GLP-1 Update: Coverage Expands as Costs Surge - Strategic Management Becomes Essential

GLP-1 Update: Coverage Expands as Costs Surge – Strategic Management Becomes Essential

July 24, 2025

The GLP-1 landscape continues to evolve rapidly, with new data revealing both expanding employer coverage and intensifying financial pressures. As we’ve highlighted in our ongoing GLP-1 series, understanding these trends, and implementing proactive management strategies, has never been more crucial for plan sponsors.

THE CURRENT MARKET REALITY

Recent data reveals a dramatic shift: 36% of employers now provide GLP-1 coverage for both weight loss and diabetes (1). While this reflects growing recognition of these medications’ value, it comes with serious cost implications. The use of GLP-1 drugs for weight loss currently represents 10.5% of total claims, and 27% of employers report GLP-1 drugs account for more than 15% of their annual drug spend (1). With oral formulations approaching FDA approval, the trend is accelerating.

HOW EMPLOYERS ARE RESPONDING

Faced with these unprecedented cost pressures, more than three-quarters of employers now employ cost-control mechanisms (1), including:

Prior authorization requirements (96% of employers using utilization management)
Strict eligibility criteria focusing on clinical severity (68% of employers)
BMI thresholds and comorbidity requirements (88% require minimum BMI; 60% require obesity plus chronic conditions)

BENECARD’S COMPREHENSIVE GLP-1 SOLUTIONS

Benecard has developed targeted benefit design features to help reduce the rising costs associated with brand-name GLP-1 drugs prescribed for weight loss while ensuring appropriate clinical care:

Clinical Severity Targeting: Limiting weight loss coverage to patients who are qualified as having clinically severe obesity (BMI ≥40 or BMI ≥35 with comorbidities) who face the highest medical cost risks.
Defined Treatment Length: Limiting all current, future, and any combination of oral and non-oral weight loss GLP-1 drugs to twelve fills each at a 30-day supply for a lifetime maximum per member.
Proactive Market Positioning: Excluding coverage for upcoming oral GLP-1 tablets approved for weight loss and/or for diabetes treatment.
Centralized Management: Requiring all brand-name injectable GLP-1s to be filled through Benecard Central Fill (BCF) for enhanced clinical oversight, improved cost control, and access to manufacturer copay assistance programs.

PREPARING FOR CONTINUED EVOLUTION

Plan sponsors implementing structured GLP-1 management today position themselves for long-term sustainability as this market continues to expand. Our fixed-rate Rx benefit solution provides the predictability you need while our innovative benefit designs help control utilization without compromising quality care.