What You Should Know:
– The Peterson Health Technology Institute (PHTI) has released a critical purchasing guide for employers struggling to manage the skyrocketing costs of GLP-1 obesity medications.
– The report recommends a shift away from broad, unchecked coverage toward a managed approach focused on three phases: Initiation (strict eligibility), Maintenance (adherence support), and Supported Discontinuation (managing off-ramps).
– PHTI urges employers to demand performance-based contracts from virtual health vendors, requiring them to prove tangible clinical outcomes rather than just providing access to prescriptions.
PHTI Releases Purchasing Guide on Virtual Tools to Help Employers Manage GLP-1 Coverage and Costs
For the last two years, employers have been caught in a vice grip. On one side, employee demand for GLP-1 receptor agonists like Wegovy and Zepbound has become deafening. On the other, the financial reality of these drugs—costing upwards of $10,000 per patient annually—threatens to capsize benefits budgets.
In late 2025, the conversation has shifted from “Should we cover them?” to “How do we survive covering them?”
A new market trend report from the Peterson Health Technology Institute (PHTI), Employer Approaches to GLP-1 Coverage, offers a standardized framework for this new reality. It acknowledges that the traditional “open formulary” model is dead for this drug class. In its place, PHTI proposes a high-friction, high-support model heavily reliant on virtual care partners to gatekeep access and ensure results.
3 Phases of GLP-1 Management
The core of the PHTI framework divides the patient journey into three distinct phases. Employers are encouraged to treat each phase as a separate contracting and management challenge.
1. Initiation: The Gatekeeping Phase
The era of easy access is over. PHTI advises employers to implement rigorous barriers to entry to ensure only patients with the highest clinical need—and highest likelihood of success—receive coverage.
- Narrow Prescribing Networks: Limiting prescriptions to a vetted list of providers who follow strict protocols, rather than allowing any general practitioner to write a script.
- AI and Behavioral Screening: Using advanced screening tools to assess a patient’s readiness for lifestyle change before a prescription is written.
- Step-Therapy Pathways: Requiring patients to try lower-cost alternatives or demonstrate failure in a lifestyle program before “stepping up” to GLP-1s.
2. Maintenance: Protecting the Investment
Once a patient is on the drug, the cost meter is running. PHTI identifies “maintenance” not as passive refilling, but as active risk management. Real-world data shows high discontinuation rates, which is a financial disaster for employers—paying thousands for a drug that is stopped before long-term health benefits accrue.
- Proactive Engagement: Virtual solutions must provide nutritional guidance and symptom management (e.g., managing nausea) to keep patients adherent.
- Lifestyle Coaching: Mandatory coaching is recommended to ensure the drug is an adjunct to health, not a replacement for it.
3. Supported Discontinuation: The Missing Link
Perhaps the most forward-looking part of the report is the focus on “off-ramps.” Most current benefit designs assume a patient stays on the drug forever. PHTI challenges this by normalizing Supported Discontinuation.
- Preventing Rebound: Employers should look for vendors offering structured diet and behavioral protocols specifically designed to stop the rapid weight regain that typically follows cessation.
- Tapering Support: Clinical support for patients who choose to lower their dose or stop therapy entirely.
5 Strategic Recommendations for Employers
Beyond the patient journey, PHTI outlines five specific actions for benefits leaders to take immediately.
1. Establish Clinically Driven Eligibility Coverage should not be binary (yes/no). It should be nuanced based on clinical criteria that go beyond FDA labels. PHTI suggests using clinical rigor to define exactly who gets the drug, prioritizing those with comorbidities where weight loss drives the most value.
2. Mandate Lifestyle Programs The “drug-only” approach is discouraged. Participation in nutrition or behavior change programs should be a condition of coverage, not an optional perk. This ties the financial investment to the employee’s active participation in their health.
3. Plan for the “Off-Ramp” Benefit designs must explicitly account for users tapering off the drug. Without structured support during this phase, the employer’s investment is often lost as weight returns. Support structures for discontinuation should be built into the vendor contract.
4. Audit Existing Vendors First Before signing a contract with a flashy new “GLP-1 clinic,” employers should audit their current carriers and digital health partners. Many existing vendors may already offer these capabilities, and adding “point solutions” can create fragmentation and unnecessary cost.
5. Demand Outcomes-Based Contracts PHTI advises employers to stop paying for activity and start paying for results. Contracts should be structured to drive outcomes—such as sustained weight loss or comorbidity reduction—while explicitly examining the overall program costs to prevent vendor bloat.
The Role of Virtual Care
The report underscores that virtual weight management solutions are the engine that makes this strategy possible. Employers cannot manage this level of clinical complexity alone. They need virtual partners to handle the screening, coaching, and day-to-day management of patients.
However, PHTI warns against “solution fatigue.” The market is flooded with vendors promising to manage GLP-1 spend. The winning strategy for 2026 will be selecting partners who can execute all three phases—Initiation, Maintenance, and Discontinuation—under a single, accountable framework.
