With escalating medical and pharmacy costs as a primary motivator, employers are moving healthcare benefit cost-containment to the top of their overall priorities for 2026, according to a new survey.
In last year’s edition of Brown & Brown’s Employee Health and Benefits Strategy report, employers ranked “attracting and retaining a healthy and engaged workforce” as their top priority. This year, however, the survey’s focus has shifted to strategic cost containment.
Central to that conversation will be managing access to and the cost of increasingly popular GLP-1 drug for weight loss.
“We can’t talk pharmacy without hitting on GLP-1 spend and coverage strategies,” says Brown & Brown’s Laura Birkel, executive vice president and national pharmacy consulting leader.
In the survey, nearly half of all respondents covered GLP-1s for weight loss (48%), with the vast majority (89%) of this group planning to continue coverage over the next one to two years.
Among those that do cover GLP-1s for weight loss, more than six in ten have restrictions in place. And a significant percentage (49%) of these employers have restrictions beyond basics like prior authorization, such as having to meet certain clinical criteria beyond FDA guidelines.
Birkel explains that, when looking at mid-market versus large-market employers, there is a difference, with a higher percentage of the latter covering GLP-1s.
About 90% of larger employers plan to continue to cover the drugs, while that figure stands at 86% for mid-market employers. It’s slightly more common for large-market organizations to have restrictions in place for coverage.
When diving deeper into strategies beyond prior authorization, about half of all employers require members to meet certain clinical criteria above the FDA label. For example, she says, about 38% of employers require participation in lifestyle behavior programs. Another common restriction is limiting prescribing to a specific or sole prescriber.
Some employers are looking to push members to access direct-to-consumer (DTC) GLP-1 drugs for weight loss by subsidizing such purchases. Birkel notes that they typically offer $100 or $200 per month rather than covering the drug as a benefit.
A look ahead
New DTC pricing strategies and the recently launched TrumpRx drug-pricing initiative will continue to drive conversation about lowering out-of-pocket costs and expanding access to GLP-1s, Birkel says. At the same time, she adds, they create “new dynamics” for employer plans, potentially increasing off-benefit utilization and challenging traditional coverage models.
“We expect that the PBMs will use any new pricing release of direct-to-consumer to reduce their cost of GLP-1 coverage,” Birkel says. “They also will push to keep utilization intact through the benefit and allow for appropriate clinical management.”
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