Which Employers Cover GLP-1s?

If you have searched for a list of companies that cover Wegovy or Zepbound, you have probably found several. They are all unreliable. Coverage is decided plan by plan, changes at every renewal, and inside a single large company can differ between the union plan and the salaried plan.

What is reliable is the survey data on how common coverage is, the conditions employers attach, and the process for finding out what your own plan does. That is what this article covers. It is not medical advice. Where it describes how a medicine is used, it is summarizing FDA-approved labeling and Instructions for Use; follow your own prescription and your prescriber’s directions.

What share of employers actually cover these drugs?

Four major surveys ask versions of this question and get four different answers, because they survey different employers and word the question differently. Read the denominator before comparing.

Survey	Who was asked	Headline finding
KFF Employer Health Benefits Survey, 2025	Nationally representative sample of firms with 10+ workers	43% of firms with 5,000+ workers, 30% with 1,000–4,999, and 16% with 200–999 cover GLP-1s used primarily for weight loss [1]
Business Group on Health, Feb–Mar 2026	105 very large employer members	67% cover GLP-1s for weight management [3] — superseded by the survey below
Business Group on Health, published August 25, 2026	Large employer members	60% cover GLP-1s for weight loss, down from 72% in 2025; about 14% have dropped or plan to drop GLP-1 coverage in 2027 [25][26] (updated 2026-09-14)
IFEBP, June 2026	About 300 US employer health plans	About 36% cover GLP-1s for both diabetes and weight loss [4]
Mercer	Employers with 500+ employees	44% covered weight-loss medications in its 2024 survey (64% among those with 20,000+); reporting in June 2026 put employers with 500+ covering them for obesity at about 44% again — flat, not growing [5][6]

The pattern underneath the noise is consistent. Very large employers are much more likely to cover these drugs than mid-size ones, and small employers rarely do. KFF’s 2025 figure for the largest firms, 43 percent, was up sharply from 28 percent a year earlier [1] — but that growth has stalled.

Is coverage still growing?

No. Every recent data point points sideways or down.

• Business Group on Health’s August 25, 2026 survey found large-employer coverage of GLP-1s for weight loss had fallen to 60 percent from 72 percent in 2025, with about 14 percent of employers having already dropped or planning to drop the coverage in 2027. The same survey put 2027 employer healthcare cost growth at 9.2 percent absent intervention, up from 8.5 percent in 2026, with pharmacy at 25 percent of spend and rising 12 percent [25][26]. The earlier reading from the same organisation — 72 percent likely to continue and 10 percent likely not [3] — is superseded. (updated 2026-09-14)
• IFEBP’s 36 percent for 2026 was unchanged from 2025 [4].
• Reporting on Mercer’s survey work says about 5 percent of large employers are actively planning to drop coverage for 2027 [6].
• KFF found that among large firms that do not cover GLP-1s for weight loss, only 1 percent said they were very likely to add coverage in the next 12 months [1].

The reason is money. IFEBP respondents said GLP-1s accounted for 11.4 percent of annual claims in 2026, up from 6.9 percent in 2023 [4]. Nearly eight in ten Business Group on Health respondents said GLP-1s are driving up their health care costs, and 66 percent of KFF’s largest firms said covering them for weight loss had a “significant” impact on prescription drug spending [1][3]. Meanwhile 87 percent of Business Group on Health employers expect oral GLP-1s to increase overall demand, and only 9 percent expect prices to fall [3].

Why does my coworker have coverage and I do not?

Because most large employers self-fund their health plans. In a self-funded arrangement, the employer pays claims from its own money and an insurance company or third-party administrator only processes them. The employer picks the drug list. KFF found 67 percent of covered workers are in self-funded plans, rising to 80 percent at large firms [1].

That single fact explains a lot:

• Two people carrying the same insurer’s card can have completely different drug benefits.
• State insurance mandates, state step therapy override laws and state anti-copay-accumulator laws generally do not apply to self-funded plans.
• Your appeal rights run through federal ERISA rules and a plan-selected independent review organization rather than a state external review program.

