GLP-1s, Pricing, and Access: A Practical Guide for 2026
Published by
Arthur Motskobili
on
GLP-1 medications have become both the most sought-after therapies and the hardest to sustainably finance. Until recently, employers were largely constrained to traditional pharmacy benefit models, subject to list prices, rebate strategies, and step-therapy requirements. But over the past several months, the landscape has shifted dramatically.
These developments echo trends we highlighted in the recent BenefitPitch Policy & Trends Report, which you can check out for free here.
One big catalyst is TrumpRx, the administration’s new effort to lower certain drug prices (including GLP-1s) and make them available directly to consumers. But TrumpRx is only one part of a larger story. Pharma companies are exploring direct-to-consumer pricing. New care models are emerging to help employees use GLP-1s safely and effectively. And vendors are stepping in to help employers manage cost, engagement, and outcomes.
Below is a simple breakdown of what’s happening, who’s involved, and what it means for employer plans.
What TrumpRX actually introduces
According to the official White House fact sheet, the administration has:
- The administration announced a “Most-Favored Nation (MFN)” approach. Translation: prices for certain medications will align with the lowest prices paid in other developed countries.
- Companies like Pfizer, AstraZeneca, Eli Lilly, and Novo Nordisk have agreed to new pricing structures for certain medications including GLP-1s.
- The platform will allow people to buy certain drugs (including obesity-related GLP-1s) directly from manufacturers at lower, MFN-linked cash prices.
For GLP-1s, this means:
- Wegovy and Ozempic drop to around $350/month for cash-pay buyers
- Similar pricing expected for Zepbound
- Medicare may cover Wegovy and Zepbound for eligible patients at $50/month
- Medicaid gains new access to MFN-level pricing
TrumpRx doesn’t replace the traditional benefits pathway, it is intended to introduce a new way for people to get certain medications at lower prices.
The Rise of Employer-Integrated GLP-1 Models
Beyond TrumpRx, another major shift is underway: pharma companies are increasingly using the employer and broker channel as a distribution strategy for consumer-level GLP-1 pricing.
GoodPath highlights a trend many employers are seeing: even when GLP-1s are affordable, employees often struggle with side effects, adherence, and appropriate use.
“Employers want to cover GLP-1s, and most feel it’s the right thing to do, but many have had to scale back because of budget pressure. In response, we’re seeing more groups push members to cash-pay options, from manufacturer programs to the upcoming TrumpRx model. The concern is that GLP-1s aren’t simple medications. We see the same pattern across our members: without guidance, people struggle with side effects, stop too soon, and ultimately lose both health progress and money. Employers also absorb downstream costs when unmanaged side effects lead to ER or urgent care visits. The answer isn’t just access; it has to be comprehensive support that improves adherence, safety, and long-term outcomes.”
— Bill Gianoukos, CEO & Co-founder, GoodPath
Concorde Health is helping employers access consumer-level GLP-1 pricing while keeping clinical oversight intact.
“The shift toward direct-to-consumer GLP-1 pricing creates an unprecedented opportunity for employers, but accessing these savings requires more than just a pricing pathway. Concorde Health bridges this gap by leveraging established employer and broker channels to deliver consumer-level pricing within a clinically governed framework that ensures appropriate utilization, sustained engagement, and measurable health outcomes, turning what could be a chaotic marketplace into a structured benefit that aligns with employer objectives.” — Jeffrey E. Vogel, MD, MPH | Chief Executive Officer, Concorde Health
And:
“As pharmaceutical companies recognize the employer market as a critical distribution channel for consumer-priced GLP-1s, the winners will be those who can marry aggressive pricing with behavioral accountability. Concorde Health's model demonstrates that employers don't have to choose between cost savings and clinical oversight, by embedding Behavioral Biology principles into the delivery mechanism, we're helping employers capture 48-60% savings while actually improving engagement and outcomes compared to traditional pharmacy benefit approaches.”
— Jeffrey E. Vogel, MD, MPH | Chief Executive Officer, Concorde Health
The conclusion is:
The future of GLP-1s isn’t just lower prices—it’s lower prices with structured support.
What’s Changing in How People Get GLP-1s
Historically, filling a GLP-1 prescription involved the standard pharmacy workflow:
Manufacturer → Wholesaler → Pharmacy → PBM → Employer Health Plan → Patient
Now, TrumpRx and manufacturer-oriented D2C programs add a second route:
Manufacturer → D2C Platform (e.g., TrumpRx, manufacturer cash programs) → Employer pay OR Member pay (cash-pay)
This pathway reduces the role of traditional intermediaries and can reshape:
- The employer’s ability to track GLP-1 utilization
- How adherence and side-effect management are coordinated
- The visibility PBMs and care navigation vendors have into member behavior
- The employer’s ability to forecast pharmacy trends
However, this does not mean all data disappears. Some GLP-1 vendors and care programs may share high-level, aggregated information (with member permission) so employers still get a sense of utilization and outcomes.
The bigger takeaway is this: Employees now have more than one way to access GLP-1s, and employers may need to adapt.
What This Means for Employers, Brokers, and PBMs
Employers and Brokers should be aware of vendors and solution providers that offer GLP-1 models.
With pharma companies actively working with vendors and point solutions that serve employers to offer lower cost GLP-1 options, the diligence employers and brokers do in this space becomes even more important. Access to lower priced GLP-1s will become a point of differentiation for some solutions. Employers and brokers should anticipate asking vendors strategic questions around current and planned access to lower cost GLP-1 pricing in vendor RFIs/RFPs and with incumbent vendors.
Employees will compare their plan to public GLP-1 prices.
Public pricing transparency: $350/month cash prices through TrumpRx and $50 Medicare copays, will inevitably lead employees to compare these figures with their employer-sponsored coverage. Expect more questions about pricing differences, authorization rules, and whether obesity-related GLP-1s should be included.
PBM contracts could face pressure.
The emergence of MFN-indexed prices creates a public benchmark for GLP-1 costs. Employers may revisit:
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Rebate guarantees
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Pass-through or cost-plus models
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List-price dependencies
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Specialty carve-out strategies
PBMs may respond by enhancing pricing competitiveness, offering alternate cash-pay arrangements, or doubling down on rebate structures to preserve differentiation.
Plan design questions are coming.
Employers may need to revisit:
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Whether obesity-related GLP-1 use should be covered
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Whether cash-pay purchases should count toward deductibles
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How to communicate differences between “cash-pay” pricing and insurance pricing
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Whether to integrate metabolic programs or adherence support models into the benefit
BenefitPitch Advanced Insights shows GLP-1s remain one of the actively searched benefit categories, reflecting an intense employer focus on recalibrating GLP-1 strategy.
Questions Employers Should Be Asking Right Now
What is our true GLP-1 spend today?
(Including diabetes vs. obesity use, trend growth, and specialty exposure.)
What happens financially if members shift to cash-pay pathways like TrumpRx?
Consider impact on data visibility, rebate structure, and plan forecasting.
Should we update our GLP-1 policy now, or wait for PBM responses to stabilize?
Which emerging models: cash pay, employer-integrated programs, metabolic care solutions, best fit our population?
How can brokers help us evaluate these choices holistically?
Employers should work closely with brokers to compare models, validate assumptions, and ensure downstream impacts are understood.
If you’d like a clear, easy-to-read snapshot of what employers are actually searching for—and how policy trends are shaping the benefits ecosystem, the newest BenefitPitch Policy & Trends Report is a great place to start.