The next phase of GLP-1s in employer health strategies

The GLP-1 wave has arrived — and most benefit leaders are still playing defense. They've watched pharmacy spend climb, fielded pressure from employees who've seen Ozempic on TikTok, and scrambled to add prior authorizations fast enough to keep budgets from spiraling. But reacting to demand is not a strategy. If you're a benefits leader at a self-insured employer, the decisions you make in the next 12 to 24 months will define your cardiometabolic spend — and your population's health outcomes — for the decade ahead.

That's the central argument we made in a recent webinar with Rich Krutsch, former head of benefits at a large national employer and now President at Abett. His read on the GLP-1 market was refreshingly direct: the employers who get this right will stop asking "how do we control GLP-1 costs?" and start asking "how do we use GLP-1s to drive real clinical and financial value?"

The Three Questions Keeping Benefit Leaders Up at Night

When employers evaluate whether and how to cover GLP-1s, they're really grappling with three questions:

• Are the right members getting access? Most employers added prior authorization guardrails early on, ensuring only the most severe obesity cases qualified. But with retail prices for some GLP-1 formulations falling toward $300–$450 per month and consumer demand surging, those same employers are asking whether they've been too restrictive.
• Is it actually working? Not in theory — in your population. Are people losing meaningful weight? Are comorbidity-related claims going down? Or is pharmacy spend simply accumulating with no measurable return?
• Is it cost-effective? With medical trend running at 10% or more, benefit leaders need a credible path to ROI. For a deeper breakdown, see our guide on what's really driving your GLP-1 spend.

Why the Direct-to-Consumer Model Fails

The first line of every GLP-1 label says the drug is intended to support lifestyle intervention — not replace it. But in the direct-to-consumer space, that framing gets lost almost immediately. Providers competing for patients have financial incentives to prescribe. Platforms with capital to spend on marketing position these drugs as quick fixes. The result is widespread use of expensive medications without the behavioral scaffolding that makes them actually work long-term.

We've written extensively about why GLP-1 medication alone isn't enough — and what to offer employees instead.

Embla started as a direct-to-consumer business, and we learned this the hard way. We shifted entirely to an employer-sponsored model — and that shift changed everything. When coverage is tied to programme participation, you have the leverage to make sure GLP-1s are used the way they're intended: as a tool to accelerate and sustain behavioral change, not to replace it.

What "Doing It Right" Actually Looks Like

At Embla, tying coverage to engagement is a core design feature. Members who disengage from the programme lose access to medication coverage. This produces a 98.6% engagement and retention rate, driven by a combination of human coaching and AI-personalized guidance.

In a peer-reviewed study published in Diabetes, Obesity and Metabolism in September 2024 — and presented at ECO 2025 — Embla members achieved remarkable results:

• 16.7% average body weight loss at 64 weeks
• Using approximately one-third of the standard cumulative semaglutide dose
• 78.5% of members remained off medication through 39 weeks of follow-up after tapering — with no average weight regain

From Weight Loss to Cardiometabolic Strategy

GLP-1s are not just a weight loss benefit. Used correctly, they are a lever for fundamentally improving cardiometabolic health at scale:

• Reversing pre-diabetes
• Reducing hypertension
• Improving lipid profiles
• The SELECT trial demonstrated a 20% reduction in cardiovascular events over five years

Embla is actively publishing data on HbA1c reduction and discontinuation of antihypertensive and lipid-lowering medications alongside GLP-1 tapering. The goal is to demonstrate that the ROI on GLP-1 investment is measurable, and it starts now. For a full breakdown, see our post on the true ROI of covering weight loss medication for employees.

The Hidden Risk: Muscle Loss and MSK Claims

There is a scenario in which widespread GLP-1 adoption makes employer musculoskeletal claims worse, not better. In phase three trials, roughly one-third of weight lost was lean muscle mass. In a real-world population without adequate protein intake, strength training, or behavioral support, that ratio could be considerably worse.

A proper GLP-1 programme addresses this through:

• Structured resistance exercise guidance
• Protein optimization protocols
• Personalised dosing that avoids rapid weight loss

The Window for Strategic Action Is Now

The GLP-1 market is entering a new phase. Prices are falling. Consumer awareness is at a peak. The employers who will look back on this period with satisfaction are the ones who asked the harder questions:

• Are we covering the right members?
• Do we have a programme that ensures GLP-1s drive real behavioral change?
• Are we measuring the cardiometabolic outcomes that demonstrate value?

GLP-1s are a tool. An extraordinary one. But a tool without a strategy is just spend. The next phase belongs to employers who treat this as a cardiometabolic investment — with the data, programme design, and accountability to prove it.

If you're evaluating how to structure this benefit, our ultimate guide to cost-effective GLP-1 coverage for employers is a good place to start. Or reach out to our team to see how Embla structures GLP-1 coverage for self-insured employers.