If you do not know which kind of plan you have, ask HR or look at the summary plan description. It is the first question to answer before anything else.

What strings do employers attach?

Covering the drug is rarely the whole story. Common conditions include:

A lifestyle or coaching program. KFF found 34 percent of firms with 200 or more workers that cover GLP-1s for weight loss require enrollees to meet with a dietitian, case manager or therapist, or participate in a lifestyle program, before the drug is covered [1]. Sometimes the employer names the vendor. Evernorth’s EncircleRx requires qualifying patients to take part in an Evernorth-sponsored lifestyle modification program, offered at no cost to the patient; its provider-facing page does not name the lifestyle vendor, though trade reporting has associated Omada Health with the program [9]. Massachusetts state and municipal employees had to be prescribed by a Vida Health provider from January 2026 until that arrangement ended in July [14].

A higher BMI bar than the label. Evernorth’s provider-facing criteria require a BMI of 32 or higher, or 27 or higher with two weight-related conditions [9]. The Kansas State Employee Health Plan raised its threshold to 35 effective January 1, 2026 [13].

A preferred product. Kansas makes Wegovy preferred and Zepbound non-preferred unless a preferred product has been tried and failed [13].

Cost-sharing that is not special. Most employers do not build a custom design for these drugs: 83 percent of Business Group on Health respondents apply the same standard cost-sharing as for other medications [3].

Restricted prescribing. Business Group on Health lists limiting prescribing to specific providers, validating clinical eligibility with objective biometric data, and excluding certain products from the formulary among the strategies employers use [3].

What are employers doing instead of full coverage?

Several new structures have appeared that sit outside the traditional pharmacy benefit.

Direct-to-employer purchasing. Eli Lilly launched Employer Connect on March 5, 2026, offering the single-patient-use Zepbound KwikPen to network pharmacies at a set $449 price across all doses (verified 2026-09-14), with no rebates, through more than fifteen independent program administrators [7][8][24]. Lilly’s own release is explicit that this is an acquisition price rather than a patient price: “Final cost to the employer may vary based on their choice of pharmacy and program administrator; and out-of-pocket patient costs for employees will vary based on the costshare model an employer chooses and the dispensing and service fees agreed to with independent program administrators.” What an employee pays depends on how much of that $449 the employer subsidizes and which administrator the employer picked. GoodRx offers access through GoodRx Employer Direct, and Omada Health joined as an administrator in May 2026.

PBM financial guarantees. Evernorth’s EncircleRx offers plan sponsors either a 15 percent annual cap on GLP-1 cost increases or a 3-to-1 savings guarantee, with the cost cap limited to existing Express Scripts clients that already covered GLP-1s and have more than 1,000 lives, in year one only [9].

Out-of-pocket caps. Evernorth also announced a program negotiated directly with Novo Nordisk and Eli Lilly capping patients’ monthly out-of-pocket cost for Wegovy and Zepbound at $200 for participating plans (verified 2026-09-14 against Evernorth’s own announcement, which also puts the saving at “as much as $3,600 per year” versus manufacturer direct-to-consumer programs), with the amounts counting toward the patient’s deductible [10][23]. It is a plan-design cap available only where the employer has opted in, not a price anyone can buy. That deductible credit is the meaningful difference from paying cash.

Carve-outs, HRAs and lifestyle accounts. Benefits lawyers describe employers keeping GLP-1s as a plan benefit but dispensing them outside the PBM network through a designated vendor, funding a standalone health reimbursement arrangement, or contributing to lifestyle accounts employees spend on manufacturer direct-to-consumer purchases [21]. Each has compliance consequences. Carve-outs usually need a PBM exclusivity waiver, and for high-deductible health plans, reimbursements generally must be limited to preventive-use products or delayed until the IRS minimum deductible is met, or the employee loses HSA eligibility [21].

If your employer offers one of these, it may not appear on the formulary at all. Ask HR directly whether there is a separate obesity medication program.

Which large insurers and employers narrowed coverage for 2026?

