Building GLP‑1 Benefit Strategies That Go Beyond TrumpRx Headlines

NEXTpert:  Dr. Ray Fabius. MD., President and Chief Medical Officer of HealthNEXT

TrumpRx‑era pricing and a rapidly evolving GLP‑1 marketplace are reshaping employer benefit decisions and plan design. Written by Dr. Ray Fabius, president of HealthNEXT and supported by the decades of experience of the HealthNEXT NEXTperts group practice, this article focuses on practical ways HR, benefits, and finance leaders can build integrated GLP‑1 strategies that manage cost, support equitable access, and improve workforce health and productivity.

The Stakes for Employers

GLP-1s are driving a large share of pharmacy trend, and many finance and HR leaders are feeling the impact in real time. At the same time, federal efforts like TrumpRx are changing how employees think about “fair” pricing and access. Employees are seeing headlines about lower direct-to-consumer prices and wondering why their employer plan looks different. Without a coherent strategy, employers risk paying more than they need to, disappointing employees, and missing the opportunity to actually improve health and productivity.

Obesity is a major driver of cardiometabolic disease, musculoskeletal problems, sleep apnea, certain cancers, and mental health conditions, all of which show up in absenteeism, disability, and presenteeism. Nearly two-thirds of the American workforce is overweight or obese, and by 2030, as many as one in two American workers may have obesity. That makes obesity both a health risk and a business issue.

GLP-1 medications such as semaglutide and tirzepatide have demonstrated meaningful, sustained weight loss, lower progression to type 2 diabetes, and fewer cardiovascular events in at risk patients. But those gains come with a high price tag, and employers covering GLP-1s are seeing pharmacy spend increase by 10–20% or more. In many organizations, weight management drugs account for a substantial portion of recent drug spend growth.

The central question is no longer “Should we cover GLP-1s?” but “How do we cover them in a way that delivers measurable value for our workforce and our budget?”

Why Coverage Without Support Backfires

The clinical evidence and mounting employer experience show that GLP-1s are most effective when combined with structured lifestyle and behavioral support. When people stop these medications, most will regain a significant share of the weight they lost, especially if healthy eating and physical activity have not become durable habits. That rebound is not just a clinical setback; it represents a poor return on a very large investment.

Adherence is another challenge. Side effects such as nausea, vomiting, diarrhea, constipation, hypoglycemia, injection site reactions, and pancreatitis contribute to discontinuation. Up to half of patients stop GLP-1 therapy in the first year, which undermines outcomes and wastes pharmacy spend.

Programs that combine medication with nutrition counseling, physical activity support, coaching, and behavioral health resources achieve much better persistence and value. For example, step therapy policies typically require members to try lower‑cost, evidence‑based options, such as lifestyle interventions and generic weight‑loss medications before “stepping up” to higher‑cost GLP‑1s, ideally under physician supervision and, when possible, in consultation with obesity‑medicine specialists who can individualize care.

International models reinforce this integrated approach. In countries like France, Germany, and Denmark, GLP-1s are typically prescribed with required nutritional counseling and specialist oversight, not as a standalone “quick fix.” The goal is to ensure that expensive therapies sit inside a care model designed for long term success.

TrumpRx and the New Pricing Reality

A new wave of formulations is further reshaping expectations. Both major manufacturers of the leading injectable GLP-1 medications now have FDA‑approved oral pill versions for weight management, and early pricing signals suggest these tablets are often 50% less expensive or more than the original injectable products depending on dose, channel, and plan design. As additional oral GLP‑1s and next‑generation agents enter the market, overall GLP‑1 treatment costs are expected to moderate over time as competition, new delivery forms, and alternative therapies expand employer and patient options.

Recent federal initiatives have added a new layer of complexity. Through TrumpRx and related agreements, manufacturers have lowered the direct-to-consumer price of several leading GLP-1s for eligible patients, while Medicare has agreed to expand coverage for certain indications. For some drugs, list prices that once exceeded 1,000 dollars a month are now being advertised starting around the mid-hundreds when purchased via TrumpRx.

From an employer’s perspective, this creates both opportunity and risk:

  • Employees who see “headline prices” may assume those prices should automatically apply to the employer plan, even though plan costs are shaped by PBM contracts, rebates, and formulary design.
  • Some employers are considering limited financial support (for example via a health reimbursement arrangement) for employees who purchase GLP-1s through TrumpRx or similar platforms when those medications are not covered under the plan.
  • At the same time, employees who obtain GLP-1s through direct-to-consumer channels are less likely to receive the wraparound support, coaching, and care coordination that drive long-term success on and after these medications, which means employers could see more obesity related health care claims if the individuals on GLP-1s aren’t having sustained success.

This environment makes it even more important to have a thoughtful, transparent strategy that aligns coverage, affordability, and outcomes, and that deliberately connects GLP-1 access to the lifestyle, behavioral health, and care management resources employees need to succeed over the long term.

What Lilly Employer Connect Means for Plan Design

Adding to this complexity, Eli Lilly has launched its Lilly Employer Connect platform, which lets employers contract directly with a network of more than fifteen independent program administrators and a dedicated pharmacy network to expand access to its obesity medicines at lower, more predictable out‑of‑pocket costs for employees. These administrators range from low‑cost benefits administration partners to more holistic obesity‑care solutions that bundle clinical evaluation, virtual care, and behavior‑change support, giving employers new alternatives beyond traditional PBM arrangements.

For employers, Lilly Employer Connect effectively creates a parallel channel alongside TrumpRx and existing PBM contracts, one that is said to improve price transparency and cost predictability, but that still requires careful integration with plan design, step‑therapy policies, and equity goals to avoid fragmented care or uneven access.

A Blueprint for Value-driven GLP-1 Coverage

For employers, simply “checking the box” on GLP-1 coverage is not enough to manage cost, equity, or outcomes. A value driven approach builds GLP-1s into a broader, evidence-based obesity and cardiometabolic strategy.

HealthNEXT’s global group practice of clinical and executive “NEXTperts” recommends that employers consider the following design principles:

  • Require participation in comprehensive lifestyle programs: This sets the expectation that medication is one component of a broader behavior change journey, not a standalone solution.
  • Embed specialist expertise and centers of excellence: This improves clinical decision making, supports step therapy, and can reduce inappropriate prescribing.
  • Integrate behavioral health, coaching, and care management: These services improve adherence and help employees sustain healthy habits even if medication is discontinued.
  • Use clear, clinically grounded eligibility criteria: Prioritize GLP-1 coverage for employees with type 2 diabetes and those who meet FDA approved criteria for obesity treatment—for example, BMI greater than 30, or BMI greater than 27 with comorbidities such as hypertension, dyslipidemia, or established cardiovascular disease. As prices moderate and budgets permit, employers can consider gradually expanding eligibility.
  • Apply step therapy where appropriate: Thoughtful step therapy helps control spend while still offering effective options, including lower‑cost generic weight‑loss medications when clinically appropriate and under physician supervision, ideally with access to obesity‑medicine specialists for complex cases.
  • Coordinate with PBMs and assess TrumpRx implications: Reevaluate PBM contracts, rebate structures, and formularies to clarify how TrumpRx level pricing and pharmaceutical direct options impact with your actual net costs and ensure employees understand how cash pay options interact with deductibles and out-of-pocket maximums.
  • Build a strong social support and culture component: Social support can significantly improve engagement, resilience, and long-term success in weight management programs. Employers work environment, policies, resources and benefits can all influence their employees to take better care of themselves.

With a thoughtful design, GLP-1s can be part of a broader, high value health strategy that improves lives, supports productivity, and uses every healthcare dollar more wisely.