What expanded uses of GLP-1s could mean for employer health plans

GLP-1 receptor agonists (GLP-1s) continue to dominate headlines, but the conversation has moved beyond diabetes and obesity toward their burgeoning use across a much wider range of conditions.

Employers who invested significant effort in deciding whether to cover GLP-1s for obesity may find that it was only the first of many such decisions they will need to make in the years ahead. They also understand that, as clinical indications expand, waiting and reacting is not a tenable strategy. 

For plan sponsors, the story of GLP-1 coverage may ultimately be one of trying to keep up. 

From off-label use to front-page news

To understand where GLP-1s are today, consider how they got here. Their runaway success as an off-label treatment for obesity led to broader use in comorbid cardiovascular and metabolic conditions, and that pattern of use preceded a wave of formally approved indications.

Since 2017, the FDA has expanded indications beyond diabetes to include obesity, cardiovascular risk reduction, chronic kidney disease, obstructive sleep apnea, and metabolic dysfunction–associated steatohepatitis (MASH).

GLP-1s’ trajectory from off-label prescribing to clinical trials and FDA approvals has helped catalyze research well beyond the realm of metabolic health.

The next chapter for GLP-1s

Early clinical data suggest that GLP-1s may be uniquely effective in treating substance use disorders because they act directly on the brain’s reward pathways.¹ Fifteen clinical trials are currently underway to test GLP-1s for cocaine, alcohol, tobacco and opioid use disorders.²

GLP-1 receptor agonists’ influence on cue reactivity, craving and impulsivity could have broader implications for psychiatric prescribing. Researchers are actively investigating the efficacy of GLP-1s for other compulsive behaviors, such as gambling and binge eating.

There is also increased focus on using GLP-1s to treat chronic inflammation. Semaglutide, which is sold under brand names including Ozempic and Wegovy, has been associated with roughly a 40 percent reduction in C-reactive protein, and a growing body of evidence suggests that GLP-1s may regulate immune activity rather than simply suppress it.³

Broad public interest has also grown around microdosing GLP-1s for a range of supposed preventative and wellness-related benefits. Evidence for these uses remains limited, but the trend is likely to continue, particularly as access expands and lower-cost options become more widely available.

At present, GLP-1s may appear to be in their “panacea era” as researchers test their potential across an unusually wide range of disease states. The boundaries of what these drugs can and cannot effectively treat will only come into focus over time, but their role in behavioral health and chronic inflammation appears increasingly likely to define the next phase of the GLP-1 story.

Why this gets complicated for employers

GLP-1s have become an entire therapy class that will continue to require ongoing judgment as new indications emerge.

FDA approvals will necessitate coverage decisions, but if GLP-1 adoption over the past few years is any indication of what lies ahead, employers may be pushed to set policy around off-label use if demand surges, as they did with obesity.

Each new potential use for GLP-1s will not arrive on a clean slate. Evidence and guidance will vary, and employers will again have to make coverage decisions under pressure from plan members and without clear precedent to draw on.

How employers can prepare for the next phase of GLP-1s

• Understand the breadth of emerging uses. GLP-1s now extend far beyond diabetes and obesity, and the range of potential applications continues to expand across metabolic, cardiovascular, behavioral, and inflammatory conditions.
• Focus on what matters for your population. Not every emerging use will be relevant for your covered lives, but if your organization has been insulated from GLP-1 demand so far, that could change quickly if a new use gains traction.
• Engage your PBM early. Coverage decisions, utilization controls, and approaches to off-label use will not look the same across plans. Those conversations are easier to have before demand spikes.
• Consider alternative funding approaches. These can reduce the need for use-by-use decisions and provide a pathway for access when GLP-1s are recommended by a plan member’s clinician for off-label use. The cash market continues to evolve rapidly, and employers that saw alternative funding routes as unfeasible even a year ago may find the numbers now add up.
• Do not expect this to slow down. New studies will continue to open up additional areas of application, and forthcoming longitudinal data from existing uses may yield insights that further influence prescribing and utilization patterns.
   
  SOURCES 
  1. Volkow, Nora D., et al. “GLP-1 Receptor Agonists for Substance Use Disorders.” The New England Journal of Medicine, 2025. PMC. 
  2. Sweet, Jacob. “What’s Next for GLP-1s?” Harvard Gazette, 2026. 
  3. Young, Lauren J. “Ozempic’s Greatest Benefit Might Be Its Anti-Inflammatory Power.” Scientific American, 2026.