The GLP-1 Coverage Decision
What covering, dropping, or replacing GLP-1 weight-loss coverage costs an employer plan.At a 20% rebate, a plan pays about 2.5 times the manufacturer’s cash price to cover a GLP-1.
Using published list prices, a plan with a 20% rebate and a $50 member cost share pays about $925 per user per month for Wegovy or Zepbound. The same drugs are available directly from the manufacturers for $299 to $449 a month. Rebates would need to reach about 70% for the plan’s net cost of the drug to match what a member can pay on their own. For a plan with 1,000 covered adults, covering GLP-1’s for weight-loss costs an estimated $1.2 million a year. A $150 monthly stipend toward a cash-pay program would cost about $198,000.
Why it matters:
Two-thirds of large employers cover GLP-1s for weight management today, and 10% say they are likely to drop that coverage in 2027 (Business Group on Health, 2026). At the same time, Novo Nordisk and Eli Lilly now sell these drugs directly to consumers at a fraction of list price. That creates a third option between covering and dropping: let members use the manufacturers’ cash-pay programs and decide whether to help pay for it. The answer depends on a plan’s rebates, its member cost share, and how many of its members are likely to use these drugs, which varies widely by location.
Data sources and scope:
This analysis uses public data only:
Obesity and diabetes rates for 3,144 U.S. counties from CDC PLACES (2025 release; Kentucky and Pennsylvania from the 2024 release)
Self-pay prices from the NovoCare Wegovy Price Guide and LillyDirect
List prices from the February 2026 TrumpRx announcement
The 2027 Medicare negotiated price for semaglutide, shown as a reference point
Prices reflect published sources as of October 2026.
How to use the report:
The report has four tabs:
Coverage Scenarios. Compare annual plan cost and member cost for each approach. Enter your plan’s covered adults, rebate, cost share, and stipend, or your own GLP-1 utilization or obesity rate if you know it. Choose a location to use that area’s obesity rate.
Obesity County Map. Explore adult obesity rates by county and state.
Pricing Inputs. See exactly how each scenario’s price is built, how your plan’s net cost compares with published prices, and every source.
Methodology. Assumptions, calculations and limitations.
Use the arrows at the bottom of the report to move between tabs.