Publicly reported examples include:

• Blue Cross Blue Shield of Massachusetts stopped covering GLP-1s for obesity for employers with fewer than 100 employees at the start of 2026; employers over 100 can choose to continue coverage at additional cost, and where they discontinue it, the change takes effect at plan renewal and existing authorizations expire then [17].
• Harvard Pilgrim Health Care excluded all weight-loss drugs including GLP-1s effective January 1, 2026 for Massachusetts small group, with larger fully insured employers able to buy coverage back [18].
• Blue Cross Blue Shield of Michigan dropped weight-loss GLP-1 coverage.
• HCA Healthcare, one of the largest US hospital systems, reportedly told employees its GLP-1 coverage was ending after usage rose about 90 percent in a year, pointing workers toward manufacturer cash-pay programs.
• Earlier health-system examples include RWJBarnabas Health ending weight-loss GLP-1 coverage, Fairview Health Services limiting Wegovy and Saxenda to BMI 40 or higher, and Mayo Clinic imposing a lifetime limit.

These are secondary reports; your own plan documents are the authority for your situation.

What about public employees, federal workers and the military?

Federal employees. OPM “continues to require Carriers to provide a range of FDA-approved anti-obesity medications on their formulary, including at least one anti-obesity medication (AOM) from the GLP-1 class for weight loss and at least two (2) additional oral AOM options” [11]. Earlier OPM technical guidance separately told carriers that they are not allowed to exclude anti-obesity medications through a benefit exclusion or carve-out [22].

A behavioral condition is being added, and the plan year matters. OPM Carrier Letter 2026-07, issued March 31, 2026, is the call letter for plan year 2027, not 2026. For that year it states that prior authorization and utilization management for any anti-obesity medication “must ensure the member has demonstrated and will continue participation in lifestyle interventions meeting the rigor of IBT… before initiating treatment and while on an anti-obesity medication,” and that anti-obesity medications “must only be covered when used concurrently with IBT” [11]. So if you are reading a 2026 FEHB brochure, that requirement may not be in it yet; check the 2027 brochures during Open Season. Tier placement still matters. For 2026, an approved formulary exception puts Wegovy and Zepbound on Tier 2 for FEP Blue Focus and Zepbound on Tier 3 for FEP Blue Basic and Blue Standard — and FEP states plainly that a tier exception cannot be requested for an approved GLP-1 [12].

State employees. This is the most volatile category.

• North Carolina ended weight-loss GLP-1 coverage for state employees in January 2024 after a 4-3 board vote, citing a needed premium increase of about $48.50 per member per month — a plan-cost figure, not a consumer price, and one sourced to reporting on the board meeting rather than to a state document. A 2025 Senate budget proposal carried $25 million toward restoring limited coverage while the House proposal carried none (verified 2026-09-14 across WRAL, North Carolina Health News and Carolina Journal); the treasurer had sought roughly $100 million to cover an estimated 14,000 higher-risk members at a BMI of 38 or above. As of May 2026 he did not expect the legislature to fund restoration, and the budget signed in July 2026 contained no such provision, though the plan has been negotiating directly with manufacturers [16].
• West Virginia paused its roughly 1,000-person PEIA pilot on March 15, 2024, honoring existing pre-authorizations through June 30. PEIA director Brian Cunningham said the pilot cost around $1.3 million a month net of manufacturer rebates (verified 2026-09-14; a gross figure near $1.4 million a month has also been reported). That is a plan-cost figure, not a consumer price. State officials later described the reasons as multifaceted, including cost, supply shortages, potential side effects and inconclusive results.
• Colorado dropped coverage effective July 1, 2025, then restored it effective May 1, 2026 for employees who meet plan criteria, ending the grandfathering rule that had required a fill at least every 120 days [15].
• Kansas kept coverage but raised its BMI threshold to 35 from January 1, 2026 [13].
• Massachusetts required Vida Health prescribing from January 2026, voted in February 2026 to eliminate coverage for obesity alone, and moved to indication-based coverage through CVS Caremark from July 1, 2026 for non-Medicare members [14].
• Connecticut kept coverage but requires enrollees to go through an online lifestyle program first.

