Self-funded health systems have been navigating a costly GLP-1 landscape in recent years, and the issue has not seemed to lighten up — yet.
Philadelphia-based Jefferson Health is one of the latest grappling with steep costs for its 65,000 employees. In an NBC News interview this month, Jefferson CEO Joseph Cacchione, MD, said the organization saved $20 million by implementing a diet-and-lifestyle program for employees, rather than immediately granting GLP-1 coverage. Ninety percent of participants are actively involved in the program.
A Jefferson statement shared with Becker’s said this initiative also aligns with the system’s broader weight-loss approach.
“Jefferson Health’s approach to weight management is grounded in the belief that obesity is a chronic, complex condition that requires comprehensive, compassionate care — not a standalone prescription,” the statement said. “Participants work with dedicated clinicians to ensure proper medication selection and dosing while also receiving dietitian support and guidance to manage side effects and sustain long-term health improvements. This model has resulted in strong engagement and adherence.”
This development follows years of health systems cutting back on GLP-1 coverage, with restrictions generally not applying to diabetes use cases. As of 2025, Minneapolis-based Allina Health dropped weight-loss coverage for employees. By March 2024, Minneapolis-based Fairview Health Services, Bloomington, Minn.-based HealthPartners and Rochester, Minn.-based Mayo Clinic established limits for coverage. Fairview’s policy aimed to recoup savings of at least $10 million. West Orange, N.J.-based RWJBarnabas Health, St. Louis-based Ascension and Minneapolis-based Hennepin Healthcare stopped GLP-1 coverage for weight loss altogether. In addition to cost, adherence was another cited concern.
Insurers and state employee health plans have been signaling a broader pullback in 2026, as well, while maintaining diabetes coverage. A December 2025 analysis from healthcare advisory group Leverage|Axiaci spotted a decline in GLP-1 coverage across ACA payers. GLP-1 weight-loss coverage dipped from 3.6 million enrollees in 2024 to 2.8 million in 2026.
As of this year, small employers and individual commercial members cannot access GLP-1 coverage for weight loss only through Mass General Brigham Health Plan, while continuing to have access to GLP-1s for type 2 diabetes. Kaiser Permanente cut base coverage for California commercial and ACA members in early 2025.
Blue Cross Blue Shield of Michigan reported a $350 million increase in GLP-1 drug costs in 2023, and Blue Cross Blue Shield of Massachusetts saw a $400 million operating loss driven by GLP-1s in 2024. Both insurers have pulled back coverage.
Ohio, Idaho, Louisiana and Massachusetts do not cover weight-loss drugs for state employees, either.
“The incremental use of GLP-1s is not offset by healthcare costs in other areas,” Dan Kueter, CEO of UnitedHealthcare’s employer and individual business, said during the Becker’s 16th Annual Meeting in Chicago.
But price compression could be coming soon, especially as oral options become more mainstream.
“The Novo pill and … just-approved Lilly pill will hopefully begin to enter the market and bring down those net costs, so that those equations come into balance,” Mr. Kueter said. He expected the price point to near the government-negotiated rates for Eli Lilly medications across Medicare and Medicaid, hovering between $100 and $200 per month. The government was going to pilot a weight-loss model to build off this deal, but the Medicare portion was paused.
Eli Lilly’s Foundayo pill is available starting at $149 per month for self-paying patients.
In 2026, drugmakers have been suggesting various pricing and access pathways. Novo Nordisk launched multimonth Wegovy subscriptions, saying they would offer more predictable and affordable pricing for self-pay patients using certain telehealth providers. Through the program, patients could save up to $1,200 annually on injections or $600 for oral formulations. Eli Lilly separately kickstarted a platform offering employers a direct pathway to Zepbound coverage at a list price of $449 per month.
While professional services firm Aon found long-term GLP-1 use could trim medical cost growth, employers still anticipated shifting healthcare costs onto employees and viewed GLP-1s as a top concern.
Even though health systems and other employers have faced financial pressure with GLP-1s over the years, some research, oral developments and pricing strategies — as well as greater comfort with the medications and the possibility of stronger future adherence — point to possible relief on the horizon.
“As we sit here today, they’re not yet in balance,” Mr. Kueter said.
Editor’s note: This story was updated to clarify insurers’ diabetes coverage.
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