The GLP-1 Market Is Loud, and Employers Need Clarity

GLP-1 medications have become one of the most closely watched developments in health care, creating new opportunities and new challenges for employers, health plans and members. While the conversation around these therapies continues to evolve, the fundamentals of effective management have remained the same: ensuring appropriate use, supporting member success and balancing clinical outcomes with affordability.

For years, Navitus has applied these principles through comprehensive utilization management, clinical oversight and member support programs.

GLP-1 Pathways now brings these proven capabilities together in an end-to-end, market-responsive approach, helping plan sponsors navigate rising demand, evolving treatment indications and a rapidly changing vendor landscape with greater confidence and clarity.

The Conversation Has Moved Beyond Coverage

For years, discussions about GLP-1s focused primarily on access. Should they be covered? For which conditions, and under what criteria?

Today, employers are asking a different set of questions. How do we ensure the right members receive therapy? How do we support them throughout treatment? How do we avoid unnecessary costs while improving outcomes? And how do we adapt as new evidence, therapies and market dynamics emerge?

Nine in ten payers have concerns about affordability, and nearly half that do not currently cover GLP-1s for obesity say that they would not cover them at any price. While many plan sponsors are reassessing coverage for weight loss, coverage for type 2 diabetes remains strong, with PSG reporting that about 95% of employers cover GLP-1s for this condition. The Navitus 2025 Drug Trend Report found that GLP-1s for diabetes remained a significant cost driver, contributing to an overall drug trend of 8.4% compared to 7.9% excluding GLP-1s.

What has become increasingly clear is that there is no longer a one-size-fits-all approach to GLP-1 management. Organizations are at different stages of their journey, with different populations, goals and financial realities. Navitus has helped clients through high-pressure drug moments before, with clear criteria, thoughtful coverage strategies, member support and the confidence to say “yes,” “no” or “not yet,” based on what best served members and plan sponsors.

Introducing GLP-1 Pathways: Clinical Expertise Across the GLP-1 Journey

Coverage and eligibility decisions are only the beginning of a successful GLP-1 strategy. Long-term value comes from what happens next: ensuring appropriate access, proactive management and optimizing outcomes.

That’s why Navitus developed GLP-1 Pathways, a clinically guided approach that applies oversight, intervention and cost-management strategies across the full GLP-1 journey. The goal is not simply to provide access to therapy, but to help employers maximize the value of that investment while supporting better member outcomes.

Along the way, pharmacists and care teams help identify opportunities to improve outcomes and reduce unnecessary costs. In some cases, savings come from helping a member fill their prescription through a lower-cost network pharmacy rather than changing the medication itself. Other interventions may connect members with available copay assistance programs, monitor for medication waste or inappropriate utilization patterns, or provide personalized support for members at greater risk of discontinuing therapy or experiencing complications.

These targeted interventions help plan sponsors move beyond managing drug spend alone. By combining clinical expertise, medication oversight, affordability support and proactive member engagement, GLP-1 Pathways helps optimize total cost of care, support appropriate use and create lasting value throughout the treatment journey.

Meeting Clients Where They Are

GLP-1 Pathways was designed with multiple options that allow plan sponsors to align their strategy with their priorities. Whether the goal is tighter utilization management, budget predictability or a phased approach to expanding coverage, organizations can choose from three flexible coverage paths based on the level of access and investment that makes the most sense for their organization.

Earlier this year, a Navitus Pulse Survey found that 83% of respondents think individuals are turning to direct-to-consumer GLP-1 programs because traditional health care access is too difficult or too expensive, which is why we are offering DirectAccess. For clients who are looking to scale back, or those trying to avoid full coverage but also respond to member demand and interest, our new DirectAccess solution gives plan sponsors a flexible, off‑benefit way to provide access to low-cost, consumer pricing for GLP‑1s for weight management. Rather than forcing an all-or-nothing coverage decision, the addition of DirectAccess provides a practical alternative that expands available choices for both plan sponsors and members.

Together, GLP-1 Pathways and DirectAccess give plan sponsors the flexibility to pursue a strategy that balances clinical goals, member experience and financial sustainability.

Let’s Discuss Your GLP-1 Strategy

Navitus can assess your current approach, identify opportunities and help determine the right solutions for your goals. Contact your Navitus representative or reach out to [email protected] to discuss our GLP-1 Pathways and DirectAccess solutions.