September 18, 2025

Nearly one-third of U.S. employers now cover glucagon-like peptide-1 (GLP-1) receptor agonist medications for weight management, but many are still hesitant. As the GLP-1 landscape evolves, the pressing question for brokers and their clients is how to choose the right coverage strategy.

The Backstory

GLP-1 medications – originally developed for diabetes and now widely prescribed for weight management – are reshaping how employers approach pharmacy benefit strategies. The first GLP-1 agonist, Byetta (exenatide), was approved by the Food and Drug Administration (FDA) in 2005 for type 2 diabetes (T2D). Nearly a decade later, in 2014, Saxenda (liraglutide) became the first GLP-1 approved for weight loss. Since then, a surge of GLP-1 medications has entered the market, challenging brokers, consultants, and their clients to balance rising employee demand with strategic decisions about coverage and overall healthcare spend.

Rising Costs vs Member Demand

A 2025 Trends in Drug Benefit Design Report by Pharmaceutical Strategies Group conducted a survey of employer groups, discovering that 9 out of 10 covered GLP-1’s for T2D, while only 3 out of 10 covered GLP-1s for obesity. 

 

Per member per month costs have nearly doubled year over year since 2021 – driven largely by the surge in GLP-1 utilization and costs. Combined with rising member demand and varied clinical outcomes, this trend underscores the need for a strategic approach over one-size-fits-all solutions. Now more than ever, weighing your options carefully is key.

RealOptions for Weight Management

At Pharmacy Benefit Dimensions (PBDRx), we’ve designed RealOptions for Weight Management©, a flexible framework that gives you three distinct approaches to consider. Each pathway offers different trade-offs in terms of cost, access, and clinical outcomes. The right fit depends on each client’s unique goals and priorities – whether that’s containing spend, ensuring member access, or finding a balance between the two.  

Questions to Consider 

To effectively serve your clients, selecting the right pathways starts with asking your PBM the right questions. To begin, consider your client’s priorities – are they focused on cost control, broad member access, or a balance of the two? Use this insight to tailor the conversation and ensure your PBM’s strategies align for the best possible outcomes:

• How will my PBM partner equip me to guide their decisions? Do they provide the data and insights needed to weigh the clinical and financial impact of GLP-1 medications?
• What are the capabilities of my PBM and health plan? Can my PBM deliver the utilization management, clinical oversight, and reporting needed to drive quality and value for my client? 
• What is my PBM’s approach to integration? Will they coordinate effectively with health plans, vendors, or third parties to complement my client’s existing benefit structure?
• How does my PBM align financial stewardship with clinical success? Beyond lowering spend, what levers exist to support member education and engagement, and improve outcomes?

The Future

GLP-1 therapies are already transforming care in diabetes, cardiovascular disease, obesity, and more. But this is just the beginning. Researchers are actively pursuing expanded uses ranging from kidney disease and sleep apnea to emerging applications in eye health, arthritis, Alzheimer’s, Parkinson’s, and even substance use disorders. The pipeline is also growing, and the impact of GLP-1s is poised to reach far beyond today’s indications.

Ready to weigh your options? 

With the right partner, you can align strategy, spend, and value for measurable impact. PBDRx’s RealOptions offer a greater edge for your clients by delivering the clinical oversight, member support, and data-driven insights that make every pathway actionable and effective.