Large employer GLP-1 weight loss coverage falls to 60% from 72%, survey finds

The share of large U.S. employers covering GLP-1 medications for weight management dropped to 60% in 2026 from 72% in 2025, and 14% say they have already ended that coverage or plan to end it in 2027, according to the Business Group on Health's 2027 Employer Healthcare Strategy Survey ^[1][4]. The survey was released Aug. 25, 2026 ^[4].

The findings come from 127 large employers representing about 11 million covered lives, ranging from companies with fewer than 5,000 workers to more than 100,000 ^[4][5]. Two-thirds of the employers surveyed said they saw rising use of the drugs ^[4].

Cost pressure is the backdrop. Employers expect overall healthcare costs to rise 9.2% in 2027 if they make no changes to their plans, up from 8.5% in 2026, the group said ^[4]. Pharmacy accounts for about 25% of employer health spending and is projected to rise 12% in 2027, unchanged from the prior year ^[4]. Ninety-five percent of surveyed employers said they are concerned or very concerned about pharmacy costs ^[5].

"This represents an unfortunate new reality for employers, who now face growing difficulty in budgeting and forecasting," said Ellen Kelsay, president of the Business Group on Health. "It's a call to take a more disruptive approach and rethink how to deliver value and improved health outcomes" ^[4].

Some large employers have already acted. Cigna Group and consulting firm PricewaterhouseCoopers eliminated GLP-1 coverage for weight loss this year, and PepsiCo and Starbucks plan to follow in October, KFF Health News reported, citing Modern Healthcare ^[2]. A separate report also lists Starbucks and Deloitte among employers removing or restricting weight-loss drug coverage ^[5].

Coverage that remains is getting tighter. Among employers that still cover the drugs for weight loss, 69% validate eligibility through biometrics and 45% require participation in a weight management program ^[1]. Some employers now cover GLP-1s only for diabetes, while others keep weight-management coverage but add stricter eligibility rules, such as prioritizing people with higher cardiometabolic risk ^[1]. Sixteen percent of employers said they would direct employees to direct-to-consumer channels for GLP-1 medications, and 17% plan direct-to-employer arrangements that bypass the pharmacy benefit manager ^[5].

Brenna Shebel, a vice president at the Business Group on Health, said most companies offering the drugs for weight loss are not yet seeing them reduce the costs of treating conditions associated with obesity, such as diabetes or sleep apnea ^[4].

Without insurance, list prices are high. Zepbound (tirzepatide) lists at $499 a month and Wegovy (semaglutide) at $1,349.02 a month, according to manufacturer websites cited by Reuters ^[4].

The direction of the numbers differs from an earlier survey. KFF's 2025 Employer Health Benefits Survey found that 43% of firms with 5,000 or more workers covered GLP-1 drugs for weight loss in 2025, up from 28% in 2024, and that 59% of those firms said use ran higher than expected ^[3][5]. The two surveys use different samples and definitions, and their levels are not directly comparable ^[3][5].

Why it matters for patients

For people whose insurance comes through a large employer, whether a GLP-1 is covered for weight loss — and under what conditions — is set by that employer, not by the prescribing clinician. When an employer drops weight-loss coverage, the same drug may still be covered for type 2 diabetes at some companies, since some employers cover GLP-1s only for diabetes ^[1].

Employers that keep weight-loss coverage may require biometric screening, participation in a weight management program or clinical documentation before approving it ^[1]. For 2027, employers also are exploring direct-to-consumer and direct-to-employer purchasing paths, which change where members obtain the drug and how it is billed ^[1][5].

In 2025 focus groups with employers, some benefits officials said they might grandfather employees already taking the drugs while applying new rules to new users, though it was not clear how widely that approach would be used ^[3].

What happens next

The 14% of employers that said they have eliminated coverage or plan to do so are aiming at the 2027 plan year ^[1]. PepsiCo and Starbucks are set to end weight-loss coverage in October ^[2]. On the pharmacy side, 32% of employers said they will offer transparent or next-generation pharmacy benefit manager plans in 2027, and another 47% are considering such a switch for 2028 or 2029 ^[5]. Which specific employers will change GLP-1 coverage for 2027 has not been disclosed in the survey.