Preparing formularies for the next wave of GLP-1s

For self-insured employers and health plans, incorporating GLP-1 drugs into obesity management programs remains a hot topic in 2026. It requires looking beyond healthcare at lifestyle, productivity, and absence data to understand how diseases and the medications used to treat them impact a person’s day-to-day life. Data contributes to innovative strategies that improve access and outcomes while reducing costs. These improvements often command a premium price.

This trend presents a critical challenge for payers. How they manage formularies today will determine tomorrow’s costs. It will be essential to determine when it makes sense to use established, lower-cost products versus when to deploy newer, higher-cost innovations.

Determining the value of GLP-1 drugs

To make informed decisions about future formularies, we need to understand the value of the drugs currently on the market. A 2025 report by the Institute for Clinical and Economic Review (ICER) provides a helpful baseline for the clinical promise and cost-effectiveness of current market leaders, such as injectable semaglutide (Wegovy®, Ozempic®) and tirzepatide (Zepbound®, Mounjaro®).

More than 16 new GLP-1 or GLP-1 adjacent products are set to enter the market over the next five years. While more competition usually drives prices down, the reality here is more nuanced. Some of these incoming therapies promise improved efficacy, lower barriers to use, or reduced side effects. 

According to the ICER report:

1. They outperform lifestyle changes alone: Tirzepatide led with an average weight loss of 17.8–20.8%, followed by injectable semaglutide at 13.1%.
2. They offer secondary health benefits: Injectable semaglutide was shown to reduce major adverse cardiovascular events (MACE) by 20%.
3. They are considered cost-effective: ICER’s model found these drugs cost-effective at a $100,000 per Quality-Adjusted Life Year (QALY) threshold.

However, despite favorable cost-effectiveness ratings, the sheer volume of eligible patients presents an affordability challenge. This makes strategic utilization management critical.

7 strategies for managing GLP-1 drugs

As the pipeline of obesity medications expands through 2026 and beyond, payers can use the following tactics to balance clinical value with financial sustainability.

1. Prioritize high-risk populations
Focus coverage on patients with obesity-related comorbidities such as cardiovascular disease, sleep apnea, or prediabetes. Data shows that the drugs deliver the greatest benefit and cost-effectiveness within these groups.

2. Use evidence ratings for decisions
Align coverage with strong evidence ratings. As new entrants hit the market, consider steering utilization toward treatments with proven efficacy data. You might consider holding coverage or implementing a higher cost share on new products at launch until robust head-to-head data becomes available.

3. Implement step-therapy pathways
Balancing cost management with evidence-based care is key. Consider requiring documented initiation of lifestyle modification efforts first, followed by an injectable GLP-1. As new oral formulations enter the market, their utilization should be carefully considered on a patient-by-patient basis.

4. Explore value-based contracting
Negotiate outcomes-based agreements with manufacturers. By tying reimbursement to sustained weight loss, reduced comorbidities, or adherence metrics, you protect your investment and ensure members receive real clinical value.

5. Plan for the “off-ramp”
A major question mark for the industry is what ongoing care looks like once health goals are met. If a patient reduces their diabetes risk or reaches their target weight, what does the transition to maintenance care look like? Developing programs that support an “off-ramp”, medication adjustment, or lower-dose maintenance phase will be crucial for long-term cost control.

6. Address health outcomes for all
The ICER report highlighted disparities in access and outcomes among Black and Hispanic populations. As you design your benefits, ensure your policies support culturally competent care and equitable coverage.

7. Prepare for price negotiations
Medicare price negotiations and direct-to-consumer programs may shift market dynamics in the coming years. Stay agile and use all available benchmarks, including real-world datasets and transparency reporting, to navigate pricing changes.

Moving forward with confidence

The transformative potential of semaglutide, tirzepatide, and the next generation of obesity management drugs is undeniable. By proactively embedding these tactics into formulary management and benefit design, employers and health plans can mitigate risks related to costs and adherence. This approach enables delivery of high-value care while managing the influx of new medications through 2026 with financial discipline.