How employers can turn GLP-1s into a value driver

Most employers file GLP-1s under pharmacy spend: a fast-growing line item to contain. That's understandable, because the way most plans cover them today, a cost is all they are. The question is whether it has to stay that way.

Beth Snyder, Chief Innovation Officer at Roundstone, put that question to Nicholas Syhler, co-founder and co-CEO of Embla. His answer: the drug isn't the problem. The setup around it is.

Key takeaways

• Without behavioral support and follow-up, GLP-1s are a cost driver. Paired with real behavior change, they become a value driver.
• In real-world use, the drugs deliver roughly half the weight loss seen in clinical trials.
• Stopping without a plan erases most of the result, so the care has to be continuous.

Why GLP-1s look like a pure cost today

"In the current setup, when you're lacking full, integrated, continuous, proper care, it is just a cost," Nicholas says. Someone prescribes, there's little oversight, and there's no lifestyle or behavioral program alongside the drug.

Employers feel it. In KFF's 2026 Employer Health Benefits Survey, 29% of large firms that cover GLP-1s for weight loss say it has had a significant impact on their prescription drug spending. Among firms with 5,000 or more workers, it's 61%.

What turns a cost into a value driver

The missing piece, Nicholas argues, is accountability after the prescription. "We just prescribe, and what is happening after the prescription, we don't know."

His alternative is continuous care that keeps checking two things: is the member reaching the outcomes they're aiming for, and are they making meaningful behavior change? When both are true, covering the drug makes sense for the plan. "If you have a behavioral program in place where the GLP-1s are actually used to help facilitate that behavior change, then it's not a cost driver. It becomes a value driver."

Employers are moving that way. In the same KFF survey, 40% of large firms that cover GLP-1s for weight loss require enrollees to see a dietitian, case manager or therapist, or to join a lifestyle program.

The drug alone delivers about half

Beth asked what the research says about the drug alone versus supported care. Nicholas's answer: real-world results fall far short of the trials. A Cleveland Clinic study of 7,881 adults found average weight loss of 8.7% after a year on semaglutide or tirzepatide, against the 15% to 21% reported in the trials that led to approval. Early discontinuation and low maintenance doses explained much of the gap.

There's a detail most people miss, Nicholas points out: "In clinical trials, there was actually a lifestyle intervention, but often that is not even included today." The STEP 1 trial tested semaglutide as an adjunct to a lifestyle program, not on its own.

When the support is there, the numbers look different. In Embla's own peer-reviewed TRIM study, members on behavior-first care reached 16.7% average weight loss over 64 weeks on less than half the standard maximum semaglutide dose.

The cliff when people stop

The second problem is what happens at the end. In the STEP 1 extension, people who stopped semaglutide regained two-thirds of the weight they had lost within a year. The trial stopped the drug overnight, and Nicholas notes that's how it often happens in real life too: people reach their goal and simply stop.

From a health economics view, that's the worst outcome: paying for the drug, then losing the result. "We need to look at this as a long, continuous care journey," Nicholas says. With behavior change in place, a structured taper becomes possible for many members instead of an abrupt stop. At Embla, tapering begins at month 16 and runs over 12 weeks. More in our GLP-1 tapering guide.

Four questions to ask about your GLP-1 coverage

1. Who follows up after the prescription, and how often?
2. Is coverage tied to progress on outcomes and behavior change, or is it open-ended?
3. Is a lifestyle or behavioral program part of the benefit, or an optional add-on?
4. What happens when a member reaches their goal: an abrupt stop, or a structured taper?

For the clinical side of the comparison, see GLP-1 coaching vs GLP-1 alone. For the cost levers, see how to offer GLP-1s without blowing the budget.

From line item to investment

GLP-1s will keep showing up on the pharmacy report. Whether they show up as waste or as value depends on what surrounds the prescription: follow-up, behavior change, and a plan for the end.

Want to see this in practice? Get the case study: how one self-funded employer cut GLP-1 costs by 65% in ten months.