The debate over GLP-1 medications has entered a new phase for US employer-sponsored health plans. The question is no longer whether to cover the blockbuster drugs, but how to manage rapidly growing demand without sacrificing their long-term health benefits.
That shift is reshaping conversations across the employee benefits market, according to stop-loss carriers and benefits consultants interviewed by Insurance Business. Rather than viewing GLP-1s as a catastrophic claims threat, they increasingly see them as a pharmacy cost-management challenge.
The financial pressures are significant. The 2026 Amwins Benefits State of the Market report estimates that some employers are adding 2% or more to their healthcare budgets solely to account for GLP-1 medications. Meanwhile, the arrival of new formulations, including oral GLP-1s, is expected to expand access and accelerate utilization further.
At the same time, employers are weighing those near-term costs against growing evidence that the drugs could improve long-term health outcomes and potentially reduce overall medical spending.
Jay Ritchie (pictured), president and CEO of Tokio Marine HCC – Medical Stop Loss & Specialty A&H, said employers should distinguish between today's budget pressures and the drugs' longer-term clinical value.
"We're actually strong advocates for GLP-1s because we believe they offer long-term benefits for cardiac health, kidney disease and potentially even cancer outcomes," Ritchie told Insurance Business.
"Many people are focused on the immediate increase in plan costs associated with GLP-1 utilization. We see that as today's challenge, but we believe the long-term benefits could be substantial. Based on the studies we've reviewed, they may ultimately reduce catastrophic claims."
While advocates point to growing evidence of broader health benefits, many employers remain focused on the immediate impact on pharmacy spending as utilization continues to rise.
Despite their high profile, GLP-1 medications are not emerging as a major source of individual stop-loss claims, according to Ritchie. Instead, he said, employers are facing a frequency challenge rather than a severity problem, with increasing numbers of employees using the drugs driving higher pharmacy costs.
"Many employers are seeing a surge in employees using GLP-1s, so they're experiencing a significant increase in pharmacy spending," he said. "There are ways for employers to integrate GLP-1 delivery more efficiently, which can reduce the short-term financial impact. Over the long term, I believe health plans will realize savings from offering GLP-1s. Right now they're dealing with an initial wave of utilization, but that should stabilize over time."
The Amwins report also points to research suggesting GLP-1 users may ultimately experience slower growth in overall medical costs than comparable non-users, although many of those projected long-term savings have yet to be conclusively demonstrated.
Benefits consultants say the conversation has evolved beyond simply deciding whether to include GLP-1s in health plans. Instead, employers are increasingly focused on determining who should receive coverage and under what conditions.
During a recent healthcare cost management webinar hosted by Hub International, specialists said employers are moving away from blanket coverage or blanket exclusions in favor of structured eligibility programs.
"The question now is how to cover them in a way that's both clinically appropriate and financially sustainable," said Nelly Rose, Hub's national pharmacy practice leader.
She noted that pharmacy costs now account for nearly a quarter of total healthcare spending, while GLP-1 medications prescribed for weight management are contributing to premium increases of between 5% and 14%.
Rather than treating every indication equally, Hub recommends differentiating coverage according to medical need. Coverage for diabetes and cardiovascular disease should remain straightforward, executives said, while weight management programs should include utilization controls such as step therapy, body mass index thresholds combined with comorbidities, participation in lifestyle management programs and regular clinical reviews.
Ashley Mayberry, Hub's national director of clinical consulting, said those safeguards are designed to balance affordability with appropriate care.
"Without these guardrails, longer-term risks such as muscle loss, reduced bone density and weight regain can generate new medical costs that offset any short-term pharmacy savings," Mayberry said during the webinar. "With them, GLP-1 programs can be both clinically effective and financially defensible."
Hub also presented internal data suggesting employers that implemented utilization management strategies beginning in 2023 have experienced slower per-member-per-month GLP-1 spending growth than plans without structured programs.
GLP-1 management is becoming one element of a broader strategy among employers to control healthcare spending. Hub executives also highlighted biosimilar adoption, pharmacy benefit manager contract reviews, site-of-care optimization and clinical analytics as complementary approaches to managing specialty drug costs. They argued that integrating pharmacy, clinical and financial oversight can generate greater savings than relying on any single intervention.
For insurers, however, GLP-1s remain a manageable utilization challenge rather than the market's biggest financial threat. Attention continues to focus on high-cost gene therapies, which can cost millions of dollars per treatment and have the potential to reshape catastrophic claims exposure.
"We still haven't seen the blockbuster gene therapy that could dramatically reshape the market," Ritchie said.
