Key Highlights

1. Why GLP-1s Are a Hot Topic Right Now
2. The Financial Stakes Are Real
3. Flexible Coverage Options to Protect Employers
4. Five Tactics to Manage Utilization

How to Manage GLP-1 Coverage Without Breaking the Bank

Fueled by media attention, celebrity endorsements, and direct-to-consumer marketing, these drugs have quickly gained mainstream awareness in the health and wellness landscape. But for employers and insurance brokers, the conversation has shifted from “Should we cover GLP-1s?” to “How can we cover them responsibly?”

According to the U.S. Centers for Disease Control and Prevention (CDC), more than 100 million U.S. adults have obesity, defined by a body mass index (BMI) of 30 or higher. With up to 40% of U.S. adults meeting the clinical criteria for GLP-1s and monthly costs exceeding $1,000 per user, the financial implications are staggering.

Employers are facing mounting pressure from employees to offer coverage, while brokers are tasked with balancing access and affordability. Without a strategy, GLP-1s could become a driver of runaway pharmacy costs in employer-sponsored health plans.

Fortunately, there are options. Let’s unpack the facts around GLP-1s, explore smart strategies to manage utilization, and see how HealthCheck360 is helping organizations implement thoughtful, scalable solutions.

Understanding the Two Types of GLP-1 Medications

It’s important to first distinguish between the two primary categories of GLP-1 medications:

• GLP-1s for Diabetes Management:
  These medications, such as Ozempic, were originally developed to help manage blood sugar levels in individuals with type 2 diabetes. During clinical trials, researchers discovered that these drugs also led to significant weight loss—a finding that opened the door to broader use applications.
• GLP-1s for Weight Loss:
  Building on the success of GLP-1 medications developed for diabetes, pharmaceutical companies created versions of the same active ingredients specifically for weight loss. These FDA-approved medications—marketed under brand names like Zepbound and Wegovy—are intended for individuals with obesity or those who are overweight with related health conditions.

In this article, we’re focusing on the weight-loss side of the GLP-1 conversation—where demand is rising and costs are climbing. HealthCheck360’s solutions are built to help employers address this challenge effectively, without compromising care for those managing diabetes.

The Financial Risk of GLP-1 Coverage

GLP-1s for weight loss have exploded in popularity since 2021 due to aggressive marketing and high-profile endorsements. As a result, employers who previously covered these medications with little concern are now seeing unexpected spikes in utilization—and costs.

A single GLP-1 prescription can cost up to $1,300 per month. Multiply that by a dozen employees, and your plan’s pharmacy expense quickly balloons. For employers who cover these medications, the budgetary impact is real and growing. For employers who have opted not to cover GLP-1s yet, pressure from employees and HR teams is mounting.

The risk isn’t just cost—it’s also misuse. Unrestricted access can lead to off-label use for cosmetic weight loss, low adherence, and minimal long-term benefits. Without guardrails, employers risk paying top dollar for short-term results.

Balancing GLP-1 Support and Cost

Sustainable weight loss with GLP-1s requires more than just a prescription. With the right support, participants are more likely to avoid side effects, low engagement, and disappointing outcomes. That’s why HealthCheck360 pairs every GLP-1 user with a dedicated health coach.

This high-touch, one-on-one support includes:

• Medication Onboarding: Personalized education on how GLP-1 medications work, what side effects to expect, and what to consider if the medication is paused or discontinued.
• Personalized Coaching: One-on-one guidance that taps into each participant’s unique motivations, helping them build sustainable habits around nutrition, physical activity, and mindset.
• Adherence Monitoring: Ongoing check-ins to ensure participants stay on track with their medication and meet the requirements for continued access.
• Digital Engagement Tools: Access to the HealthCheck360 app for tracking weight, activity, and biometric data, plus self-paced learning modules and direct communication with their coach.

GLP-1 Coverage Models with HealthCheck360

While GLP-1 coverage decisions ultimately rest with the employer and their benefits partners, the success of those decisions depends heavily on what’s built around them.