Military. TRICARE covers weight-loss medications including Wegovy and Zepbound for beneficiaries enrolled in TRICARE Prime, TRICARE Select or a premium-based plan, with prior authorization, clinical criteria and a network prescriber. Since August 31, 2025, that coverage is no longer available to beneficiaries outside those plans, including TRICARE For Life [20]. GLP-1s for type 2 diabetes remain covered with prior authorization.

Can my employer legally exclude these drugs?

Yes, as the law currently stands. Weight-management drugs are not a required essential health benefit under federal law. In February 2026 the US Court of Appeals for the First Circuit affirmed dismissal of a putative class action alleging that a self-funded plan’s weight-loss drug exclusion amounted to disability discrimination under Section 1557 of the Affordable Care Act, holding that the complaint failed to plausibly allege that the plaintiff’s obesity substantially limits a major life activity [19]. It was the latest in a string of similar outcomes. Employment lawyers still warn employers about indication-based exclusions and state-law exposure, but no federal court has held that GLP-1 exclusions are unlawful discrimination.

How do I find out what my own employer does?

1. Search the formulary for “Wegovy” and “Zepbound” by exact name and device form, and note the PA, ST and QL flags.
2. Search the plan documents — Summary of Benefits and Coverage, Evidence of Coverage, or summary plan description — for “weight loss,” “weight management,” “anti-obesity” and “obesity.”
3. Ask HR three specific questions: Is the plan self-funded or fully insured? Does the plan exclude drugs prescribed for weight loss? Is there a separate obesity medication program outside the pharmacy benefit, such as a direct purchase program or a lifestyle account?
4. Call the pharmacy benefit manager and ask for the name and number of the criteria document that applies.
5. Check the renewal date, not January 1, if you have heard coverage is changing.

If coverage is ending

You generally have four practical paths, and they are worth lining up before the last covered fill:

• A formulary exception where your plan allows one for an excluded or non-covered drug. BCBS FEP, for example, allows GLP-1 formulary exceptions even for excluded products, though it does not lower your out-of-pocket cost [12].
• Another covered indication, if one genuinely applies to you. That is a clinical determination for your provider, not a workaround.
• Manufacturer self-pay channels or an employer direct-purchase program, if your company participates.
• A plan change at open enrollment, remembering that your options are limited to what your employer offers.

Whatever route you take, talk to a healthcare provider before you stop, start or change any medicine.

