Over the past two years, GLP-1 prescriptions have surged across the U.S. Thanks to the clinical effectiveness of medications like Wegovy, Zepbound, and Ozempic, employers are seeing more employees asking for coverage — and more plans adding them to their formularies.
But these medications aren’t cheap. GLP-1s typically cost $12,000–$16,000 per person per year. For self-funded employers, even 5–10% member participation can drive pharmacy costs up by 8–10% annually, according to IFEBP.
The real problem? Most of that spend is uncontrolled.
What’s really driving your GLP-1 costs
The true cost of GLP-1s doesn’t just come from who’s using them — it comes from how they’re being used. Here are the biggest cost drivers:
1. Max-dose prescribing by default
Most GLP-1 programs escalate members to the highest dose available, whether they need it or not. Higher doses mean higher costs and more side effects — leading to dropout and waste.
2. No dose management strategy
Without clinical oversight, many members stay on high doses longer than necessary. This inflates cost and reduces adherence.
3. Lack of behavior change support
GLP-1s reduce appetite — but they don’t teach lasting habits. Without structured coaching, most members regain weight after stopping the drug, restarting the cycle (and the cost).
4. No offboarding plan
Many programs don’t include a tapering strategy. That means members stay on indefinitely — even if they’ve met their goals.
5. No employer visibility
If you can’t see who’s using what, at what dose, and with what outcome — you can’t manage spend or prove ROI.
A smarter model: cost control without compromising outcomes
At Embla, we help employers reduce GLP-1 spend without limiting access. Our model combines:
- Lowest effective dose protocols — start low and escalate only if needed
- 1:1 video coaching rooted in Acceptance & Commitment Therapy (ACT)
- Tapering support for members who hit goals or plateau
- Data visibility so you know what’s working — and what’s not
This approach delivers:
- 16.7% average weight loss in 12 months
- 66% lower average GLP-1 usage
- 8 in 10 members offboarded successfully without weight regain
5 ways to get your GLP-1 costs under control
If you’re a self-funded employer or plan consultant, here’s how to take back control of your GLP-1 spend:
1. Implement lowest effective dose protocols
Avoid automatic escalation. Require clinical review before dose increases.
2. Require behavior change support
Pair GLP-1 access with high-touch coaching to reduce dropout and support long-term success.
3. Set a tapering policy
Build an exit strategy from day one. Plan for how members will transition off medication safely.
4. Track medication usage, not just enrollment
Measure dose levels, side effects, weight outcomes, and coaching engagement.
5. Partner with a vendor who can manage it for you
Choose a solution that handles clinical oversight, coaching, and reporting — not just prescription access.
Final thoughts: it’s not just what you cover — it’s how you manage it
You don’t need to say no to GLP-1s to control costs. You just need to rethink how they’re delivered.
With the right partner and structure, GLP-1s can deliver lasting weight loss and reduce long-term health risks — without draining your pharmacy budget.