Should People Who Want GLP-1s Have to Work for Them?

Dan Gorenstein (DG): One in eight Americans are taking a GLP-1 right now – for weight loss, for diabetes for sleep apnea. The list of conditions just keeps growing. 

In fact, nearly one third of workers say they would switch jobs just to gain access to one.

Not surprisingly, employers are struggling to afford the drugs that everyone seems to want. 

Newsclip: The growing demand is driving up healthcare costs and now some employers say they can’t afford to cover them.

Newsclip: Because of surging healthcare costs statewide, coverage of these types of drugs are being dropped. 

DG: A growing number of companies are beginning to ration GLP-1s by funneling their employees through programs that ask them to track their diet or meet with clinicians as employers eye the bottom line. 

Rae-Ellen Roy (RR): There’s been so much focus on increasing prescriptions for people who need prescriptions. But, it really is so much more about looking at the outcomes, and looking at the cost.

DG: Today, companies threading the needle on obesity drugs, and what it’s like for employees who must prove they deserve them.

From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein. This is Tradeoffs.

*****

DG: To help tell this story about how employers are trying to cover GLP-1s to treat obesity, we’ve asked Tradeoffs reporter Julie Wernau to check in with an old friend.

Nick Miller (NM): Oh, how you been?

Julie Wernau (JW): I’m pretty good. How you been?

NM: Good.

JW: It’s been more than 20 years since I’ve seen my friend Nick Miller. 

JW: Oh my gosh. Yep. It’s so good to see you. 

I stopped by his house in Waterford, Connecticut on a Friday morning in March just as he was getting his kids ready for school.

NM:  Are they clean? Do you need them clean before school? They’ll clean.

Nick’s children: I’m gonna do 20 pushups. They’re a little dirty. What? 2, 3, 4.

JW: Nick…

Nick’s children: Where did you put my sweatshirt?

NM: It was right over here.

JW: Has his hands full.

NM: No Play-Doh time. Not right now, baby?

Nick’s children: Then we would make ice cream and then we could do an ice cream sale.

JW: He and his husband have FIVE kids. Eight, seven, seven, seven and five. My friend loves being a dad. 

NM: I will drop you off at school tomorrow.

Nick’s children: Yes.

NM: You wanna know why. Tomorrow’s Saturday. (Kid Laugh)

JW: After his kids pile onto their various buses.

NM: We’re gonna behave right. Good days. 

JW: Nick and I walk back to his kitchen and water the dog.

JW: Nick has struggled with his weight for most of his life. I ask him what that’s been like. He picks up a photograph. Nick, his husband and their brood of children posed together at a local park. 

The photo is from two years ago, right before Nick started his GLP-1. I’d seen the photo earlier – Nick’s kids told me all about it.

Nick’s children: This is a picture of all of us. Dad.

JW: Okay, so who’s in this picture?

Nick’s children: Me. This is me when I was five. Me.

JW: Anyone else in the picture?

Nick’s children: This was me when I was four. This whole family. Where was it? Four. Wow. 

JW: Nick’s kids just saw their family having a fun day. Nick sees something else.  

NM: If I could, you know, like place a child collectively in front of my, you know, my stomach here or covering up my chest there, or, you know, exhale before the photo because it might remove like a half inch from your waist.

JW: Nick weighed more than 400 pounds then. His blood pressure ran 190 over 100, at serious risk of a stroke. 

His stomach hurt all the time. He worried he might have colon cancer. Nick was scared. 

NM: I wasn’t sharing a lot of those things with my husband or with my kids or with a doctor. You know, like there was a lot, there was a lot of loneliness in this

JW: Nick was in a bad way. His health. His weight. His appearance. 

NM: This running dialogue that is always going through your head.

Whether you’re awake, whether you’re asleep, whether you’re driving in your car. It makes it hard to, you know, experience life fully with your kids.

JW: He felt so low so little of himself, Nick tells me, that he questioned if he was worthy of getting any help.

NM: Seeking medical treatment almost felt like it was something I didn’t deserve. So like I was really wrestling with, do I even try to get this treated? Because I’ve let my body get to this place. Do I do, I deserve to get better? 

 And at the same time, the guilt of leaving behind a family if I didn’t get better.

JW: Nick is one of more than 12,000 Connecticut state employees, family members or retirees enrolled in a program run by a company the state has hired to treat people with obesity.

