Employer GLP 1 coverage shrinks as 2027 costs climb

Employer GLP 1 coverage for weight loss is shrinking as open enrollment begins for 2027. A WTW survey found that 53% of larger employers still cover the drugs, down from 57% last year, while Marsh expects health costs per employee to rise 8.2%. CNBC reported the shift on October 27. Some workers will see the drugs dropped and offered a cash price route, partial reimbursement or a coaching program instead.

Surveys show the first drop in three years

WTW fielded its annual health benefits survey over the summer and is releasing it in full this week. Among firms with more than 100 staff, CNBC says the share paying for GLP 1 drugs used for weight loss slipped from 57% last year to 53% now. No earlier year in the past three showed a fall. A further 16% said they cover the drugs now but are considering removal, up from 9% a year earlier. The figures describe larger employers only, and the survey does not say which plans have already made a final choice for 2027. Smaller firms, public plans and union plans are not covered by these numbers, so readers should treat these employer GLP 1 coverage figures as one slice of the market.

Cost is the main driver. CNBC reported that covering these drugs for weight loss typically costs employers in the mid $500s to mid $600s per user each month. Marsh surveyed more than 1,800 US employers and projects that 2027 will bring an average 8.2% rise in health cost per employee, the steepest since 2003. GLP 1 use alone accounts for one point of that rise. Not every large employer is retreating. Bank of America chief executive Brian Moynihan said in August that the bank spends about $250 million or more on these drugs and called it a good investment. Other plans have narrowed access too. Walmart's 2027 plan design is one example. Another is the Massachusetts coverage data.

Direct pay and direct to employer routes

Some employers now point workers to the cash price programs run by drug makers. WTW found that 8% of employers have taken this route and 28% are planning or considering it. Gallagher's Seth Friedman estimated that 20% to 30% of the firm's clients dropped coverage for 2027 and send employees to those programs. CNBC cited self pay starting prices of $149 a month for the Wegovy pill, $199 for the shot and $299 for Zepbound. Novo Nordisk says its current promotional pricing may be changed or canceled in 2027. Gallup data show 11% of US adults took a GLP 1 drug for weight loss in 2026, up from 3% in 2024. WTW's Jeff Levin-Scherz said many people "will choose to pay for this on their own even if it's not covered by the plan."

WTW's Jeff Levin-Scherz said many people "will choose to pay for this on their own even if it's not covered by the plan."

A second model is called direct to employer. Here the company removes the drug from its standard pharmacy benefit and instead repays a share of what the worker spends. A spokesperson for Vida Health, one of several vendors in this area, said these arrangements give employers better pricing and more control over their contribution. Marsh's Alysha Fluno said employers can shape the program to fit their staff and save a good deal compared with paying through a pharmacy benefit manager. Levin-Scherz estimated that, using manufacturer cash prices, a company could cover the full cost and add a vendor fee yet still pay far less than a benefit manager contract for Wegovy. These are expert estimates, not audited results, and show why employer GLP 1 coverage is being redesigned. Compare this with the wider access pathways study published this week.

Weight management programs replace the drug

Other employers drop the drug and hire a vendor to run a weight management program. The providers CNBC listed include CVS Weight Management, Noom, Omada Health, UnitedHealthcare, Vida and Virta. Marsh data from 2025 show that 25% of employers with 500 or more employees had a vendor partner for lifestyle and nutrition support. Employers, not workers, usually pay, and Marsh's Caroline Susie put the cost at about $65 to $100 per employee each month. A vendor that also offers prescription services could cost $150 or more per participating employee. Offerings usually center on coaching, live or online, about habits, food, exercise and general health. Friedman of Gallagher said worker uptake can be a challenge, since patients can ask their doctor for a prescription and go straight to the drug maker.

Providers cite results, but the numbers come from the companies themselves. Omada Health reported that 63% of members checked 12 months after stopping a GLP 1 kept their weight or kept losing. UnitedHealthcare said 88% of at risk participants in its Real Appeal program lost weight over 52 weeks, and 37% lost 5% or more of body weight. CVS Weight Management reported 90% weight maintenance for members up to 10 to 12 months after ending drug therapy. CNBC does not describe how these groups were chosen or measured, so the figures cannot be compared with each other or with trial data. Employers weighing a switch should ask vendors for methods, not only headline rates.

What FSA and HSA accounts can cover

Tax advantaged accounts can soften the blow, though they do not replace a health plan. According to CNBC, a prescription from a licensed provider for a diagnosed condition such as obesity makes GLP 1 drugs eligible for FSA and HSA reimbursement. The tradeoff is that money spent from an HSA cannot grow tax free for retirement. The FSA employee contribution limit is $3,400 in 2026. The IRS HSA limits for 2026 are $4,400 for self only coverage and $8,750 for family coverage, rising in 2027 to $4,500 and $9,000. Official 2027 FSA limits have not been announced. At the cited starting price of $299 a month, a year of Zepbound would come to $3,588, which is above the 2026 FSA limit.

Several things remain unknown. No survey says how many workers will lose coverage, and the surveys count employers, not employees. Drug maker cash prices may change, and Novo Nordisk has said so. Vendor program results lack outside review, and employer GLP 1 coverage terms differ from plan to plan. Andrew Stocker of Voya Financial said employers need to educate workers about the benefits that do exist, which suggests that plan documents and benefits teams are the first places to check. People using these drugs should talk with their prescriber before changing treatment, because stopping or switching products is a medical decision. This article is research reporting, not medical advice, and it does not recommend any seller or program.

Conclusion

Employer GLP 1 coverage fell for the first time in three years in the WTW survey, and Marsh expects 2027 costs to rise faster than at any point since 2003. Workers may meet cash price routes, reimbursement models, coaching programs or tax accounts at open enrollment. Each option moves cost from the plan to someone else, and the evidence for vendor programs is company reported. Read your plan documents before the enrollment deadline.