Glucagon‑like peptide‑1 drugs (GLP‑1s) began as treatments for type 2 diabetes, but they’ve quickly become known for their weight loss effects because they help lower blood glucose and curb appetite when paired with diet and exercise. Today, some GLP‑1s are used not only for diabetes and chronic weight management, but also for additional FDA‑approved indications — most notably for reducing cardiovascular (CV) risk in overweight or obese adults with established heart disease, and for noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH) in adults with moderate to advanced liver fibrosis.
For health plan sponsors, this evolving landscape raises practical questions about employer coverage, medication affordability, and how to encourage evidence-based use alongside lifestyle support. In the sections that follow, we outline key considerations for thoughtful coverage of GLP-1s and related therapies — keeping the focus on obesity while noting other clinically relevant uses.
Role of GLP-1s in managing diabetes, obesity, and other conditions
GLP-1 receptor agonists – and the newer dual GLP-1/glucose dependent insulinotropic polypeptide (GIP) agonist – have ushered in a new era of care for type 2 diabetes and obesity in the U.S. These medicines mimic natural gut hormones that help the body release insulin appropriately, slow gastric emptying, and curb appetite, making them effective for lowering blood sugar and supporting clinically meaningful weight loss.
Today, multiple FDA-approved options are available as daily (liraglutide) or once-weekly injections (semaglutide and tirzepatide), and as a daily oral tablet. Within this class, semaglutide and tirzepatide are the most commonly used agents for diabetes and chronic weight management and carry additional indications.
There are currently three FDA-approved semaglutide products and two tirzepatide products:
Ozempic injection (semaglutide). Approved for the purpose of lowering blood sugar levels in adults with type 2 diabetes mellitus, in combination with diet and exercise. It is also approved for reducing CV risk in adults with type 2 diabetes mellitus with established heart disease.
In January 2025, the FDA approved another indication for Ozempic to reduce the risk of sustained eGFR decline, end stage kidney disease, and CV death in adults with type 2 diabetes and chronic kidney disease (CKD). FDA Access Data
Rybelsus tablets (semaglutide). This oral medication was introduced as the original tablet form of Ozempic. Similarly, it is indicated for lowering blood glucose levels in adults diagnosed with type 2 diabetes in combination with diet and exercise.
Rybelsus has two formulations approved for type 2 diabetes management only: the original 3/7/14 mg (R1) and a newer formulation (R2) available as 1.5/4/9 mg tablets with different recommended dosing. These formulations are not substitutable on a mg per mg basis. FDA Access Data
In October 2025, Rybelsus gained a new indication in adults with type 2 diabetes at high risk for cardiovascular disease. AJMC
Wegovy injection (semaglutide). Wegovy, a higher dose of semaglutide, is approved in combination with diet and exercise to reduce excess body weight and maintain weight reduction long term in adults and children aged 12 years and older with obesity, or adults with overweight who also have a weight-related condition.
In March 2024, Wegovy was approved for reducing CV risk in overweight or obese adults with established heart disease, in combination with diet and exercise. In August 2025, the FDA granted accelerated approval for Wegovy to treat MASH in adults with moderate-to-advanced fibrosis (F2–F3), in combination with diet and exercise. Continued approval for MASH depends on studies confirming clinical benefits beyond diagnostic and lab improvements. FDA Access Data
Mounjaro injection (tirzepatide). A dual GIP/GLP-1 agonist approved for lowering blood glucose levels in adults diagnosed with type 2 diabetes in combination with diet and exercise. Not indicated for weight loss. FDA Access Data
Zepbound injection (tirzepatide). Approved in combination with diet and exercise to reduce excess body weight and maintain weight reduction long term in adults with obesity or adults with overweight who also have a weight-related condition. FDA Access Data
Generic competitors of GLP-1s
GLP-1 injections for type 2 diabetes and chronic weight management now have generic competitors in the U.S. Reuters
Liraglutide injection (generic Victoza). Approved for lowering blood sugar in adults and children aged 10 years or older with type 2 diabetes in combination with diet and exercise.
