This edition covers:
- The latest and most consequential shift in employer-sponsored healthcare
- Why most employers still don’t cover GLP-1s for obesity
- How GLP-1s are influencing systemic change in cardiometabolic care
We’re living through one of the biggest shifts in employer‑sponsored healthcare in decades, and GLP‑1 medications are the clear conduit.
These medications have redefined what’s possible in obesity and cardiometabolic care. But right now, the system around them is straining to keep up. Pharmacy benefit managers (PBMs) are racing to manage one of the fastest-growing drug categories in history. Pharma manufacturers are working to expand indications, introduce oral options, and build alternative pathways to grow access. Policymakers are experimenting with new ways to meet the need in Medicare. Even compounding pharmacies are being challenged in court.
But amid this turbulence, one truth is emerging: employers hold the most immediate power to drive meaningful change.
They are the architects of access for millions of working Americans, building impactful benefits packages from a crowded offering of health plans, PBMs, and an endless pool of digital programs.
Today’s moment calls for that same level of leadership. Employees are asking for access to these breakthrough medications; CFOs are demanding smarter benefit design. Benefit leaders are balancing equity with cost and sustainable outcomes, and the market is bombarded with compelling price drops through direct-to-consumer channels. The future of obesity care for the majority of Americans largely depends on how employers innovate to bridge those needs with fairness, foresight, and fiscal responsibility.
Employers Want to Do Right by Their People
Let’s be clear: employers want to provide comprehensive, forward‑thinking benefits. They’ve led on mental health, preventive care, family benefits, and now obesity care is the next frontier.
Obesity is not a personal failing—it is a chronic, relapsing disease that increases the risk of heart disease, diabetes, and 13 types of cancer. It is also a leading driver in a majority of preventable medical costs in the U.S., with ripple effects reaching every corner of the workplace, influencing absenteeism, productivity, injury rates, and long-term disability.
Employers understand this better than anyone. They’ve invested for years in wellness programs, diabetes, and other chronic disease prevention efforts, and virtual care solutions designed to keep their people healthy and productive. The power and promise of GLP‑1s fit perfectly within that intent.
The Employer Dilemma: Most Still Don’t Cover GLP‑1s for Obesity
Coverage of GLP‑1s for obesity has grown from 28% in 2024 to 43% in 2025 among employers with 5,000+ employees. Progress, yes, but that still means that the majority, or 57%, of these employers don’t cover (or don’t know if they cover) these medications.
And it’s usually not because they don’t believe in GLP-1s as a treatment for this common chronic disease. Small and mid-size employers are beholden to the coverage designs within their fully insured health plans, while large, self-insured employers are wrestling with how to make coverage and outcomes sustainable.
Those who have taken the leap are now evaluating costs, eligibility criteria, and long‑term outcomes. Coverage growth is slowing, rising only slightly last year among all sizes of large employers, and some employers are even rethinking prior decisions as utilization spikes.
The pattern is clear: employers want to act, but they’re demanding smarter models that balance access, cost, and outcomes. That’s not hesitation, it’s leadership.
Why a Simple “Yes/No” Decision Isn’t Enough
When it comes to GLP‑1s, a binary coverage decision doesn’t cut it.
A blanket “yes, we cover” can trigger runaway costs and unpredictable outcomes if prescribing and behavioral support aren’t aligned. A flat “no” might protect a short‑term budget but erodes employee retention, and sends people to less‑regulated medication alternatives.
As forward‑thinking employers consider the trade-offs of keeping GLP-1s on formulary versus a different approach, they are looking for solutions that are the right fit today and adaptable over time.
That might look like:
- Offering cash‑pay or hybrid options for flexibility.
- Layering in clinically validated medication guidance or behavioral and nutritional support.
- Iterating coverage as prices drop and data matures.
This isn’t about flipping a switch; it’s about building an adaptive framework that can scale.
Flexibility is the New Chapter of GLP‑1 Care
The future belongs to employers who build GLP‑1 strategies that evolve with the market versus those implementing short-term solutions like expedited off-ramping or no coverage at all. They have the opportunity to leverage the range of available options, working with neutral and flexible care partners who can direct them to the best financial scenario today, and position them for success in the long term.
How to Gauge Flexibility in GLP-1 Partnerships
Questions to ask when considering GLP-1 care partners:
- Is the model built to support today’s budget goals, reduce waste, and facilitate longer-term outcomes?
- Is the program designed to bridge the gaps between medical visits where 80 to 90% of health outcomes are heavily influenced?
- Are GLP-1s being viewed in a prescription-drug-spend silo or incorporated into a broader cardiometabolic health approach?
- Can the partnership flex based on your evolving coverage preferences, e.g. whether you want to cover GLP-1s on formulary or leverage an alternative cash-pay strategy in the near term?
- Can the partnership be configured to your organization’s needs? Configuration levers might include:
- Requiring lifestyle engagement or a specialized network for GLP-1 medication management.
- Tuning the balance between plan-paid and cash-pay access.
- Evolving as the GLP-1 medication landscape expands to include new formulations, new indications, and more.
This type of flexibility allows benefit teams to treat GLP-1 strategy as an iterative, data-informed decision, not a one-time, high-stakes bet.
That’s what it looks like to treat GLP‑1 coverage not as a line item, but as an investment—one that improves productivity, reduces high‑cost events, and strengthens the foundation of workforce health.
Turning Dilemma Into Opportunity
When done right, GLP‑1 care is about more than medication—it’s about bending the curve of chronic disease. Employers who align access, affordability, and outcomes can change the game for their populations.
At Omada, we’re helping employers seize that moment through GLP-1 Flex Care, integrating evidence‑based care, behavior change, and flexible purchase models that meet each organization’s unique needs. Whether employers want to cover GLP-1s with a PBM solution or route through employee cash-pay channels, we’re making flexible solutions available across the benefits ecosystem.
Because the real question isn’t “can we afford to cover GLP‑1s?” It’s “how do we design GLP‑1 care that serves our people, our mission, and our margins?”
What’s Next?
Employers have always been at the forefront of innovation in healthcare benefits—driving mental health parity, preventive care, and family-supportive policies before many systems caught up. GLP‑1 adoption represents the next era in benefit design.
To every benefits leader and HR professional navigating this decision: we see you, and we know how committed you are to caring for your people.
You have the power to help reshape how obesity and chronic disease are treated in America. You can be the catalyst for real, scalable change.
The organizations that act now won’t just facilitate healthier populations, they’ll set a new standard for what comprehensive, future-ready care can look like.
Learn more about Omada GLP-1 Flex Care.
