Glucagon-like peptide-1 (GLP-1) medications have moved from a niche pharmacy category to one of the top drivers of employer healthcare spend. Monthly costs for GLP-1s often range from $500 to $1,000 per member, and after factoring in the impact on employee health, wellness, productivity and retention, the return on investment can be unclear. As such, many employers are reevaluating how their plans approach coverage and how to manage costs.

According to Mercer’s Survey on Health & Benefits Strategies for 2026, most large employers now consider managing GLP-1 costs a top priority. Rather than choosing between full coverage and full exclusion, many are landing on a middle path, layering in guardrails that protect the plan while still supporting employees who need these medications.

Consider the following strategies and plan design tactics to manage GLP-1 spend.

• Eligibility Criteria
  Rather than covering GLP-1s for any member who requests them, many plans are limiting eligibility to specific clinical indications, such as a documented Type 2 diabetes diagnosis or a body mass index (BMI) above a defined threshold, often paired with a qualifying comorbidity. Standardized documentation requirements help ensure the medication is going to members with the greatest clinical need.
• Prior Authorization
  Prior authorization adds a clinical checkpoint before a prescription is approved, often requiring proof of medical necessity and evidence that lower-cost alternatives were tried first. This helps plans confirm the appropriate use of drugs while curbing spending tied to off-label or low-value prescribing.
• Step Therapy
  Step therapy requires members to try and fail a lower-cost, clinically appropriate alternative before the plan approves a GLP-1. In practice, this often means a member must first attempt treatment with a drug such as Metformin, a standard, inexpensive first-line therapy for Type 2 diabetes that is often prescribed off-label for weight management, before moving on to a more expensive GLP-1 medication.
• Lifestyle Program Requirement
  A growing share of employers require members to enroll in a structured weight management or lifestyle pro-gram that covers nutrition, coaching or behavioral support as a condition of ongoing GLP-1 coverage. These programs are associated with better adherence and outcomes and can help protect results if a member even-tually tapers off the medication.
• DTE Exploration
  Direct-to-employer (DTE) programs, recently launched by manufacturers including Eli Lilly and Novo Nordisk, let employers purchase GLP-1s directly, often bypassing the traditional pharmacy benefit manager (PBM) channel. GoodRx has also entered this space with its Employer Direct platform, which lets employers subsidize manufacturer cash-pay pricing on GLP-1s and other brand medications without changing their existing plan design. Exploring DTE pricing can give employers a valuable benchmark for PBM negotiations, even if they don’t ultimately switch to a different model.

What Can Employers Do?

There’s no one-size-fits-all answer to managing GLP-1 spend. Employers seeing the best results are pairing these strategies and revisiting them regularly as the market, pricing and clinical guidance continue to evolve.

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