As GLP-1 utilization continues to grow, formulary design has become an important lever employers have to influence cost, access, and member experience. In 2026, PBMs are adjusting coverage in response to new oral GLP-1 formulations and expanding utilization management guardrails around weight-loss spend. At the same time, plan sponsors must navigate increasingly complex tradeoffs across access, utilization controls, rebates, and member experience.
This shifting environment has made it more difficult for employers and benefits consultants to understand what is changing around GLP-1s, why it matters, and how formulary decisions today may impact future spend and flexibility of GLP-1 medications.
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What’s inside the GLP-1 Formulary eBook?
This eBook provides an in-depth look at how PBMs and payers are approaching GLP‑1 coverage today and what employers should be evaluating as these programs evolve. In this report, we cover:
Oral GLP‑1 Formulary Coverage
A breakdown of how PBMs are handling newly approved oral GLP‑1 options (such as Foundayo and Wegovy), including early coverage approaches, tier placement, and considerations employers should be tracking as utilization expands beyond injectables.
Expansion of “Smart Edits” for GLP‑1 Medications
An overview of how automated utilization management tools are becoming more sophisticated, including point‑of‑sale checks, automated prior authorizations, and edits designed to prevent duplication, off‑label use, and inappropriate prescribing.
GLP‑1 Carve‑In and Carve‑Out Programs
A comparison of carve‑in and carve‑out approaches, outlining how each model works, where clinical oversight sits, and the financial and operational implications for employers.
Weight Loss Coverage Decisions
A look at the factors influencing whether employers choose to cover or exclude GLP‑1s for weight loss, including cost impact, rebate considerations, and the role of direct to consumer and manufacturer affiliated programs.
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