Liraglutide injection (generic Saxenda). A higher dose of liraglutide is approved in combination with diet and exercise to reduce excess body weight and maintain weight reduction long term in adults and pediatrics aged 12 years and older with a body weight greater than 60 kg and obesity, or adults with overweight who also have a weight-related condition.
What plan sponsors should be aware of
Obesity continues to affect a large share of U.S. adults: 40.3% met criteria for obesity in 2021–2023, underscoring sustained demand for weight management support. CDC Notably, 55% of U.S. adults say they want to lose weight, but only 27% report seriously trying — illustrating both interest and the practical barriers many face. Gallup.com Public engagement with GLP 1s keeps rising, too, with 12% of adults having reported ever using a GLP-1 drug, and among those who have used a GLP-1, 54% said affordability was difficult. KFF
Considering these trends, it’s understandable that employers seek to provide a responsible benefit for their employees while balancing concerns about associated risks versus benefits of GLP-1s, overall health outcomes, and affordability. Coverage of weight loss drugs is likely to vary based on the needs of each member population and plan sponsor. In general, decision-makers should be aware that along with the immense popularity of this class of drugs, challenges and potential drawbacks remain, including:
– Patients have experienced significant weight regain following the discontinuation of GLP-1 drugs. STEP extension study data and subsequent analyses suggest about two thirds of lost weight may return within a year off drug. More long-term studies are needed to understand the optimal length of therapy. JAMA Network
– Nutrition and physical activity support are important for long-term management on or off medication. In a randomized trial, exercise plus GLP-1 therapy helped preserve bone mineral density compared with GLP-1 alone during weight loss — supporting integrated care models that include resistance training and dietary counseling. JAMA Network
– Safety risks can be significant with off-label use of GLP-1s, and FDA has warned about compounded or otherwise unapproved GLP-1 products (including semaglutide salt forms), citing dosing errors and adverse events. These products are not FDA-reviewed for quality, safety, or effectiveness. FDA
– Patient selection and timing impact outcomes in adults with overweight or obesity who already have heart disease. Heart health benefits build over time and were studied over several years, so the treatment value depends on how high a person’s risk is to begin with and how long they stay on therapy. American College of Cardiology
– Costs are a continuing concern — costs to members prescribed GLP-1 medications, as well as costs to plan sponsors. This class of drugs is a major driver of recent pharmacy trend in the U.S. with a recent study finding 500% growth in spend from 2018-2023. JAMA Network
Monitoring and managing the use of GLP-1s
Employers may wonder, “How are GLP-1 medications – originally approved for certain medical conditions – now being used as a common tool for weight loss?”
At CarelonRx, our primary goal is to optimize health outcomes. We rely on evidence-based programs and policies (e.g., prior authorization criteria) to guide the use of these drugs in individuals with conditions where there is clear evidence of clinical benefit.
At the same time, we are focused on reducing waste and managing costs. We do this by discouraging use/coverage where there is no evidence of clinical benefit, and encouraging clinically effective treatments that help ensure access to the right medications for the right conditions at the right time.
That’s why we continue to closely monitor clinical trials of GLP-1s. We look for evidence of efficacy and improvements in clinical outcomes prior to FDA approval of these drugs.
We also are committed to the value of real-world research findings once drugs are on the market. For instance, Carelon Research has recently published results from a large, 8-year cohort study assessing serious clinical outcomes on behalf of CarelonRx, Comparative Safety of Glucagon-Like Peptide 1 Receptor Agonists (GLP-1-RAs) in Type 2 Diabetes and Chronic Weight Management: A Real-World Data Study .
This clinical-first approach helps us ensure our formulary decisions around GLP-1s are based on the quality of evidence available at the time of pipeline review, FDA approval, and after. Similar to other drugs gaining new indications, our Pharmacy & Therapeutics (P&T) Committee will evaluate relevant evidence as it arises, to assure clinically appropriate therapy.
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