GLP-1 medications have moved quickly from emerging therapy to one of the most disruptive forces in employer-sponsored health plans. While the clinical conversation continues to evolve, many plan sponsors are now grappling with unexpected utilization, rising pharmacy spend, and frequent coverage changes.

Recent employer surveys show what many benefits teams are already experiencing firsthand: Among large employers that cover GLP-1s for weight loss, a significant share report utilization that exceeded expectations and had a noticeable impact on overall prescription drug costs.¹ As a result, 2026 planning conversations are increasingly focused on tighter eligibility criteria, stronger utilization management, or reconsidering coverage altogether.²

This volatility has created a new challenge for benefits administrators: how to adapt plan design decisions without creating confusion or frustration for employees. Administration and communication matter just as much as coverage decisions.

Whether a plan expands GLP-1 access, narrows eligibility, or pulls back entirely, employees still expect clear answers to basic questions:

• Is this medication covered under my medical or pharmacy benefit?
• Can I use my HSA or FSA to help pay for it?
• What documentation is required?
• What happens if coverage changes mid-year?

When those answers aren’t clear, benefits teams feel the impact through increased service volume, appeals, and employee dissatisfaction, often at the exact moment they’re trying to control costs.

As employers reassess GLP-1 coverage, consumer-directed healthcare (CDH) accounts remain a critical but often underutilized part of the affordability strategy. Used correctly, HSAs, FSAs, and HRAs can help employees manage out-of-pocket costs while reinforcing plan intent. But that only works when reimbursement rules are clearly defined and consistently administered.

Key considerations include:

• HSAs and FSAs – GLP-1 medications may be eligible when prescribed for a qualifying medical condition, supported by a prescription and (in many cases) a letter of medical necessity. Clear documentation workflows are essential.
• HRAs – Eligibility is determined entirely by plan design. If GLP-1s are included (or explicitly excluded), that decision must be reflected in plan documents and participant communications.
• OTC alternatives and adjunct therapies – As coverage tightens, employees often look for lower-cost or supplemental options. Administrators need to be prepared to explain what is and isn’t eligible under their specific plan rules.

In an environment where GLP-1 strategy may change year over year, flexibility and clarity are the real differentiators.

1. Put plan intent in writing: Ensure SPDs, HRA plan documents, and reimbursement rules clearly address GLP-1 medications and related treatments. Ambiguity drives inconsistency and, potentially, appeals.
2. Operationalize documentation requirements: If a prescription or letter of medical necessity is required, make the process straightforward for employees and providers. Breaking down complexity helps minimize frustration.
3. Align coverage with clinical pathways: Many employers are pairing GLP-1 access with lifestyle programs, coaching, or ongoing clinical oversight. Administration should support those guardrails.
4. Communicate for change, not perfection: Employees don’t expect static benefits, but they do expect transparency. Proactive communication about eligibility rules, prior authorization, and renewal timing builds trust even when coverage shifts.

Public policy discussions around GLP-1 affordability continue, supply constraints have eased, ³ and employer strategies are still evolving. What’s unlikely to change is employee demand around access and cost.

For benefits administrators and plan sponsors, the question isn’t simply whether to cover GLP-1s. It’s how to design and administer benefits that can adapt to change without losing clarity or control.

Sources:

¹Kaiser Family Foundation (KFF) | ²Mercer | ³FDA