Navigating GLP-1 coverage for weight loss has been a sore spot for insurers and employers. These drugs — alongside other specialty drug spending — have been behind price hikes going into 2026.
Still, as some employers, states and insurers hesitate to expand coverage, a handful of organizations are trying to boost accessibility, including by negotiating lower costs.
Four notes on the state of GLP-1 coverage in 2025:
1. The Trump administration and CMS have been getting more involved in negotiating specialty drug prices. CMS published plans in late December for its “Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth” — or BALANCE — model, which will encompass drug affordability and lifestyle support for weight management. Leading up to the model, President Donald Trump had been negotiating with manufacturers on prices for Medicare and Medicaid. While President Trump’s moves do not have a direct effect on GLP-1 access across every health plan, some are thinking the initiative could “create downward pressure for drug manufacturers to lower costs for commercial plans,” Bruce Rogen, MD, chief medical officer of the Cleveland Clinic Employee Health Plan and chair of the Cleveland Clinic Quality Alliance, told Becker’s.
2. Despite speculation as to whether the drugs will remain at such hefty costs, GLP-1 pricing is still a headwind for insurers. Losses due to GLP-1 costs were a common thread across recent earnings reports, including for Highmark Health and Blue Cross Blue Shield of Massachusetts. In April, BCBS Massachusetts dropped GLP-1 coverage for weight loss. Coverage availability under ACA plans nationally is on the decline, as well.
3. Employers, including state employee health plans, have been wary of GLP-1 coverage. In 2025, Idaho and Louisiana moved away from coverage for state employees. Employer-provided coverage that includes GLP-1s could raise premiums by about 5% to 14%. One survey found that cost management for these drugs is a top prescription benefits concern for employers, and more than half of employers plan to shift healthcare costs to workers next year. Firms of different sizes had varying sentiments on how much GLP-1s weigh on drug spending, and Eli Lilly is launching a direct-to-employer GLP-1 model to provide more flexibility.
4. Meanwhile, some insurers are leaning in. During a May earnings call, Cigna said it is focusing on programs to mitigate cost and delivery. The insurer is also capping Zepbound and Wegovy out-of-pocket costs at $200 per month.
