The share of U.S. employers covering GLP-1s for weight loss fell from 57% to 53%, the first decline in three years, according to the 2026 Best Practices in Healthcare Survey from WTW, released Oct. 28. The survey is based on responses from 471 employers with at least 100 employees, collected between June 22 and Aug. 7.
Here are six things to know:
- Of the employers that still cover GLP-1s for weight loss, 30% are considering eliminating coverage.
- Among employers that have dropped or are weighing dropping coverage, 91% cite cost as a reason.
- The shift comes as pharmacy spending becomes the second-biggest cost pressure for employers, cited by 83%, after high-cost claimants at 86%. WTW estimates pharmacy costs will rise 11.5% in 2026, up from 9% in 2025, and that pharmacy accounts for about 36% of total healthcare claims when drugs paid through medical benefits are included.
- WTW said GLP-1s, specialty drugs and gene therapies can change patients’ lives, but the costs of these advances are hard to sustain. Removing coverage outright tends to fall hardest on the employees with the most to gain, and WTW advised employers to consider clinical programs, risk protection such as stop-loss and lower-cost purchasing channels first.
- Employers and employees are wary of restrictions. Six in 10 employers (61%) said they are unwilling to tolerate significant complexity and member pushback to reduce costs, and in a separate WTW survey, 58% of U.S. employees said they would rather pay higher out-of-pocket costs than accept a plan with more restrictions.
- Other surveys show similar pressure. Business Group on Health found fewer employers covering GLP-1s for weight management and more using direct-to-consumer and direct-to-employer channels, and about half of CVS Caremark’s PBM clients cover GLP-1s for weight loss. Another survey found more than three-quarters of employers rated managing GLP-1 costs as an extremely or very important concern.
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