Coverage was more common among the largest employers, with 43% of firms employing 5,000 or more workers expected to provide GLP-1 coverage for weight loss in 2025, up from 28% in 2024, the survey found. However, the rapid increase in utilization and associated costs has posed challenges for employers trying to balance coverage with budget constraints.

Only 19% of U.S. firms with 200 or more workers reported offering coverage for GLP-1 inhibitors such as Ozempic for weight loss in their largest health plans in 2024, according to a Kaiser Family Foundation (KFF) survey.

The rising cost of GLP-1 drugs has significantly impacted prescription drug spending. KFF data show that 64% of large firms reported a moderate or significant impact on prescription drug costs due to GLP-1 coverage, with that figure rising to 66% among firms with 5,000 or more employees. Simulations based on real-world drug prices estimate that premiums could increase between 5.3% and 13.8%, depending on patient adherence and eligibility criteria. In hypothetical scenarios assuming a $200 monthly drug cost, premium increases ranged from 1% to 3.9%, according to KFF researchers.

Employers have adopted various utilization management strategies to control spending. Many require prior authorization, step therapy, and participation in behavioral or lifestyle programs as conditions for coverage. These programs often restrict prescribing to specific clinicians who enforce clinical criteria and provide counseling, sources said. Employers also design eligibility pathways and support tapering or discontinuation of GLP-1 therapy to manage long-term costs, according to pharmacy benefit managers (PBMs) and employer health plan officials.

Coverage decisions vary substantially depending on whether employers are self-insured or fully insured. Self-funded employers typically collaborate with PBMs to negotiate formularies, pricing, and utilization rules. Fully insured employers have less control, with coverage decisions largely handled by insurance carriers and their PBMs. For example, Aetna allows employers to customize benefits to include or exclude GLP-1 coverage for weight management through prior authorization protocols, company representatives confirmed.

No broad federal mandate requires large employer health plans to cover GLP-1 drugs for obesity or diabetes. Under the Affordable Care Act (ACA), GLP-1s must be covered as essential health benefits only for type 2 diabetes treatment, not for weight loss. North Dakota became the first state to require GLP-1 coverage for weight loss by adding the drugs to its essential health benefits benchmark plan starting in 2025, although this mandate applies only to individual and small group ACA plans, not large group or grandfathered plans, according to state health officials and KFF reports.

Some hospital-affiliated health plans are updating their coverage policies in response to these trends. Mass General Brigham Health Plan announced it will revise GLP-1 coverage for fully insured commercial members beginning Jan. 1, 2026. Other employers have considered adjusting eligibility thresholds or coverage criteria based on budgetary impacts, KFF data show.

The growing use of GLP-1 drugs has led to higher-than-expected utilization rates among employees, contributing to increased pharmacy spending despite negotiated price reductions. Employers are investing in digital health solutions to support medication adherence and access management, industry experts said. Meanwhile, states are exploring inclusion of GLP-1 coverage in Medicaid and state employee health plans.

Experts warn that without targeted eligibility criteria or prior authorization, rising GLP-1 utilization could drive sustained premium increases. The Food and Drug Administration’s recent approvals expanding GLP-1 indications to cardiovascular disease and other conditions may prompt further policy reviews among employers and insurers, according to health policy analysts.

At present, compounded GLP-1 formulations, which lack FDA approval, are generally excluded from coverage. Plan sponsors of self-insured health plans retain discretion over coverage decisions but remain subject to ACA market reforms. The evolving landscape of GLP-1 coverage reflects ongoing efforts by employers, insurers, and regulators to balance expanding access with cost containment in employee health benefits.

The study found that interruptions of six months or more in glucagon-like peptide-1 receptor agonist (GLP-1) therapy, including drugs like Ozempic (semaglutide) and Wegovy, were associated with a 4% to 8% increased risk of major adverse cardiovascular events (MACE)—heart attack, stroke, or death—compared to continuous use, according to researchers at Washington University School of Medicine in St. Louis. Veterans who discontinued GLP-1 treatment for one to two years experienced even higher risks, ranging from 14% to 22%, the study published March 18, 2026, in BMJ Medicine reported.

