Bank of America’s CEO revealed recently that the company spends $250 million annually on GLP-1s for its employees, representing more than 12% of the firm’s total $2 billion healthcare budget. Nevertheless, the company is bucking the downward trend in employer-sponsored coverage of GLP-1s for weight loss by maintaining its comparatively generous policies.

Glucagon-like peptide-1 receptor agonists are popular diabetes and obesity prescription medications. In addition, the treatments have been gaining supplemental indications over time, including cardiovascular risk reduction, sleep apnea and an advanced form of liver disease called metabolic dysfunction–associated steatohepatitis. At present, over 40 million Americans are prescribed these medicines.

But employers and other payers in the commercial sector often don’t cover the products, if taken for obesity. And a growing number of high-profile employers such as Starbucks are cutting back on coverage.

While many employees believe access is critical to treatments that they deem are essential, employers apparently see things differently . The percentage of large employers offering GLP-1 medications for weight loss has dropped from 72% in 2025 to 60% in 2026. And according to a recent survey published by the International Foundation of Employee Benefit Plans , just 36% of all businesses in the United States cover GLP-1s for weight loss. Furthermore, 14% of employers have already planned to drastically reduce or even eliminate coverage in 2027 for obesity medications to stay “financially viable.”

There are multiple reasons for employers to balk at paying for these pharmaceuticals. The most obvious is financial. But the emergence of widespread availability of cash-pay options for patients is another important consideration. Since Novo Nordisk and Eli Lilly rolled out direct-to-consumer cash-pay options along with telehealth partnerships, the cash prices for a variety of starter and maintenance doses of different GLP-1s — both subcutaneous and oral pill formulations — have decreased to approximately $149 to $399 per month via online platforms.

While about half of Americans say they still struggle to afford GLP-1 weight loss drugs , about a quarter are willing to spend $250 a month on the treatments. Additionally, 60% of a sample of around 1,000 Americans surveyed by Trimi — a licensed telehealth provider specializing in compounded GLP‑1 weight management medications — say they’re willing to incur medical debt in their quest to access obesity pharmaceuticals.

At least in the short term, employers can gain financially by not covering the pharmaceuticals, effectively incentivizing employees who wish to take them to make use of cash-pay alternatives. In addition, whatever employees spend out-of-pocket on the various online portals does not count towards their deductibles. This can save employers money, too.

By contrast, Bank of America says it’s making a good investment in its employees’ health by spending $250 million on GLP1-s. Notably, a prerequisite for coverage of the drugs for obesity is that bank employees participate in lifestyle and health coaching programs to enhance or reinforce benefits. These initiatives are also sponsored by Bank of America.

However, as the Bank of America example illustrates, nearly 80% of employers say that GLP-1s are substantial drivers behind increases in their companies’ healthcare costs. And so, whether on their own or outsourcing to health plans and pharmacy benefit managers, firms are deploying various approaches to manage appropriate use of GLP-1s for weight loss or establish pre-conditions for coverage. The strategies include validating clinical eligibility such as body mass indices, requiring participation in lifestyle management programs, limiting prescribing to specific healthcare providers and excluding certain medications from the formulary or list of reimbursable pharmaceuticals.

While the commercial insurance sector is either reducing coverage or ratcheting up restrictions, the state-federal insurance program for low-resourced individuals, Medicaid, is dropping GLP-1 reimbursement for obesity, too. Constrained budgets are driving Medicaid’s retreat from reimbursing GLP-1s for weight loss.

In terms of coverage, the news isn’t all negative. The Trump administration’s Bridge program in Medicare, offering beneficiaries access to GLP-1s for obesity for a $50 co-payment per month, is off to a strong start . More than 600,000 enrollees have signed up thus far. Nonetheless, the temporary nature of the program — which runs through 2027 — could be a limiting factor, particularly if costs balloon without sufficient offsetting savings from possible reductions in downstream hospital and physician use for those on GLP-1s. If this turns out to be the case, it’s unlikely the program would be extended.