by Hines Sales & Accounts Team
Over the last two years, GLP-1 medications such as semaglutide have become one of the most talked-about topics in employer benefits. Many employees are asking for coverage, and many employers are weighing the true cost of adding these drugs to their health plans. Despite the hype, data shows that most employer groups are either limiting or fully opting out of GLP-1 weight loss coverage because the long-term financial and clinical value is unclear.
Employers Are Pulling Back on GLP-1 Coverage
The attention around GLP-1s continues to grow, but employers remain cautious. A 2024 analysis by Kaiser Family Foundation found that fewer than one in five large employers cover GLP-1s when they are prescribed for weight loss (source: forbes.com). Even among employers that do offer coverage, many require prior authorization or mandatory participation in lifestyle programs before approving the medication.
A 2025 survey of 237 self-funded employers found that only 37 percent cover GLP-1s for weight loss, and 60 percent report they do not cover these medications at all and do not intend to add coverage (sources: bbrown.com, mcgriff.com).
The financial impact is the most cited concern. According to a 2025 report by Willis Towers Watson, pharmacy cost per member per month for GLP 1 medications increased from $4.34 in 2022 to more than $27 in the first quarter of 2025 (source: wtwco.com). Another national survey reported that 27% of employers say GLP-1 claims alone represent more than 15% of their total annual drug costs (source: ifebp.org).
Why Employers Are Questioning GLP-1s
Many employers view GLP-1 medications as a temporary fix rather than a durable strategy for metabolic health. Key concerns include:
- High and rising prescription costs for long periods of time
- The elective nature of most GLP-1 use, since many people pursue these medications without having a chronic disease diagnosis
- Weight regain after discontinuation
- Reported gastrointestinal side effects, nutritional deficiencies, and muscle loss
- Uncertainty around long-term safety research
Adherence is also a major issue. Many patients have difficulty staying on the medication, and much of the weight loss evaporates once treatment is paused. Because GLP-1s do not address nutrition, activity, sleep habits, or stress, they are not considered a comprehensive approach to improving metabolic health.
The Real Crisis: Obesity, Prediabetes, and Type 2 Diabetes in the United States
GLP-1s are often presented as the solution to the obesity crisis. In reality, obesity and metabolic disease require a prevention-based strategy. The data paints a clear picture of the challenge facing employers:
- More than 41 percent of U.S. adults have obesity (source: cdc.gov)
- More than 9 percent have severe obesity (source: cdc.gov)
- Obesity is associated with major chronic disease risks such as high blood pressure, heart disease, and type 2 diabetes
- More than 38 million Americans have diabetes (source: cdc.gov)
- More than 97 million adults have prediabetes, meaning a large portion of the working population is on the path toward disease (source: cdc.gov)
- Adults with obesity experience diabetes rates above 24 percent, which significantly drives long-term employer health plan costs (source: cdc.gov)
- Obesity results in more than 173 billion dollars in medical spending each year (source: cdc.gov)
These figures confirm that obesity and metabolic dysfunction are not only individual health issues but major workforce and economic challenges. Employers cannot rely on expensive weight loss medications alone to reverse long-term disease trends.
Prevention and Disease Management Offer a Stronger, More Sustainable Solution
A growing body of employer benefits research shows that proactive prevention and chronic disease management can reduce high-cost claims, improve employee health, and lessen the need for GLP-1 medications altogether. Unlike short-term weight loss drugs, prevention targets the root causes of metabolic disease, including nutrition, daily activity, sleep regularity, stress, blood sugar patterns, and early warning signs of chronic conditions.
When lifestyle-based interventions are supported by clinical oversight, the long-term return on investment is significantly higher than the return provided by indefinite GLP-1 prescriptions.
This is exactly where Optimal Health by Hines Healthy Tomorrows delivers value.
Optimal Health: A Clinically Backed, Nurse-Led Alternative to Wellness and Prevention
Optimal Health is a comprehensive wellness, prevention, and disease management solution designed specifically for employer groups seeking to improve employee health outcomes while lowering long-term healthcare spending. The program replaces guesswork with clinical accuracy by integrating biometric monitoring, wearable data, and nurse-driven support.
Optimal Health Acuity Levels
Wellbeing (Foundational Tier):
This entry-level solution focuses on assessing disease risk and promoting healthy behaviors. It lays the groundwork for long-term health through education and engagement.
Prevention & Preconditions:
This tier targets early intervention, recognizing that timely action can halt or even reverse certain disease processes. Coaches work with members to set personalized goals aimed at preventing chronic conditions and long-term complications.
Single Topic/Condition:
For members managing a specific chronic condition, such as Diabetes, or undergoing treatment like GLP-1 Agonist therapy for weight loss, this product offers focused support through nurse coaching and biometric monitoring via wearable devices.
Integrative Condition:
Designed for members with multiple chronic conditions, including mental health challenges, this tier provides comprehensive care using the same tools as the Single Topic/Condition product, with added coordination to improve overall quality of life.
For Wellbeing, and Prevention/Precondition Products Optional Add-Ons Include:
- Home Lab Kits
- Biometric Bands with Mobile App powered by all.health
About the app: Unlike novelty wearables that just count steps or track sleep, our FDA-registered biometric band is built for serious healthcare impact. This isn’t a gadget, it’s a clinical tool. The band continuously monitors key biomarkers for early signs of chronic diseases like COPD and diabetes, transmitting constant insights directly to Hines clinicians. This allows proactive, personalized intervention long before symptoms escalate; a capability no other wearable program offers. It’s precision health management for plan sponsors who want measurable results, not wellness gimmicks.
The Case for Investing in Prevention
With obesity continuing to rise and chronic disease driving billions in healthcare spending each year, employers must prioritize scalable and cost-effective solutions. Prevention and disease management programs reduce long-term risk, improve population health, and provide the clinical rigor that GLP-1s cannot deliver alone.
Optimal Health embodies this approach through biometric data, holistic coaching, clinical supervision, and measurable health outcomes. It helps employers move beyond temporary pharmaceutical fixes and toward sustainable workforce health.
Conclusion
GLP-1 medications have a role in certain clinical cases, but they are not the foundation of a sustainable benefits strategy. Employers are increasingly opting out because costs are rising, long term value is questionable, and the medications do not address the true sources of metabolic disease.
Optimal Health offers a proven alternative that focuses on prevention, lifestyle, and whole person well-being supported by continuous biometric data and nurse led clinical care.
The cheapest way to get GLP-1 medication is to not need it at all.
To learn more about Optimal Health and all of Hines’ comprehensive care management solutions, reach out to sales@hinesassoc.com and discover how prevention can transform your workforce health strategy.