The analysis tracked more than 333,000 U.S.

veterans with type 2 diabetes over a three-year period. About 26% of GLP-1 users discontinued their medication, and 23% had interruptions lasting six months or longer, the researchers said. The data revealed that cardiovascular benefits accrued during treatment were quickly lost upon stopping, with longer treatment gaps amplifying the risk. Veterans who used GLP-1s for 18 months or less before stopping showed no significant cardiovascular risk reduction, the study noted.

Lead author Ziyad Al-Aly, MD, of Washington University, said the findings highlight a “metabolic whiplash” effect resulting from stopping GLP-1 therapy. This phenomenon entails metabolic changes detrimental to heart health, beyond weight regain, which was also observed in participants after discontinuation. Al-Aly added that restarting GLP-1 medication partially restored cardiovascular protection but did not fully reverse the increased risks caused by treatment interruption.

GLP-1 receptor agonists have gained prominence for their ability to reduce cardiovascular events in patients with type 2 diabetes and obesity. The SELECT trial, published in 2023 in the New England Journal of Medicine, demonstrated a 20% lower risk of major cardiac events with weekly Wegovy (2.4 mg semaglutide) in non-diabetic individuals with obesity and cardiovascular disease. The trial showed a 28% reduction in heart attacks, a 7% decrease in non-fatal strokes, and a 15% decline in cardiovascular deaths, according to trial investigators. Additionally, semaglutide has been shown to reduce heart failure symptoms and hospitalizations by 70% in obese patients with heart failure with preserved ejection fraction (HFpEF), based on pooled data published in The Lancet and the New England Journal of Medicine.

Washington University researchers emphasized that GLP-1 therapy acts more as a long-term risk-reduction treatment than a short-term intervention. “Persistence and follow-up truly matter; benefits accumulate slowly but are lost surprisingly fast,” the study stated. Sanjiv Shah, MD, a cardiologist involved in HFpEF trials, noted semaglutide’s role in doubling weight loss, improving walking distance, and reducing biomarkers such as NT-proBNP and C-reactive protein, which are linked to heart failure prognosis.

The study’s findings also align with the December 2024 FDA expansion of Wegovy’s approval to include secondary cardiovascular disease prevention in overweight and obese non-diabetic patients. This regulatory decision was informed by accumulating evidence of semaglutide’s cardiovascular benefits.

The research team compared veterans who maintained continuous GLP-1 use with those who experienced treatment interruptions or full discontinuation. Records showed that nearly half of GLP-1 users stopped shortly after starting therapy, prompting investigation into the cardiovascular consequences of such discontinuation. The study found that stopping GLP-1 drugs led to weight regain and reversal of improvements in cardiovascular risk factors, including blood pressure and cholesterol levels. These changes contributed to the observed increase in adverse cardiovascular outcomes.

Mandy French, who authored an article summarizing the study’s findings for Healthline on March 20, 2026, highlighted that cardiovascular protection from GLP-1s builds gradually but deteriorates rapidly after stopping treatment. The Washington University news release accompanying the BMJ Medicine publication underscored the importance of continuous therapy for sustained heart protection.

Harlan Krumholz, MD, a Yale University cardiologist, described the SELECT trial as a “major breakthrough” for managing cardiovascular risk in non-diabetic patients with obesity. The current study’s demonstration that stopping GLP-1 therapy reverses these benefits reinforces the need for long-term adherence in chronic disease management.

The study adds to a growing body of evidence supporting GLP-1 receptor agonists as integral components of cardiovascular risk reduction strategies in patients with type 2 diabetes and obesity. It also raises clinical considerations regarding treatment persistence and monitoring to prevent interruptions that may negate cardiovascular gains.