The cost of GLP‑1 medications has become one of the most pressing concerns for employers heading into 2026. According to Sequoia’s 2026 Wellbeing Trends Report, steep price tags and continued demand have pushed GLP‑1 coverage conversations to the top of the benefits agenda for 35% of employers. Benefits leaders are evaluating how these medications fit into their budgets, people strategies, and overall wellbeing approach.

What’s clear from the data is that organizations aren’t approaching GLP‑1s casually. They’re asking: What’s sustainable? What’s fair? What’s realistic for a company of our size? This article breaks down what employers need to know – and how the 2026 insights can guide your decision‑making.

GLP‑1 Coverage Has Stabilized and Company Size Still Drives Adoption

Sequoia’s report shows that overall GLP‑1 coverage for weight loss has remained relatively steady year over year, but size remains the strongest predictor of adoption. About a quarter of all employers cover GLP‑1s for weight management overall. Coverage rises to nearly half (48%) among companies with more than 1,000 employees, while small and mid-sized employers remain in the low 20% range.

For smaller companies, this gap reflects a predictable reality:

  • Budgets are tight
  • Premiums continue to rise
  • One or two high‑cost claimants can shift the entire financial picture

Still, even with cost constraints, employee awareness and expectations continue to rise, keeping pressure on employers to clarify their position. Employees increasingly expect support for metabolic health, prompting many small employers to reconsider how GLP‑1 medications fit into their offerings.

Stabilization With Ongoing Uncertainty

Even as GLP‑1 coverage remains selective, employers remain deeply uncertain about whether to expand coverage in the coming year. According to the report, 55% of employers overall are not planning to add weight‑loss coverage next year, and another 44% remain unsure.

This hesitation reflects the tension many small and mid‑sized employers feel. While employees are asking for support, the financial implications are still difficult to predict. For organizations without deep claims visibility or large benefits budgets, the question often isn’t whether GLP‑1s are valuable, it’s whether they’re financially feasible right now.

This uncertainty sets the stage for the next major theme in the report: employers want to be supportive, but they also need structure and predictability.

Employers Want GLP‑1 Access in a Controlled, Sustainable Way

The report indicates that employers aren’t rushing into broad, open‑ended coverage. In fact, 85% are approaching GLP‑1s with some type of guardrail that supports responsible spending and appropriate use. This often includes policies like:

  • Prior authorization (most common with 67% requiring this)
  • Stricter clinical criteria
  • Enrollment in a weight management program
  • Required step therapy

These controls are especially important for employers who need predictability in their benefits budgets. The data shows that most employers covering GLP-1s are using these levers to balance support for employees with the need to manage rising pharmacy costs.

The key takeaway is coverage isn’t binary. Employers are finding ways to offer access without losing financial stability.

The Broader Wellbeing Landscape Matters, Too

While GLP‑1s are a major focal point for 2026, Sequoia’s trends report highlights that employers are making decisions with the full wellbeing ecosystem in mind. They aren’t treating these medications as standalone solutions. They’re one part of a larger wellbeing strategy that also prioritizes:

  • Mental health support
  • Preventive care
  • Flexible digital tools
  • Lifestyle and behavior programs

Employers are continuing to maintain investment across these areas, demonstrating a holistic wellbeing approach, even when individual benefits like GLP‑1s draw headlines.

What HR and Benefits Leaders Can Do Today

For employers looking to offer a supportive and effective metabolic health program, but need to keep budget and practicality in mind, here are three steps to approach this:

1. Decide what version of coverage makes sense for your size

Start narrow if needed. Many employers begin with diabetes‑related GLP‑1 coverage and revisit weight‑loss coverage later. This approach mirrors common adoption patterns in the report.

2. Add one simple support that complements medication decisions

Instead of building complex care pathways, consider:

  • Implementing a weight management program that provides clinical oversight and lifestyle modifications alongside medication
  • Offering a fitness app or gym membership
  • Access to virtual nutrition services

These smaller investments help employees pursue health goals with or without GLP‑1s and help make your benefit offering feel complete.

3. Communicate clearly and proactively

One of the easiest wins for smaller employers is simply clarifying what the plan will cover, why, and how employees can get help if they have questions. Clear communication reduces confusion, prevents misaligned expectations, and builds trust.

GLP‑1 Strategy in 2026: A Balanced Approach Wins

The theme emerging from Sequoia’s 2026 Wellbeing Trends Report is balance. Employers are concerned about the rising cost of GLP‑1s. They are evaluating coverage more thoughtfully than ever. And yet, they are finding measured, sustainable ways to incorporate these medications into broader wellbeing strategies that support their people and their budgets.

For small and mid‑sized employers especially, the opportunity isn’t to replicate a large‑enterprise program. It’s to understand the trends, make informed decisions that fit your reality, and build a wellbeing strategy that evolves with your workforce.

Download the full 2026 Wellbeing Trends Report to get more insights on GLP-1 coverage, mental health, and AI in benefits to help shape strategy at your organization.

Shannon Arens — Shannon is Director of Wellbeing at Sequoia, specializing in market insights, industry trends, and strategic initiatives to enhance employee wellbeing for clients. With a keen eye on the ever-changing wellbeing landscape, Shannon is focused on helping employers prioritize what will best address the needs of their people. Outside of work, Shannon enjoys spending quality time with family, staying active through exercise, and connecting with friends.