As the demand for Glucagon-like peptide 1 agonists (GLP-1s) continues to rise, employers face significant challenges in managing the costs and ensuring effective outcomes. First approved 20 years ago for type 2 diabetes, GLP-1s are revolutionizing the treatment of obesity, cardiovascular disease, sleep apnea, and more.

The 2025 Pharmacy in Focus report from the Evernorth Research Institute, which analyzed the growing use of GLP-1s in the U.S., found GLP-1s have become a major driver of prescription drug spend for plan sponsors. At the same time, proportionally higher GLP-1 discontinuation rates raise concerns about long-term effectiveness and value. Below we look at some key findings of the report and offer considerations for employers to optimize coverage for GLP-1s in their health benefit plans.

GLP-1s have a significant financial impact for plan sponsors

The rapid uptake of GLP-1 prescriptions, primarily for weight loss, has contributed to a steady rise in overall drug spending. This surge in demand, coupled with high cost, can create substantial financial strain on employers. A recent Business Group on Health survey reported that 96% of employers are concerned about the long-term cost implications of GLP-1s.

Concerns persist around long-term efficacy for weight management

GLP-1s have high discontinuation rates: Evernorth research shows that more than 50% of patients using GLP-1s for weight loss stopped their treatment within 12 months, with concerns about side effects and medication safety cited as primary reasons. We are also just beginning to amass data on how well patients do once weight loss goals are achieved and GLP-1 medications are stepped down or discontinued. This makes it difficult to determine the long-term benefits and return on investment as employers try to balance the need for effective treatments with budget constraints.

One certainty: GLP-1 growth will continue

There are more than 25 new GLP-1s or combinations thereof in the pipeline. Some of the new indications currently in clinical trials include Alzheimer’s, Parkinsons, Polycystic Ovary Syndrome (PCOS), and substance use disorders. As use expands with new approvals, employer benefit spend on GLP-1s will continue to grow.

Another source of burgeoning GLP-1 use is increasing obesity among younger generations; members of Gen Alpha (14 and younger) represent the highest percentage increase in GLP-1 use for weight loss, followed by Gen Z (15 to 28 years), and millennials (29 to 43 years). Early adoption of GLP-1s could lead to an unsustainable burden on employers due to potential lifelong reliance on these treatments.

Source: A comparison of 2023 and 2024 pharmacy claims among 27.3 million Evernorth members with commercial insurance coverage

Considerations for employers 

Most employers cover GLP-1s for diabetes in accordance with established best practices and the latest ADA treatment guidelines. And, despite concerns, employers continue to add weight management GLP-1 coverage.

“Employers recognize that offering GLP-1 coverage in their benefit plans can help attract and retain talent,” said Candice Michaelson, vice president and general manager of Cigna Healthcare’s integrated pharmacy business. “And GLP-1s for diabetes are now the first-line therapy per the American Diabetes Association (ADA), so we will see material trend increases there, too. In 2024, our diabetic GLP-1 utilization trend was 21%.”

Cigna Pharmacy has also seen a steady increase in weight management GLP-1 claims as more employers – about 20% as of the start of 2025 – add this coverage.

Source: Cigna Healthcare national book of business data

“Managing GLP-1 medications effectively requires managing the conditions they treat, focusing on whole-person care management, not just medication appropriateness and compliance. Plan sponsors need a comprehensive approach to diabetes and weight management inclusive of GLP-1 medication protocols, supporting both sustainable and effective long-term solutions,” Michaelson said. She noted that optimal outcomes contribute to the long-term value of these medications.

Michaelson offered four key strategies for employers to consider.

1. Focused, efficient clinical oversight

Sound GLP-1 management begins by ensuring clinical and diagnostic appropriateness. For type 2 diabetes, integrated benefit clinical reviews using medical data to confirm diagnoses in real time at the point of sale eliminates prior authorization delays, providing quicker access to therapy. The ability to leverage medical diagnostic data at the point of sale also minimizes customer and provider follow-up. For weight management, BMI and other health data are inherent to programs that focus treatment on those most likely to benefit from these medications.  

