It seems impossible to discuss pharmacy benefits today without mentioning one class of drugs: GLP-1s. They are in news headlines, in viral social media memes, and anyone who is involved in managing pharmacy benefits has likely witnessed their impact firsthand. With one in eight U.S. adults having tried a GLP-1 medication, what was once a treatment for managing blood sugar for Type 2 diabetics has exploded into a multi-billion dollar market phenomenon for weight loss and a host of expanded indications. And, this trend shows no signs of slowing down.
The GLP-1 pipeline is also filled with promising research into prediabetes, psoriasis, and even substance dependency. Our latest Pharmland podcast explores the ongoing GLP-1 buzz and why these medications will continue to be a hot topic in 2026. This constant expansion means utilization and costs will leave many employers wondering how to manage this new reality.
Keys to balancing GLP-1 access and cost
1. Align coverage with plan goals through design
A foundational step is to ensure that the pharmacy benefits plan design clearly defines what is and is not covered. For some employers, this may mean excluding coverage for certain uses, like weight loss, if it doesn’t align with the primary goals of the health plan. This approach is about purposefully allocating resources to meet the organization’s specific health and financial objectives.
2. Implement robust clinical management
Another effective tool is targeted clinical oversight. Implementing strategies like independent, unbiased, prior authorization reviews ensures appropriate use of prescriptions as intended by your plan design. This simple step can deliver significant savings by preventing inappropriate or non-covered uses. For example, RxBenefits‘ targeted GLP-1 reviews delivered $52 million in savings for clients in 2024 alone.
3. Trying lower-cost, effective treatments first
Step therapy guides members to try clinically effective, lower-cost medications before “stepping up” to more expensive options like GLP-1s. This approach ensures that GLP-1s are reserved for cases where they are truly necessary, after other proven treatments have been attempted. To make this strategy effective, a confirmed diagnosis and relevant chart notes should be required before approving a GLP-1 prescription.
4. Alternative solutions
Incorporating alternative programs such as wellness benefits that focus on lifestyle changes – including trying access to GLP-1s to such modifications – can provide a foundation for long-term health and control costs. Direct-to-consumer manufacturer programs also enable employees to access these drugs at a lower cost without impacting the employer’s plan.
By implementing a thoughtful, sustainable strategy, employers can manage costs effectively while empowering employees to access the medications they need for better health outcomes.
Navigating the future of your pharmacy benefits
The GLP-1 phenomenon is not just a temporary surge. It represents a lasting transformation in healthcare and pharmacy benefits. The market’s explosive growth presents both opportunities for improved employee health and significant financial challenges for employers. As utilization continues to climb, waiting to act is no longer a viable option.
A proactive, multi-faceted approach is essential. By implementing robust clinical management to ensure appropriate use, exploring creative solutions like wellness programs or direct-to-consumer options, and maintaining a focus on long-term strategy, you can strike a balance. The goal is to manage immediate costs without sacrificing the long-term health and well-being of your workforce.
Listen to our latest episode of Pharmland. You can also read our recent blog post.
