Risk Versus Reward: The Balancing Act of GLP-1’s
70% of employers anticipate pharmacy cost increases in the coming year, with GLP-1 utilization emerging as a major contributor. More than half identified GLP-1 medications as their leading driver of pharmacy cost growth, according to NFP's 2026 U.S. Benefits Trend Report.
A growing number of members are requesting GLP-1s, but who is footing the bill? Health plans face a growing challenge: these therapies can improve health outcomes for many members, but they are also among the most significant and rapidly growing drivers of pharmacy spend. What to do?
Pharmacy Benefit Management (PBM) partners have a dual responsibility – balancing appropriate access to clinically effective therapies for members while helping employers achieve long-term affordability and sustainability in their pharmacy benefit.
A Rapidly Expanding Market
What’s driving demand?
- Success with weight loss for chronic weight management
- Expanded patient eligibility due to newly approved indications
- Ease of use with both injectable and oral options
- Increased media attention
- Better access through private and public insurance policies
This increase in demand is compounded by a surge in broader healthcare costs, creating added pressure for employers who rely on robust benefits as a tool for talent acquisition and retention.
As concerns about pharmacy spend intensify, organizations are making weight management strategies a clinical and financial priority.
A Growing Patient Population Means New Drugs
The growth of GLP-1 therapies extends beyond diabetes and weight management. Emerging evidence supports their use for cardiovascular disease, kidney disease, sleep apnea, and other chronic conditions, broadening their impact across the market. As clinical applications expand, so have treatment options.
Manufacturers are also introducing new formulations designed to improve access and convenience:
- Novo Nordisk’s Wegovy® became the first oral GLP-1 approved by the U.S. Food and Drug Administration (FDA) for weight loss
- Eli Lilly recently launched FDA-approved Foundayo®, a once-daily oral GLP-1 to compete with Wegovy®
At the same time, eligibility criteria continue to expand. Mounjaro®'s FDA approval now includes pediatric patients ages 10 and older with Type 2 diabetes, reflecting the growing clinical reach of these therapies. While increased access may improve health outcomes and potentially reduce downstream medical costs, it also introduces important questions about how employers can balance access with affordability.
The Employer Challenge
Employers increasingly view healthcare benefits as a competitive advantage for attracting and retaining talent, as evidenced by NFP's finding that 29% of employees would consider changing employers to obtain GLP-1 coverage.
This creates a difficult balancing act; employers must balance these considerations against financial realities. Unmanaged utilization can lead to runaway costs, accelerated by rapidly increasing utilization and expanding treatment eligibility.
Looking Ahead
While drug costs often dominate the conversation, the bigger question is how to maximize long-term value by balancing risk and reward. Obesity and metabolic disease can drive higher healthcare costs, absenteeism, reduced productivity, and chronic health risks. Realizing the potential benefits of GLP-1 therapies requires more than coverage alone – it requires appropriate use, strong adherence, measurable outcomes, and a sustainable benefit strategy.
The future of GLP-1 management is not about choosing between access and affordability. It is about creating a thoughtful approach that helps employers deliver meaningful benefits while maintaining a sustainable path forward.
How PBDRx Helps
The tension created by this rising drug trend has led many organizations to seek more sophisticated approaches to pharmacy benefit management. As our client’s trusted advisor, PBDRx takes an active role both clinically and financially – not simply to block access or drive utilization – but rather to ensure that members receive the right therapy, at the right cost, for the right clinical reason.
To support this balance, PBDRx developed the RealOptions for Weight Management program to provide the clinical insight, flexibility, and financial guardrails needed to support members’ health outcomes while keeping benefit sustainability in check.
This strategic approach aligns with a broader market trend. NFP reports that nearly half of self-funded employers now carve out pharmacy benefits to a specialized PBM partner, underscoring the growing importance of clinical oversight, cost management, and customized solutions.
Recognizing that no two plans have the same goals or challenges, PBDRx works alongside clients to develop pharmacy strategies aligned with their populations, budgets, and objectives. Whether they choose comprehensive GLP-1 management or a more targeted approach, we provide the data, support, and expertise needed to help keep pharmacy benefits affordable, predictable, and sustainable.
Let’s Connect
As GLP-1 utilization continues to evolve, the right strategy can make all the difference. PBDRx is here to help you build a more sustainable approach.