2. Dedicated access and dispensing

Access to GLP-1s has become a challenge, as many retail pharmacies no longer dispense these medications. EnReachRx for Cigna Healthcare includes dedicated GLP-1 pharmacies staffed with specialized pharmacists to help customers stay adherent, curtail waste, and discourage patient “stops and starts.” Discontinuing GLP-1 therapy – even for the short term – has a significant influence on clinical outcomes and drug trends. A recent Cigna Healthcare study examined Wegovy and Saxenda use among our integrated customers who have both Cigna Healthcare medical and pharmacy benefits and found that total medical cost savings were associated with 12 months or more of continuous use. Customers on these medications for 12+ months had an average per-member-per-year savings of $346 between months 13-18 and $1,179 between months 19-24, while those who discontinued therapy in the first six months actually had increases in total medical costs.

Source: Cigna Healthcare study of integrated plan customers, January 2021 - October 2024 (individual results will vary with utilization and benefit programs)

3. Integrated care management

The same study also found that 90% of the treatment group had an endocrine, nutritional or metabolic disease diagnosis, while 69% had an overweight or obesity claim, underscoring the need for integrated care management.

Cigna Healthcare customers engage us in a context of end-to-end benefit resources. “When our customers engage us or we engage them, whether for diabetes, weight management, or any condition, they are connected to all of their benefit resources in real time,” Michaelson said. “Our proprietary algorithms inform care teams who are able to provide timely support across the customer’s health profile, including proactive gap-in-care outreach.”

A recent internal analysis of 2024 national book of business data found that Cigna Healthcare integrated customers using GLP-1s to treat type 2 diabetes had a 61% reduction in diabetes-related hospital admissions and a 41% reduction in diabetes-related emergency room (ER) visits. Additionally, these customers showed no evidence of increased gastrointestinal-related ER events, and on average, HbA1C was lowered by ~1% within 12 months of adding a GLP-1 to a diabetes regimen.

When it comes to weight management GLP-1s, the importance of early and appropriate clinical and care management cannot be overstated. Launched January 1, 2025, EncircleRx for Cigna Healthcare is a comprehensive program focused on those with higher BMIs and at highest risk to offer enhanced clinical support, promote better outcomes, and provide financial predictability. The program requires participation in Omada lifestyle management, with regular check-ins and built-in digital monitoring. Early data findings from January 1 to June 20, 2025, showed integrated Cigna Healthcare customers had higher engagement when compared to all other customers enrolled in the Omada program:

• 6% higher educational engagement (96% vs. 90%)
• 4% more device usage (97% vs. 93%)
• 14% more messaging with their care team (90% vs. 76%)
• 26% higher involvement with community activities (54% vs. 28%)
• 13% more tracking of exercise (80% vs. 67%)
• 16% more tracking of medications (83% vs. 67%)

Integrated customers also have better clinical outcomes than the rest of the Omada population, including weight loss and medication persistence:  

• 92% remain on the drug through 12 weeks vs. a 58% real-world average
• 3.7% average weight loss (benchmark: 2.2%)
• 34% achieving 5% weight loss (benchmark: 29%)

“It’s simply easier for our customers to get support across benefits,” Michaelson said. “Integrated data inform our care teams in real time, enabling better informed interactions. We also back up our weight management program at the client level – clients choose between an annual drug cost cap or program performance guarantee, whichever best meets their needs.”

4. Comprehensive employee education

Health and wellness education needs to be a central component of an employer’s benefit program, helping employees live healthy lifestyles before GLP-1s may be needed. “Employers who prioritize prevention, including pre-diabetes intervention, well-care benefits, and promotion of healthy lifestyle choices can improve workforce vitality and save on total costs in the long term,” Michaelson said. “An integrated benefit program that supports healthy eating, physical activity, stress management, and the importance of good sleep can go a long way toward increasing workforce health and reducing total costs.”