mean that GLP-1s are inherently bad—they’re undeniably effective medications. Rather, it emphasizes the importance of using GLP-1s as one piece of a broader weight-management strategy. In other words, they’re a valuable tool and not a total fix. GLP-1s can (and should) be used in combination with:

  • Nutrition guidance and a high-protein diet
  • Regular exercise (especially strength training to protect muscle and bone health)
  • Behavioral and psychological support to address eating behaviors, habits, and emotional drivers of weight

In fact, using GLP-1s alongside other weight management efforts can counteract some of the potential drawbacks. For example, research shows that combining a high-protein diet and regular exercise with GLP-1 treatment actually has the greatest benefit in preserving bone and muscle mass (compared to diet alone or a high-protein diet alone).

GLP-1s are also often used as a complement to bariatric surgery, especially for people with severe or complex obesity or obesity-related complications, who need to lower their BMI to safely pursue surgical options, or who are at higher risk of weight regain after surgery. For these people, surgery isn’t a replacement for GLP-1s, and GLP-1s aren’t a replacement for surgery. They work together to improve outcomes.

What should employers know about GLP-1s?

GLP-1 utilization is rising fast—and so are employer costs. From 2018 to 2023, spending on GLP-1s rose by more than 500%. That likely won’t slow down anytime soon, with research predicting that GLP-1s could increase employer-provided coverage premiums by as much as 14%.

This puts a big strain on employers, with 64% of large employers saying GLP-1 drug coverage has moderately or significantly impacted their prescription drug spending. And some have had a knee-jerk reaction to skyrocketing costs and dropped coverage of weight loss drugs entirely.

But that can have adverse effects on not just work culture but costs, especially when obesity contributes to many other high-cost conditions like MSK pain, diabetes, and cardiovascular disease.

So, the best move isn’t to limit care—it’s to ensure you’re giving employees access to the right care. That can mean GLP-1s, yes. But not in isolation.

Employees should have access to high-quality care that guides them through a comprehensive weight-management plan. This includes not only medications but also nutrition coaching, exercise, blood sugar monitoring, behavioral support, and, in some cases, surgery.

Holistic weight management

GLP-1s are reshaping conversations about weight loss—but they’re only a part of the story. For employees who need other solutions, bariatric surgery remains one of the most effective and evidence-backed interventions available.

With Carrum Health, you can connect your employees to high-quality bariatric care through a curated network of top Centers of Excellence, with transparent pricing and coordinated support the whole way through.

In addition, we just announced a groundbreaking partnership with Virta Health to expand the metabolic care services your members can receive. By combining Virta’s clinically rigorous metabolic care—including nutrition-first weight loss, diabetes reversal, and responsible GLP-1 prescribing—with Carrum’s high-touch, value-based specialty care pathways, we’re creating a coordinated, end-to-end model that increases utilization of the right care, improves outcomes, and lowers total cost of care for you and your members.