Only Half of Clients Cover Weight-Loss GLP-1s
GLP-1 medications have emerged as one of the most debated topics in employer health benefits. During CVS Health’s Q1 2026 earnings call on May 6, company leadership confirmed that only about half of CVS Caremark’s pharmacy benefit manager (PBM) clients currently cover GLP-1 drugs for weight loss. This figure signals a widening gap between the demand for these treatments and what employers are willing — or financially able — to pay.
CVS Caremark, the PBM arm of CVS Health, serves a broad base of clients including employers, health plans, and government programs. Its coverage decisions ripple across millions of plan members nationwide. Therefore, when only half of those clients opt to include GLP-1 weight-loss coverage, it reflects the scale of the affordability problem facing the industry.
Why Affordability Remains the Biggest Challenge
Employer Pressure Is Growing {#section2a}
Prem Shah, PharmD, Executive Vice President and Group President at CVS Health, oversees the company’s pharmacy, consumer wellness, and healthcare delivery operations. On the earnings call, he spoke directly to the challenge GLP-1s present for clients.
“About half of our clients cover GLP-1s for weight loss,” Dr. Shah said. “It’s an indication that our clients need more solutions and innovative solutions that PBMs bring to market for their customers.”
He also noted that CVS was “very deliberate last year in creating competition in this category and helping reduce costs.” Despite those efforts, Dr. Shah acknowledged the affordability gap remains real. “It’s a real reality that we face in driving that competition and bringing down cost,” he added.
This challenge is not isolated to CVS Caremark’s clients. A 2025 Mercer survey found that more than three-quarters of employers consider managing GLP-1 costs an extremely or very important concern. Notably, this pressure centers specifically on weight-loss uses. Coverage for GLP-1s prescribed for Type 2 diabetes has remained comparatively stable and consistent across employer plans.
Insurers Face Rising Drug Costs Too
Beyond employers, health insurers are also grappling with rising drug expenditures tied to GLP-1s. The growth in prescriptions — driven by blockbuster medications like semaglutide and tirzepatide — has placed sustained upward pressure on pharmacy spend. Moreover, as these drugs gain broader clinical recognition for obesity management, the volume of coverage requests continues to climb.
For payers and PBMs alike, the core question is not whether GLP-1s work. The clinical evidence supports their effectiveness. Instead, the central challenge is: how do health plans manage coverage in a way that is both equitable for members and financially sustainable for plan sponsors?
What CVS Health Is Doing About It
Driving Competition to Lower Prices
CVS Caremark’s strategy centers on fostering market competition among GLP-1 manufacturers. By encouraging multiple drug makers to compete for formulary placement, the company aims to push list prices lower. Dr. Shah confirmed this approach, noting that CVS was “very deliberate” in building competitive dynamics within this drug category in 2025.
CVS Health CEO David Joyner echoed this urgency on the earnings call. “Cost still remains the single biggest issue from a budget standpoint, whether it be the GLP-1s or the rising-cost specialty pharmacy,” he said. “Clients still want us to continue to drive costs down and actually improve the experience for the members.”
This dual focus — cost reduction alongside member experience — reflects a broader shift in how PBMs are expected to operate. Clients no longer accept cost-pass-through models without accountability. Instead, they want their PBMs to deliver tangible savings and better health outcomes simultaneously.
Federal Policy Could Slow Progress
CMS Pause Creates Uncertainty
Some payer leaders had hoped that federal government-led negotiations with pharmaceutical manufacturers could compress GLP-1 prices across the market. If Washington could secure lower list prices for Medicare, that competitive pressure might spill over into the commercial sector as well.
However, the Centers for Medicare and Medicaid Services (CMS) recently paused its GLP-1 weight-loss payment model for Medicare indefinitely. This pause introduces fresh uncertainty into an already complex landscape. Without federal momentum, the timeline for broad price reductions grows less predictable. Consequently, employers and insurers cannot count on government action alone to solve their GLP-1 cost problem.
Furthermore, political and regulatory headwinds could delay even moderate reforms. As a result, PBMs like CVS Caremark will likely carry a greater share of the responsibility for negotiating savings in the near term.
The Road Ahead for GLP-1 Coverage
Innovation and Access Must Move Together
The gap between clinical demand and insurance coverage for GLP-1 weight-loss drugs is unlikely to close on its own. Prices remain high, employer budgets are under strain, and federal intervention is on hold. Against this backdrop, PBMs hold an increasingly important position as intermediaries who can shape formulary design, negotiate rebates, and create tiered access pathways.
For the roughly half of CVS Caremark clients not yet covering weight-loss GLP-1s, the path forward may involve value-based arrangements, outcomes-linked contracts, or expanded biosimilar competition. As more GLP-1 biosimilars enter the market in coming years, prices may eventually soften. Until then, plan sponsors must weigh the cost of coverage against the long-term health and productivity costs of untreated obesity.
CVS Health’s recognition of this challenge — and its stated commitment to driving competition and innovation in the GLP-1 space — is a step in the right direction. However, translating strategy into affordable access for plan members will require sustained effort from PBMs, insurers, employers, and policymakers alike.
