Picture two owners. Both have about 40 people. Both have the same renewal in front of them.

One covers these medicines and thinks it is the best thing the plan does. The other does not. That owner would tell you covering them takes money out of people’s pay for something nobody can measure.

Neither one is careless. Neither one is wrong for the company they run.

This article is for companies with 20 to 99 employees. It argues both sides and it does not pick one. That is not a dodge. Read to the end and you will see why the honest answer sits inside numbers that only you can go and look up.

GLP-1s are a group of medicines used for type 2 diabetes and for weight loss. You may know them by their brand names. Wegovy® and Zepbound® are the two approved for weight loss. They work, people want them and they are expensive.

The case for covering

Made as well as it can be made.

The health benefit has been measured. It is not small. A large trial followed 17,604 adults who already had heart disease and carried extra weight. Over about 40 months it found a drop of about 20% in heart attacks, strokes and deaths from heart disease. In 2024 the Food and Drug Administration approved Wegovy for that added use. This is not a wellness fad with a study attached. It is a result that changed a label.

The weight change in the trials was large too. In one trial, average weight loss over 68 weeks was about 17.3%, against about 2.0% for people given a dummy treatment.

Your plan already pays for chronic conditions. It pays for the medicines people take every day for the rest of their lives. Nobody asks those people to explain themselves first. A plan that covers other long-term conditions and carves this one out has made a choice. It is worth being able to say out loud why.

Benefits are one of the few places a 40-person company can match a 4,000-person one. You cannot match their pay scale. You can sometimes match their plan. People compare, they talk and they leave over this. Employees increasingly value access to these medicines and that is not going backwards.

The biggest employers in the country are moving toward covering, not away from it. Among employers with 5,000 workers or more, about 43% now cover these medicines for weight loss, up from about 28% a year earlier. Those are the companies with the most information and the most people paid to study it. That does not make them right. It does mean the trend is not an accident.

And somebody at your company may already be waiting on this. For them it is not a line item. It is whether their doctor’s advice is something they can afford to follow.

The case against covering

Made as well as it can be made.

Nobody has shown it pays for itself. No neutral source publishes a return, a payback period or a saving for an employer who covers these medicines. Anyone who shows you one is selling something.

The one neutral model points the other way in the short run. A simulation of adding GLP-1 coverage to an employment-based health plan found premiums rising by between 5.3% and 13.8%. In a lower-price scenario the range was between 1% and 3.9%. The model assumed no medical savings in the short run.

A premium increase does not come only out of the company’s money. This is the part that gets missed. At a company with 10 to 199 workers, the worker pays $8,889 a year toward family coverage. At bigger companies it is $6,227. Your people are already carrying more of this than workers at big firms. Adding cost to the plan adds cost to their pay, for a benefit some of them will never use. Covering is not automatically the generous choice.

The benefit may not land on your plan. People change jobs. A benefit that shows up in year seven may show up on somebody else’s plan while the cost lands on yours this year. That is an awkward thing to say and it is true.

The money has other jobs. The same money could lower the deductible for the whole team. It could buy the weight and lifestyle support your company may not have at all. About 56% of employers with 10 to 199 workers offer a smoking cessation, weight management or lifestyle coaching programme, against about 83% of employers with 200 or more workers. At your size the missing piece is often the support, not the medicine.

And staying power is a real problem. In the research the New Jersey commission reviewed, more than 68% of people did not stay on these medicines for a full year. A plan can pay for the expensive early months over and over without the benefit ever arriving. That is money out with nothing to show for it. It is nobody’s fault.

Free guide: Whichever way you lean, start with the facts about your own plan. The free Employer’s GLP-1 Coverage Checklist gives you five questions to ask before you decide.

What both sides have to live with

Three things are true whichever way you go.

Whatever you choose, you are choosing for more than one year. One year after stopping, people in the trial had put back two-thirds of the weight they lost, which is why this is a long-term decision and not a one-year one. Read that twice, because it cuts both ways. If you cover, you may be signing up for something that only works while you keep paying for it. If you exclude, you are not simply delaying a decision, because three years of not covering is itself an answer.

A lot more people could ask than are asking today. In one analysis, about 3% of non-elderly adults with job-based coverage had a claim for one of these medicines in 2022, while more than 40% of privately insured adults were clinically eligible. Whatever your plan does now, the gap between those two numbers is where the next few renewals live.

Nobody has counted companies your size. The big national surveys only count employers with 200 workers or more, so nobody publishes a number for a company your size. Every figure in this article describes somebody bigger than you. The only number that tells you anything about your plan is your own.

Talk to a doctor about the medicine. Talk to us about the plan.

So what should you do

Here is the honest answer. It is not a shrug.

It depends on your plan, your people and your numbers.

Your plan, because what it does today may not be what you think it does. The answer is often buried in an exclusions list rather than a drug list. Your people, because 40 people is not a statistic and you know things about your team that no survey does. Your numbers, because the arguments above swing on how many people would use it, how the cost is shared and what rules sit around it.

Three things to go and find out, in order:

1. 1)What your plan does today, for weight loss specifically and not just for GLP-1s in general

2. 2)What you can and cannot see about your own pharmacy costs, which depends on how your plan is funded

3. 3)What the options are between covering everything and covering nothing, because there are more than two

We will not tell you whether to cover these medicines. We have not told you here and we will not tell you on a call. That is your decision to make. It should be yours, because you are the one who has to stand behind it in front of your team.

What you get from us is the full picture: what your plan does, what it costs, what your options are and what each one trades away. Then you decide.

See where you stand

Answer 6 quick questions and see how much of your own plan you can see today. It takes 2 minutes.

Take the 2-Minute GLP-1 Employer Assessment →

Sources

• Lincoff AM et al., “Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes”, New England Journal of Medicine 2023;389(24):2221-2232, https://www.nejm.org/doi/abs/10.1056/NEJMoa2307563

• U.S. Food and Drug Administration, “FDA Approves First Treatment to Reduce Risk of Serious Heart Problems Specifically in Adults with Obesity or Overweight”, https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-reduce-risk-serious-heart-problems-specifically-adults-obesity-or

• Wilding JPH et al., “Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension”, Diabetes, Obesity and Metabolism, 2022, https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14725

• Employee Benefit Research Institute, “GLP-1 Coverage and Its Impact on Employment-Based Health Plan Premiums: A Simulation-Based Analysis”, https://www.ebri.org/content/glp-1-coverage-and-its-impact-on-employment-based-health-plan-premiums--a-simulation-based-analysis

• KFF, “Employer Health Benefits 2025 Annual Survey Summary of Findings”, https://files.kff.org/attachment/Employer-Health-Benefits-Survey-2025-Annual-Survey-Summary-of-Findings.pdf

• Peterson-KFF Health System Tracker, “Perspectives from employers on the costs and issues associated with covering GLP-1 agonists for weight loss”, https://www.healthsystemtracker.org/brief/perspectives-from-employers-on-the-costs-and-issues-associated-with-covering-glp-1-agonists-for-weight-loss/

• New Jersey Mandated Health Benefits Advisory Commission, “A Study of New Jersey Assembly Bill 5200”, https://www.nj.gov/dobi/division_insurance/mhbac/A5200.pdf