GLP-1s for all conditions, not just obesity, cost Connecticut $80 million dollars last year.

State Comptroller Sean Scanlon says his office ran the numbers, giving access to everyone who wanted these drugs was too expensive.  

His staff told him he had two choices. 

Sean Scanlon (SS): Do you want to continue covering these drugs or do you want to do what other plans had done and basically turn the faucet off and stop the coverage. And I asked our team to find a third option.

JW: Sean really wanted to ensure that some people would have some access, but it needed to be the people who stood to benefit the most. 

Sean told me that meant, people who were serious about changing their lives  instead of people who were unlikely to follow through, or just wanted to lose 10 pounds before vacation.

SS:   How can we help people continue to get these drugs but not blow up the economics of our plan and what can I do to incentivize people who want to change their life? That’s when we found FlyteHealth.

JW: FlyteHealth promised Sean that it could save the state money and state workers would get the kind of education and coaching that could actually help them manage their obesity.

The program requires constant engagement from employees. 

For example, Nick’s gotta weigh himself on Flyte’s app a few times a week.

JW: Wow. Wow. This is like you stepped on a scale in April and you were at 412.

NM: Yeah. And today I am 243.

JW: To get access to GLP-1s, employees like Nick must take mandatory lab tests, log food intake and exercise, have their blood pressure monitored remotely, watch videos on the science of obesity. 

It’s a lot. FlyteHealth’s goal is twofold: compel people to take charge of their condition AND scare off everybody but the most committed. 

To me, this felt like Nick and his other co-workers were part of some kind of surveillance state.

But FlyteHealth’s co-founder Dr. Katherine Saunders says the program aims to help people get the most out of these super expensive drugs. 

Katherine Saunders (KS): What we pitched was, you know, real medical care, not just, you know, a program that, tracks engagement or has coaching, but really full cardiometabolic medical care. 

JW: From the jump, Dan, Katherine says Flyte wants patients to know immediately that Flyte’s treatment is different.

A nurse practitioner or a doctor sits down with a patient for sixty minutes. They discuss all the ways the patient could lose weight.

KS:  Most people by the time they see us, have lost and gained a million times. And so, we explain it biologically, we give them hope, we normalize, and then we go through, you know, diet, and exercise.

DG: Hold on Julie. Can I ask you something?

JW: Sure, Dan. Go ahead.

DG: Katherine just said that most of their patients have already lost and gained weight a million times.

I’m guessing Nick had tried diet and exercise before. 

Nick has lost more than 150 pounds. What makes their program any different than what he’s done before?

JW: Yeah, so about 15 years ago Nick lost half his body weight.

He did this super intense diet and exercise program.

NM: I had to burn a certain number of calories in my workout in order to eat food.

JW: And it worked… sort of. He was featured in our hometown newspaper. He was literally the face of the Hartford Half Marathon.

Nick looked different but still heard the same voice – what he calls the bully in his head. 

NM: Like everybody was proud of me and this and that and all, but I was full of eating disorders, you know, like full of eating disorders. Since I was six, I was bullied for being heavy, so the only thing I’ve ever known is that I’m less than.

JW: Nick says working with Flyte was the first thing he’d done in 40 years that silenced that voice that says, he’s ‘less than.’ 

And, he chalks it up to how he’s been treated. 

Like, on his initial telehealth call, Nick said he was skeptical that the clinician could empathize. She was pretty. She was bubbly. She was thin.

NM:  Being, you know, 412 or 13, however many pounds I was talking to this woman. There was this fear of judgment and stuff, but she was so warm and so welcoming and she, you know, was able to break down for me what was happening in my body.

JW: Usually, Nick felt clinicians had talked to him about his obesity as a moral problem, but this nurse practitioner had treated it like a medical one. 

Over the call, they reviewed Nick’s weight, his bloodwork and his medical history.

She prescribed him a GLP-1 on the spot. And her whole approach made an impression.

NM: She gave me permission saying like, and Nick, this might be a lifelong choice for you. You know, like you might continue this for the rest of your life, and that’s okay. And it was like, oh. Like, okay.

JW: He left his appointment feeling like someone would help him with his health instead of just telling him to ‘find more willpower.’

Until then, he’d considered taking this weekly shot as cheating, somehow being weak 

But being cared for helped him realize that was just the bully voice.

