Employers are enthusiastic that effective new drugs to address obesity are now available but are distraught by their exceptionally high-cost impact. The GLP-1 class of obesity medicines can lead to 15% to 20% body weight loss, which can dramatically decrease health risks. However, Wegovy (semaglutide) and Mounjaro (tirzepatide) retail for over $16,000 and cost employers close to $10,000 annually even after discounts and rebates. Facing rising costs, employers are re-examining their strategies to support employees to address obesity and cardiometabolic syndrome.

Providing support to employees in this area can be challenging, as obesity is influenced by many factors. Obese individuals rarely lose more than 6% of their weight without medical or surgical intervention. Bariatric surgery is expensive and has been performed on less than 1% of those who are obese. Semaglutide and tirzepatide are highly effective but are currently only covered by 38% of employers. Three quarters (74%) of employers that provide GLP-1 coverage have, or are considering, access restrictions such as raised BMI thresholds, coverage or treatment limits or requiring step therapy with behavioral modification programs.

Lifestyle modifications alone to control obesity have historically been ineffective at the population level. Despite that, there are a range of lifestyle modification programs of varying efficacy being sold to employers and directly to consumers. Employers are faced with unappealing choices: continue to promote lower-cost lifestyle interventions that are of minimal efficacy, allow generous but costly coverage for GLP-1s for obesity, or combine lifestyle programs with GLP-1s with an unknown impact on total cost.