A 12.7 million-patient analysis gives HR teams data for weight loss drug coverage reviews
Among patients using glucagon-like peptide-1 (GLP-1) drugs for Type 2 diabetes, the group whose blood sugar and weight did not improve stayed on therapy at a rate of 83 percent, against 94 percent for the group that responded well, according to an analysis of 12.7 million patients released October 13, 2026, by the Health Transformation Alliance (HTA). The findings arrive as employers weigh GLP-1 coverage for the 2027 plan year, and they give human resources teams new population data to bring to pharmacy benefit manager and clinical discussions.
HTA, an employer-owned purchasing coalition that says it includes more than 85 US companies covering over five million lives, was explicit about the limits. The group stated in its published analysis of who benefits from GLP-1 therapy that the work is not intended to predict individual outcomes or establish coverage criteria.
What the diabetes results show about GLP-1 persistence
The study identified two response profiles among patients using GLP-1s for Type 2 diabetes. The more effective group started treatment with a hemoglobin A1c (HbA1c) above 8 percent, a lower illness burden and no emergency room or inpatient visits in the prior six months. HbA1c measures average blood sugar over roughly three months. Illness burden was measured by the Charlson Comorbidity Index (CCI), which averaged 1.9 in this group. HbA1c fell 2.6 percentage points, average weight loss was 8.4 percent, and 94 percent stayed on therapy for at least nine months.
The less effective group averaged a CCI of 2.1 and had at least one emergency room visit or hospital admission before starting. HbA1c in this group rose 0.1 percentage point, patients gained 2.7 percent of their body weight on average, and 83 percent still stayed on therapy for nine months or longer. For a self-insured employer paying per prescription, that is the pattern with the clearest cost implications.
How the obesity results compare
Among patients with obesity but no Type 2 diabetes, the more effective group lost 9.4 percent of body weight on average, and 84.5 percent lost at least 5 percent. Eighty percent stayed on therapy at nine months. These patients were more likely to be 44 or older, to weigh 175 to 299 pounds, to have no sleep disorder and to have filled fewer than three prescriptions for obesity-related conditions, such as hypertension, in the baseline period.
The less effective group still lost 5.3 percent on average, with 64.4 percent reaching the 5 percent mark and 76 percent staying on therapy for nine months. These patients tended to weigh less than 175 pounds or 300 pounds and above, and to be younger, for example under 40.
What can HR leaders do with the findings?
The study was observational, and HTA noted that it did not evaluate workforce outcomes such as productivity, absenteeism, disability or retention. Most results reflect about one year of follow-up, so long-term return on investment remains uncertain. Merative, the analytics firm whose claims data the study drew on, internally validated the predictive models.
“If we can better understand who is likely to see a meaningful health benefit, employers can focus on getting the right treatment to the right people rather than treating every prescription the same,” said Rob Andrews, chief executive of HTA.
Turning that into plan rules calls for caution. The traits linked to weaker response include higher illness burden and recent hospital use, and eligibility rules built on those factors can raise questions under the federal nondiscrimination requirements for group health plans. Employers considering changes to prior authorization or continued-use reviews should have legal counsel and their pharmacy benefit manager examine any criteria before adoption.
Why is the coverage question urgent now?
Business Group on Health reported that the share of employers covering GLP-1s for weight management fell from 72 percent in 2025 to 60 percent in 2026, and 14 percent have dropped or plan to drop that coverage by 2027. Some employers have looked at fixed monthly reimbursement carve-outs for GLP-1 drugs to cap spending without ending access, and Alight’s new health reimbursement account for weight management drugs adds another product to that category.
Marsh projected that employer health costs will rise 8.2 percent in 2027, the steepest increase since 2003. The International Foundation of Employee Benefit Plans reported that GLP-1 drugs accounted for 11.4 percent of total annual claims in 2025 among employers that cover them for weight loss.