NM:  From where I was to where I am now. To think of that as cheating, I think is, is really a disservice to the science and a disservice to me.

JW: Nick’s experience with Flyte is the kind that leaves a smile on the face of Connecticut Comptroller Sean Scanlon. 

This is exactly how he wants the program to work. 

It’s about more than losing weight. It’s about managing the underlying medical condition and the promise of all that. 

SS: When people are committed to this and bought into it and we invest in them, they can make their health outcomes significantly better in just a short period of time. I believe that these drugs can be effective for not just people losing weight, but for treating the conditions that then turn to worse problems that then cost plans like the one I run more money in the long run. 

DG: Ok, Julie. Let’s talk about the state’s twin goals: better health and lower costs. What do we know?

JW: Well, we know the state has a mountain of data. Connecticut is about to publish their second report in two years. 

In terms of outcomes, workers like Nick are losing on average 24-37% of their body weight. 

They’re also seeing major reductions in indicators that can lead to strokes, heart attacks and diabetes.

DG: And what about the money?

JW: So it’s still going up, Dan. But at a slower rate. 

Over the last 24 months, Connecticut has cut its spending increases on these drugs by as much as a third.

DG: And let’s go slow here for a second, Julie. 

Because we just heard Sean Scanlon say that giving workers GLP-1s today can stave off bigger, more expensive problems down the road. 

But that’s not WHY state spending has slowed. It’s not like they are saving money on Nick or someone else avoiding costly hospitalizations or whatever. 

The state is spending less because – through Flyte – they are limiting, honestly, rationing who gets the GLP-1s, right?

JW: That’s right, Dan. Here’s a stat that captures that point, I think. 

In this Connecticut report that’s just about to come out, Flyte has weeded a bunch of people out. 

Of the more than 26,000 eligible for the program during a given time, only about 20 percent enroll … so right there the state is saving a lot of money.

Connecticut also switched people from pricier GLP-1s to cheaper GLP-1s, or no drugs at all.

DG: Yeah, in an effort to control costs, the state is trying to better target who gets the drug. 

And Julie – does the report get into the health outcomes for people who are going without these drugs?

JW: So here’s how the state gets at that question.

Workers who didn’t get GLP-1s had higher medical and mental health costs, emergency room costs and surgical costs compared to people who did get those meds. 

DG: After the break, we’ll explore some of the most common solutions companies are considering to help workers get obesity drugs without breaking the bank … and one more check-in with Julie’s friend Nick.

BREAK

DG: Welcome back. Before the break, Tradeoffs reporter Julie Wernau told us Connecticut has slowed its healthcare spending on GLP-1s. 

They’ve done that by directing employees to enroll in an obesity management program. 

This is just one strategy employers are taking to improve worker health without going bankrupt.  

Julie, you’ve been talking to companies for eight weeks and you’ve come back with some popular approaches employers are using. 

You’ve got 90 pages of notes, right? 

JW: Yeah, people have a LOT to say about this. First thing, Dan, this is a problem for everyone – public employers, private employers, insurance companies. 

And that’s because the prices of these drugs are sky high and everybody – and their mother – wants them. 

DG: Those prices, plus that kind of demand, sounds like a real one, two combo.

JW: It is. That’s why Ann Lewandowski says this is the phrase on employers’ lips. 

Ann Lewandowski (AL): The watch word of 2026 is cost containment. How are we going to contain this cost? 

JW:  Ann’s firm – Healthcare Rebel Alliance – works with employers who run their own insurance plans.

She says many of her clients are locked in contracts where they’re paying basically near-cash prices. 

According to the online site GoodRx, that could be up to 1700 bucks a month per employee. 

AL: The cost was considerable to the point where it was potentially financially unsustainable for some employers. 

JW: Ann says many need an out.

Dan, that’s why there are hundreds of companies circling overhead offering employers so-called solutions. 

AL:  If you can imagine a solution to the GLP-1 sort of cost containment problem, it exists out there today. 

JW: There are companies offering apps, wellness programs, obesity management, rebates, reimbursements, one-off deals with drugmakers, even GLP-1 gift cards.

DG: Like a gift card to J. Crew or Starbucks? 

JW: Exactly! Look, Dan, to figure out the right fit, the right solution, companies need to be honest with themselves and figure out what they’re trying to do.

