Helping Employees Understand GLP-1 Coverage During Open Enrollment

GLP-1 medications, commonly prescribed for weight loss and diabetes management, are a key open enrollment topic. Employees want clear answers about eligibility, costs and coverage criteria, often comparing information from peers and online sources.

Whether your plan covers these medications, sets limits or excludes them, communicating the decision clearly can help build trust, guide benefit use and ensure employees feel respected.

The Current State of GLP-1 Coverage

GLP-1 weight-loss coverage varies by employer and continues to shift as costs rise. Don’t base this year’s communication on last year’s assumptions.

Employees may compare your plan with policies at other organizations. Clearly explain your coverage decision, the reasons behind it and any changes so employees understand what to expect during open enrollment.

Matching the Message to the Decision

Clear communication matters, but each coverage decision requires a tailored approach to its risks.

Communicating Full Coverage

When your plan broadly covers GLP-1 medications for weight management, focus on setting realistic expectations. Full coverage should include these elements:

• How the medication works, using plain language
• Expected timelines, potential side effects and the role of nutrition, activity and behavioral support
• How to access coverage, including enrollment, prior authorization and support contacts
• How employee privacy is protected and what information, if any, HR or managers can access

Communicating Partial Coverage with Criteria

When GLP-1 coverage includes requirements or limits, explain each one and its rationale in plain language. These may include body mass index thresholds, qualifying conditions, prior authorization, trying other treatments first, lifestyle program participation or coverage duration.

Clarify next steps for employees who fall outside the criteria but believe they may qualify. Provide a confidential channel for eligibility and clinical questions rather than asking employees to share medical details with Human Resources (HR).

Communicating a Decision Not to Cover

If your plan excludes GLP-1 medications for weight management but covers them for diabetes, communicate the distinction directly and respectfully:

• State the decision and explain the reasons, including plan costs and potential premium impacts.
• Highlight available support, such as nutritional counseling or health coaching.
• Identify self-pay options and encourage employees to verify savings program terms and flexible spending account (FSA) or health reimbursement arrangement (HSA) eligibility for out-of-pocket costs.
• Keep the message focused on plan sustainability, not judgments about employees seeking treatment.

Communicating a Meaningful Year-over-Year Change

When GLP-1 coverage changes, give employees advance notice, especially those already using the benefit. Clearly explain:

• What is changing and the effective date
• How current prescriptions and authorizations are affected
• Whether a new prior authorization is needed or an existing one carries over
• Any differences between weight-management and diabetes coverage
• Next steps and a direct contact for questions

Specific guidance can help employees navigate the transition and reduce confusion for HR.

Communication Best Practices for Any Coverage

Whatever your GLP-1 coverage decision, keep communication clear, respectful and ongoing:

• Explain how the medications work and what they treat, not just coverage rules.
• Clarify privacy protections and what information HR or managers can access.
• Offer a confidential support line or anonymous way to ask questions.
• Treat obesity as a clinical condition, not a matter of effort or willpower.
• Gather feedback and update employees throughout the plan year.

Give GLP-1 coverage a prominent place in benefits materials or send a dedicated message before the open enrollment packet. This gives employees time to understand their options before making other benefits decisions.

Employer Takeaway

There’s no one-size-fits-all approach to GLP-1 weight-management coverage. Whatever your decision, explain your reasoning, protect confidentiality and treat obesity as a clinical condition. Clear, respectful communication can reduce confusion and strengthen trust in your benefits program. Download the bulletin for more details.