That’s where HealthCheck360 comes in. Our tools and coaching programs are designed to integrate seamlessly with any coverage model—ensuring that, no matter how access is structured, members receive the support they need to succeed, and employers maintain control over outcomes and costs.

Let’s break down the options for GLP-1 coverage.

1. Integrated With Independent PBMs (for plans that cover GLP-1s):
   HealthCheck360 partners with independent pharmacy benefit managers (PBMs) to embed coaching compliance into the prior authorization process. This ensures people are committing to long-term lifestyle changes and filters out those seeking a fast way to lose weight.

• • Members must be enrolled and compliant with HealthCheck360’s coaching program to receive
    medication.
  • If a member becomes noncompliant, the pharmacy is notified, and the prescription is paused.
  • This model ensures only committed individuals gain access, helping control costs and improve outcomes.

2. HRA Reimbursement Model (for plans that do not cover GLP-1s):
   Employers can offer GLP-1 access outside the health plan via a Health Reimbursement Arrangement (HRA).

• • Members pay the cash price (often reduced 50% or more with manufacturer coupons).
  • They enroll in HealthCheck360 coaching and submit receipts for reimbursement.
  • Employers can choose to reimburse the medication cost fully or partially.

3. RxSaveCard Model (for plans that do not cover GLP-1s):
   This option removes the upfront cost barrier for members.

• • Members use a pre-funded RxSaveCard to purchase the medication at the manufacturer’s online pharmacy.
  • The card is linked to the employer’s pharmacy account and can be configured for full or partial payment.
  • No receipts or reimbursements needed—transactions are automatic and eligibility is managed by HealthCheck360.

No matter which coverage path is preferred—PBM integration, HRA reimbursement, or RxSaveCard—HealthCheck360 offers scalable solutions to enhance that model and drive real results.

GLP-1s are here to stay. With growing demand and expanding use cases, brokers and employers need a plan. Dynamic options aren’t just a nice-to-have, they’re essential for meeting the diverse needs of today’s workforce and managing the evolving landscape of GLP-1 medications.

Why Multiple GLP-1 Coverage Options Benefit Employers

1. Flexibility to Match Budget and Risk Tolerance
   Not every employer has the same financial capacity or appetite for risk. By offering multiple models—full coverage, partial reimbursement, or cash-based access—employers can choose the approach that aligns with their budget and benefits philosophy.
2. Scalable Solutions for Diverse Workforces
   Different employee populations have different needs. Some people may be ready for a structured coaching program, while others may need financial assistance to access medications. Multiple options allow employers to serve a broader range of employees without a one-size-fits-all approach.
   
3. Adaptability as Market Conditions Change
   GLP-1 pricing, availability, and clinical guidelines are evolving. Having multiple models in place allows employers to quickly pivot—tightening or expanding access as needed without overhauling their entire pharmacy benefits strategy.
4. Control Over Utilization and Cost
   Each model includes built-in guardrails—like coaching compliance, prior authorization, or cost-sharing—that help employers manage who gets access and under what conditions. This prevents overuse and ensures resources are directed at those most likely to benefit.
5. Enhanced Employee Satisfaction and Retention
   Offering any level of access to GLP-1s—especially when paired with coaching—shows employees that their health is a priority. This can improve satisfaction, reduce turnover, and support a culture of well-being.
   

Want a behind-the-scenes look at how brokers are helping employers manage GLP-1 medications - without sacrificing budget or care options? Download our infographic with five factors you need to know to manage GLP-1 utilization.

Let’s Talk Strategy: Partner With HealthCheck360

HealthCheck360 offers a smarter, safer way to integrate GLP-1s into your benefits strategy. Whether your clients cover these medications or not, there’s a path forward that balances access, accountability, and affordability.

HealthCheck360 offers scalable solutions that meet employers where they are. Let’s build a benefit model that works—for your clients, your employees, and your bottom line.

Ready to talk strategy? Contact HealthCheck360 today to explore your options!