AL:  I really want them to have those discussions so we understand what the goal is here, folks, right? Are we just here to attract talent and say yay?

JW: There are three things companies are doing Dan that I wanted us to talk about. 

The first one is similar to what the state of Connecticut is doing, what are sometimes called ‘lifestyle programs.’

DG: That sounds corporate-y.

JW: Fair. It basically means what we heard Nick do. 

The employee has to do something – jump through a hoop – if they want to access GLP-1s. 

The upside of this approach for employers – just like in Connecticut –  is that they control who gets the drug, they can track the workers’ progress, and, ideally, employees lose weight and improve their health.

DG: And what about the downside? 

JW: Well, some programs offer legitimate, evidence-based interventions like Flyte, with its team of clinicians.

Others, Ann tells me, basically just throw up a giant to-do list for employees to make it as hard as possible for anyone to get these meds, whether they could benefit or not. 

DG: Julie, how do employers know which type of lifestyle program is the best fit? 

JW: That’s another downside. There is very little information to help companies compare vendors against each other. 

Who is just throwing up walls, who is treating obesity like a medical condition? 

What employers do have are prices and the promises these vendors make.

DG: Promises like what?

JW: A common one is that a certain percentage of employees will lose 5% of their body weight within three months. 

As you might expect, Dan, the higher the price point, the more services people get, the bigger, the bolder the promise. 

DG: One more thing about these programs, Julie. 

Asking people to do something in order to get the GLP-1s is different than how we treat most health care conditions. 

JW: That’s right. Here’s a way to think about this. Like how’s your son Khalil’s teeth flossing, Dan?

DG: Pretty good to be honest. Sometimes too good when I need him to get himself to school on time. Not always easy. 

JW: Imagine if the only way your insurance would cover his dental appointments was if you documented – every morning – him flossing his teeth. 

DG: That is brutal to think about. No way. Never happening. 

JW: And that’s really the last downside I want to flag, Dan. Employers are being sued for imposing discriminatory barriers to GLP-1s. I came across half a dozen major cases. 

DG: Ok, Julie, just a quick review. The upside is employers can better target who gets these drugs and have more control over their spending. 

The downside, it might be hard to figure out which program is the best fit, and you may be opening yourself up to a lawsuit because you’re discriminating against some of your workers. 

JW: Yeah, those complications, are why Ann Lewandowski, says, a good chunk of her clients are going with the second option I want us to talk about. 

AL:  We’re gonna give employees a set amount of money and it doesn’t matter how you spend it, we’re not gonna put restrictions on it. We want you to decide what’s best for you and your family.

JW: What Ann is saying is that workers get a set dollar amount. And then they go figure it out. The upside of this strategy for employers is that it’s simple to administer and puts the onus on the employee. 

DG: No vendors to sort through and keep track of, just cut a check and let the employee do the rest.

JW: Yeah, it’s really interesting, Dan. You’ve got all these firms out there making deals to get these drugs cheaper, direct-to-consumer firms like Ro.

Drug makers are jumping in with subscription models. Even President Donald Trump struck a deal so anyone can get these drugs cheaper through the federal government.

Ann says this new kind of marketplace is emerging. 

AL:   I think it completely shifts the mindset, right? So rather than being stuck in a network that’s hard to shop in, hard to get, we’re starting to see this price transparency and we’re starting to see people really aggressively saying, I want the lowest cost for me so I can stretch this dollar the fastest.

DG: And Julie, what are the drawbacks to these GLP-1 gift cards or whatever?

JW: Well, it’s very hard to track what’s happening for the employees. People take this cash and go get a GLP-1. 

Are they losing weight? Is their health improving? 

And for employees, they’re still on the hook. Employers are often giving people a few hundreds dollars a month for a drug that can cost as much as $1,700. 

DG: Ok. So that’s the second option. What’s the third and final one?

JW: Declining to cover the cost of the drug at all. 

This year, according to GoodRx, a lot of employers stopped covering these drugs. About 16 million people with commercial insurance are now on their own for these GLP-1s.

The pro for employers is obvious. They’re saving a ton of money so they can focus their resources on pregnancy, cancer and wages. 

The con is that people who could really benefit are paying completely out-of-pocket.

DG: Given how expensive these drugs are Julie, what are people doing to afford it? 

JW: I had the exact same question, Dan. So I used an ancient reporting technique. I asked people.

Joseph Dowden (JD): I went to an online doctor.

