By JOHN SAMARAS
Most employers nonetheless received’t cowl GLP-1s for weight reduction, and a few of them now inform the worker the place to purchase them with out the plan. The Worldwide Basis of Worker Profit Plans’ 2026 survey, printed in July, discovered that 60 % of employers cowl the medication for diabetes solely and 36 % for each diabetes and weight reduction. Among the many employers that exclude weight reduction, 27 % steer workers to a direct-to-consumer platform and 21 % to their FSA, HSA or built-in HRA.
The identical survey reveals why. For its respondents, GLP-1s went from 6.9 % of annual claims in 2023 to 11.4 % in 2026. In a Enterprise Group on Well being survey reported by Reuters in June, 10 % of enormous employers that cowl them plan to drop them in 2027. Cigna stopped protecting them for its personal workers in July.
What the worker walks into
I report the printed money worth of each US GLP-1 telehealth program each Monday, and that is the market these workers are despatched to. On the upkeep dose, Novo Nordisk sells its Wegovy pen direct for $349 a month and its Wegovy capsule for $299. The capsule’s $149 worth covers solely the starter doses. The most cost effective month on my chart, checked September 28, 2026, is $149 with auto-refill for compounded semaglutide, a pharmacy-made model that’s not FDA-approved and isn’t Wegovy or Ozempic.
The tax remedy is one sentence in IRS Publication 502: you possibly can embody “quantities you pay to shed pounds if it’s a remedy for a particular illness identified by a doctor (reminiscent of weight problems, hypertension, or coronary heart illness).” Pharmaceuticals qualify. The 2026 restrict on a well being FSA is $3,400.
Run by an FSA, a $149 month prices an worker within the 22 % bracket about $105, as a result of the {dollars} skip federal revenue tax and the 7.65 % payroll tax. The employer skips its personal 7.65 % on the identical {dollars}. The federal authorities offers up that income on a drug the plan declined to cowl.
The tax break has no formulary
A lined drug passes by a formulary, a previous authorization and a pharmacy community. The money profit passes by none of them. Publication 502 activates whether or not a drug was prescribed, and a compounded product qualifies on the identical phrases as a branded pen.
Screening the vendor turns into the worker’s job. On September 29 the Justice Division introduced the extradition of one among two males charged with promoting counterfeit Ozempic to US distributors “at deeply discounted costs,” with pretend packing containers, inserts, labels and needles. The FDA’s personal recommendation for getting drugs on-line lists “deep reductions or costs that appear too good to be true” as a warning signal.
The report goes too
On the plan, a fill leaves a declare with the drug, the dose and the date. On the money route that report sits in a telehealth app or within the FSA administrator’s receipts, and it doesn’t attain the medical claims.
Stopping is the occasion a plan would most wish to see. Within the STEP 1 trial extension, individuals had regained about two-thirds of the burden they misplaced inside a yr of stopping semaglutide. A number of the costs workers finances in opposition to additionally carry an finish date. Walgreens’ weight-management web page, learn September 26, lists 4 drugmaker presents, three of them with an finish date: Foundayo drugs from $149 a month, the primary two months of Wegovy injections from $199, and Zepbound KwikPens from $299. All three say “By December 31, 2026,” and the Foundayo and Zepbound presents listing greater costs for the doses that comply with.
Open enrollment asks workers to dimension their 2027 FSA in November, in opposition to costs that expire on December 31.
Three issues a plan sponsor can do
Preserve the report. A plan that sends workers to money can nonetheless depend the money fill towards the deductible in change for the receipt, which names the drug, the dose, the date and the pharmacy.
Print the upkeep worth in the advantages information, not the starter worth, so the FSA election covers the dose individuals keep on.
Give workers the FDA’s 4 indicators of a reliable on-line pharmacy: it requires a prescription, lists a US road handle and telephone quantity, has a licensed pharmacist to reply questions, and holds a state board of pharmacy license.
John Samaras is the founding father of GLP Chart, which verifies the money worth of each US GLP-1 telehealth program each Monday.
The value information above is free to reuse beneath CC BY 4.0, with a hyperlink and no registration. The October launch of my GLP-1 Money Worth Index, protecting September, publishes immediately at https://glpchart.com/price-index/ with the CSV and the JSON beside it. In order for you a special minimize, by state, by drug or by program, ask and you’ll have it inside a day.
