GLP-1 medications like Wegovy, Ozempic, and Zepbound are among the most powerful tools we’ve ever had to address obesity. They’re also among the most expensive. So it’s no surprise that employers are asking: Should we cover them? And more importantly — can we do it in a way that drives outcomes and controls cost?
This guide walks through the full picture: what makes GLP-1s work, what makes them expensive, and how self-funded employers can deliver better results without runaway pharmacy spend.
GLP-1s are clinically effective — but financially risky
There’s no denying the effectiveness. Clinical trials and real-world data consistently show:
- Average weight loss of 15–20% on semaglutide or tirzepatide
- Improvements in blood pressure, cholesterol, and blood sugar
- Reduced risk of developing type 2 diabetes and cardiovascular disease
These outcomes are meaningful — both for employee health and long-term cost avoidance. But they come at a steep cost. Most GLP-1s are priced between $12,000 and $16,000 per person per year.
For self-funded employers, the math gets serious fast:
- If 5% of your population enrolls, you could see a 4–6% increase in total health plan costs
- At 10%, costs could spike 8–10% — even before considering complications or non-adherence
This is why it’s not enough to offer access. The real question is: How do you cover GLP-1s responsibly?
What drives GLP-1 cost — and what to avoid
Many employers have learned the hard way: the true cost of GLP-1s comes not just from who uses them, but how they’re delivered. Key pitfalls include:
1. High-dose prescribing by default
Many vendors escalate members to the maximum dose, regardless of need. But higher doses = higher costs + more side effects.
2. No dose management strategy
Without clinical oversight, members often stay on high doses far longer than necessary.
3. No behavior change support
GLP-1s suppress appetite — but they don’t build habits. Without structured coaching, weight regain is likely after stopping.
4. No offboarding plan
Programs without a tapering strategy leave members on medication indefinitely — which drives up long-term spend.
5. No data transparency
If you can’t see who’s progressing, who’s escalating doses, or who’s ready to stop — you can’t manage the benefit effectively.
When these issues compound, GLP-1s become a line item with no end in sight.
Measuring success: what matters more than access
It’s easy to measure GLP-1 adoption. But the most important metrics for employers are:
Clinical outcomes
- % weight loss at 3, 6, 12 months
- Improvements in blood pressure, HbA1c, cholesterol (where available)
Medication usage trends
- Average GLP-1 dose per member
- Time on medication
- Escalation and tapering rates
Behavior change engagement
- Weekly coaching session attendance
- Improvements in sleep, nutrition, movement, stress
Financial impact
- Changes in obesity-related claims (e.g. diabetes, hypertension, MSK)
- Reduction in high-cost events or preventable procedures
Satisfaction and retention
- Member satisfaction
- Retention in program beyond 6 months
These are the leading indicators of ROI — not just whether people are filling prescriptions.
What happens if you don’t cover them?
It’s tempting to assume that doing nothing keeps costs flat. But obesity-related health costs are already high — and rising. The CDC estimates obesity accounts for $173 billion in annual medical costs, with downstream impact on:
- Diabetes, hypertension, cardiovascular risk
- MSK claims and joint surgeries
- Mental health, absenteeism, and productivity
Over 40% of U.S. working-age adults live with obesity. Choosing not to cover treatment doesn’t eliminate spend — it just delays and redistributes it.
A smarter way to cover Wegovy: the Embla approach
Embla is a digital obesity clinic designed for self-funded employers. Our approach helps employers say “yes” to GLP-1s — while avoiding the common cost traps.
Here’s how we do it:
- Lowest effective dose protocols: We start low, escalate only when needed, and stay low for as long as members make progress.
- 1:1 video coaching: Members get weekly support from licensed health professionals trained in ACT (Acceptance & Commitment Therapy).
- Structured tapering: When goals are met, we help members come off medication without weight regain.
Across thousands of members, we’ve seen:
- 16.7% average weight loss in 12 months
- Achieved using 66% less GLP-1 medication than traditional programs
- 8 in 10 members taper off without regaining weight
What a high-ROI GLP-1 benefit looks like
If you want to make covering GLP-1s sustainable, your benefit should include:
1. A coaching-first foundation
Medications don’t build habits — coaching does. Real 1:1 support changes behavior.
2. Dose control protocols
Avoid automatic titration. Start low, stay low, escalate only when progress stalls.
3. An offboarding plan
Without one, members stay on medication forever. Design your exit ramp from day one.
4. Outcome tracking
Engagement is nice — but outcomes matter more. Track weight loss, tapering, and adherence.
5. A partner with clinical infrastructure
The best vendors manage prescribing, coaching, and outcomes — not just access.
Final thoughts: GLP-1s need a strategy, not just coverage
Covering Wegovy and other GLP-1s can be a high-impact move — but only if it’s done right. Employers who win in this space:
- Lead with behavior change
- Set medication boundaries
- Require outcome tracking
- Build a clinical off-ramp
With the right design, covering GLP-1s becomes more than a benefit — it becomes a business case for long-term health, productivity, and cost control.
At Embla, we help employers deliver better weight loss outcomes with less medication, fewer side effects, and more sustainable results.