JW:  I heard all kinds of stories.

Patrick Murphy (PM): Going to an online compounding prescription mill.

Toya Smith (TS):  I have cousins who are sharing their maintenance doses and splitting $500 a month.

JW: People splitting doses, using unregulated overseas pharmacies.

The bottom line, we have no idea what people are putting in their bodies that could pose a serious health risk. 

DG: OK, Julie. Here’s the state of play. Employers are kind of caught in this bind. A lot of them want to cover these drugs, but it’s crazy expensive. . 

So their options are don’t cover it, cover it for everyone and blow their budgets, or these in-between options of reimbursements or lifestyle programs.

JW: That sums it up. One last thing. 

I want to go back to employers having honest conversations with themselves. Based on my reporting, a lot of them think they can attract talent and improve worker health and save money.

Chris Whaley (CW): Every study that’s looked at that has shown that’s absolutely not the case. 

JW: That’s Brown Professor Chris Whaley.

In 2025, Chris worked on this massive report for the Institute of Clinical and Economic Review, or ICER, about all these solutions employers are experimenting with. 

He says most literature shows that – whatever path employers take- none of them are likely to save any money.

CW: There’s among employers, you know, this kind of, magic ideal that we can improve patient health. And that’s just gonna be this magic wand that cuts employer healthcare spending by huge amounts.

JW: Chris says many employers are making an assumption if a worker loses a ton of weight today, they will be healthier tomorrow, and thus avoid a bunch of costly health care bills down the road.

Sean Scanlon in Connecticut told me as much in our interview.

SS:  I will not be the comptroller when we start to save real money on this because somebody that doesn’t have a heart attack in 2035 is not a data point that somebody is gonna be able to point to, but it’s gonna be the reality.

JW: Chris says this is more aspirational than anything. 

The way employers can reliably control spending is by doing what Sean and others are doing right now – limit who gets the drugs.  

DG: Right, these ‘down the road’ savings are unlikely because even if there are one or two fewer heart attacks, whatever savings would come from that would be offset by other spending, right?

JW: Yeah. You’ve got the cost of drug and lifestyle programs. And then, Chris says, people lose weight, become more active and end up with entirely different types of medical bills. 

CW: If somebody, you know, is out being healthy and active and twist their knee playing pickleball, I think that’s actually, you know, net positive.

JW: Chris says companies need to figure out what kind of return they are actually seeking. 

In other words, if you remove the potential long-term savings from the calculation, do employers still think access to GLP-1s is worth it. 

For Chris, it’s an easy answer. 

CW: If we all agree that there is obesity crisis, this is the most effective thing at treating obesity and] I think treating obesity is a goal in of itself.

DG: Chris’s point, Julie, is reminding me about your buddy Nick. It seems like being on these drugs has had a real impact.  

JW: It totally has, Dan.

NM:  I am a happier, more well-rounded, more fulfilled person.

JW: You know, something that I’ve kept thinking about for weeks, is that Nick’s had this voice in his head that’s haunted him his whole life and now it’s gone. 

NM:  I knew that I thought about food way more than I should, if I went to work and it was donut day that I would. Not eat a donut. But at the same time, I’m obsessed about the fact that there’s donuts down in the break room.

And I would do this and I would do that, and I would be worrying about somebody saw me, would they judge me for taking it? But  that first dose of Ozempic on a Tuesday in April, and within three hours that noise was gone and all of a sudden my brain had room. Like there was silence.

JW: Nick’s less isolated. He feels more connected to his husband, less embarrassed to talk about his health concerns. 

Before, he felt like he was like a background character in his kids’ lives. 

NM: I wasn’t the person who would show up for the soccer practices or for the birthday parties. I was a supporting parent. I was not the headliner, you know, I was, it wasn’t even the opening act, I was the stage hand in the back. 

JW: Now, he feels like he is there for his kids. His daughter’s birthday dinner, volunteering at his son’s school. He’s getting to be the person, the partner, the dad he wants to be. 

NM:  I deserve opportunity. I deserve honesty. I deserve to not live in fear or shame and to, um, and to experience life in the way that everybody can.

Kids. Come on. Jasmine was just trying to get out. 

DG: Julie, thank you for your reporting on this story.

JW: Your welcome, Dan.

DG: I’m Dan Gorenstein. This is Tradeoffs.