Sources

1. KFF, 2025 Employer Health Benefits Survey. https://www.kff.org/health-costs/2025-employer-health-benefits-survey
2. KFF, Employer Health Benefits 2025 Annual Survey — Summary of Findings (PDF). https://files.kff.org/attachment/Employer-Health-Benefits-Survey-2025-Annual-Survey-Summary-of-Findings.pdf
3. Business Group on Health, GLP-1 Costs Loom Large for Employers, Forcing Challenging Coverage Decisions, 2026. https://www.businessgrouphealth.org/newsroom/news-and-press-releases/press-releases/2026-glp-1-survey
4. CNBC, Employers aren’t expanding coverage of GLP-1 obesity drugs: survey, July 8, 2026. https://www.cnbc.com/2026/07/08/employers-arent-expanding-coverage-of-glp-1-obesity-drugs-survey.html
5. Mercer, GLP-1 considerations for 2026: Your questions answered. https://www.mercer.com/en-us/insights/us-health-news/glp-1-considerations-for-2026-your-questions-answered
6. Pharmaceutical Commerce, Why Some Employers Are Scaling Back GLP-1 Coverage in 2027. https://www.pharmaceuticalcommerce.com/view/why-some-employers-are-scaling-back-glp1-coverage-in-2027
7. CNBC, Eli Lilly launches program to boost employer coverage of obesity drugs, March 5, 2026. https://www.cnbc.com/2026/03/05/eli-lilly-launches-program-to-boost-employer-coverage-of-obesity-drugs.html
8. Eli Lilly and Company, Lilly Employer Connect platform launches with over fifteen administrators. https://investor.lilly.com/news-releases/news-release-details/lilly-employer-connect-platform-launches-over-fifteen
9. Evernorth, EncircleRx. https://www.evernorth.com/our-solutions/cardiovascular-disease-diabetes-obesity
10. Fierce Healthcare, New Evernorth program to cap out-of-pocket costs for GLP-1s at $200. https://www.fiercehealthcare.com/payers/new-evernorth-program-cap-out-pocket-costs-wegovy-zepound-200
11. US Office of Personnel Management, 2026 FEHB Call Letter (CL 2026-07), March 31, 2026. https://content.govdelivery.com/attachments/USOPM/2026/03/31/file_attachments/3601982/CL2026-07%20-%202026%20FEHB%20Call%20Letter.pdf
12. Blue Cross Blue Shield Federal Employee Program, FAQ — Pharmacy. https://www.fepblue.org/faqs/faq-pharmacy
13. Kansas State Employee Health Plan, GLP-1s. https://sehp.healthbenefitsprogram.ks.gov/glp-1s
14. Massachusetts Group Insurance Commission, June Update on Vida Health Program and GLP-1 Coverage. https://www.mass.gov/news/june-update-on-vida-health-program-and-glp-1-coverage
15. Colorado Department of Personnel & Administration, Medical Benefits — FAQs: GLP-1s for Weight Loss Coverage Change. https://dhr.colorado.gov/state-employees/state-employee-benefits/medical-benefits
16. WRAL, Expected NC budget won’t restore GLP-1 weight-loss drug coverage for state employees, treasurer says, May 27, 2026. https://www.wral.com/news/nccapitol/north-carolina-expected-budget-wont-restore-weight-loss-coverage
17. Blue Cross Blue Shield of Massachusetts, GLP-1 Coverage Update. https://www.bluecrossma.org/glp-1-coverage-update
18. Harvard Pilgrim Health Care, What You Need to Know for 2026. https://www.harvardpilgrim.org/documents/broker/2026-what-you-need-know-ma-sg
19. Becker’s Payer Issues, Cigna defeats class action alleging GLP-1 coverage exclusions are disability discrimination. https://www.beckerspayer.com/legal/cigna-defeats-class-action-alleging-glp-1-coverage-exclusions-are-disability-discrimination
20. Express Scripts (TRICARE pharmacy), GLP-1 Medications (Diabetes and Weight Management) FAQ. https://militaryrx.express-scripts.com/faq/GLP-1-medications-diabetes-weight-management
21. Bass Berry & Sims, Emerging Alternatives for GLP-1 Prescription Drug Coverage: What Plan Sponsors Need to Know. https://www.bassberryhrlawtalk.com/emerging-alternatives-glp-1-prescription-drug-coverage
22. STOP Obesity Alliance, George Washington University, Federal Health Plans Step Up Coverage of Obesity Treatment (reporting OPM technical guidance that carriers may not exclude anti-obesity medications by benefit exclusion or carve-out). https://stop.publichealth.gwu.edu/LFD-apr22
23. Evernorth, Evernorth Launches New Benefit Option That Drives Lower Net Cost for Weight Loss Medicines and Limits Patient Cost to No More Than $200 Per Month, May 21, 2025. https://www.evernorth.com/articles/evernorth-launches-new-benefit-option-drives-lower-net-cost-weight-loss-medicines
24. Eli Lilly and Company, Lilly Employer Connect platform launches with over fifteen independent program administrators, March 5, 2026. https://investor.lilly.com/news-releases/news-release-details/lilly-employer-connect-platform-launches-over-fifteen
25. Reuters, More US employers to drop weight-loss drugs in 2027, as healthcare costs increase, August 25, 2026. https://www.reuters.com/legal/litigation/more-us-employers-drop-weight-loss-drugs-2027-healthcare-costs-increase-2026-08-25
26. STAT News (Pharmalot), GSK shingles shot; US employers dropping GLP-1 coverage, August 26, 2026. https://www.statnews.com/pharmalot/2026/08/26/gsk-shingles-shot-us-employers-dropping-glp1-coverage