Sun Life data connects GLP-1 coverage decisions to catastrophic claim risk for HR and people leaders
HR leaders who have been weighing GLP-1 drug coverage purely as a pharmacy spend question may be asking the wrong question entirely. According to Sun Life US data, high-dollar claims that include GLP-1s increased 24 percent in a single year, while hepatic liver disease spend — one of the conditions GLP-1s can help prevent — climbed 43 percent year-over-year, with the average cost per patient reaching $230,000.
"Everyone kind of looks at it as a pharmacy expense issue," said Jennifer Collier, President of Health and Risk Solutions at Sun Life US, headquartered in Wellesley Hills, Massachusetts. "But it really should be a cardiometabolic risk strategy. That's how I believe employers should be looking at it."
Collier, who holds a clinical background as a registered nurse, spoke with HRD America about GLP-1 plan design, the downstream cost implications for self-funded employers, the case for second opinions, and what she believes HR leaders are getting wrong about the obesity drug debate.
The workforce health case employers are missing
The financial argument for GLP-1 coverage becomes considerably stronger when viewed through a comorbidity lens. Sun Life's claims data identifies significant overlap between obesity-related conditions and the drivers of the most expensive claims an employer plan will ever absorb. Of Sun Life's high-cost claims book, 22 percent involve cancer and cardiovascular conditions simultaneously; 11 percent combine cancer and kidney disease; and 23 percent combine cancer and orthopedic conditions.
"The comorbidities and that connection to the metabolic component is really amplifying both the volume of those claims, but also the cost associated with them," Collier said.
Read more: GLP-1 coverage cuts push employers to rethink benefits packages
For HR directors and CFOs managing self-funded plans, the connection extends beyond medical claims. Everything in that comorbidity data, Collier noted, "shows up in our disability data as well" — meaning the same conditions driving catastrophic medical spend are also driving short-term disability leave, productivity loss, and workforce absence.
Several large employers have already pulled GLP-1s from their plans entirely, while others are restructuring cost-sharing arrangements. In either scenario, Collier argues, HR leaders are making plan design decisions without the full actuarial picture — and employees are bearing the consequences.
What good GLP-1 plan design actually looks like
Collier is direct about what separates effective GLP-1 benefit design from open-ended coverage that generates cost without proportionate return. The starting point is evidence-based eligibility: body mass index combined with type 2 diabetes, cardiovascular risk, or kidney disease. From there, two levers determine whether coverage delivers value — structured support programs and thoughtful cost-sharing.
On support, adherence is the central challenge. "There are reasons — side effects, et cetera — where people choose not to continue," Collier said. "And then you are mitigating, you're losing out on the value that you would get further down the road after you've taken on the expense." Coaching, behavior change reinforcement, and care navigation are not optional add-ons — they are the mechanism through which GLP-1 coverage generates long-term return.
Read more: GLP-1 coverage cuts push employers to rethink benefits packages
On cost-sharing, the financial reality facing most American workers makes high out-of-pocket costs a direct driver of non-adherence. "Most Americans don't have $800, $1,000 in disposable cash," Collier said. "They want to have the benefits. It's not for lack of want, but then you get into a decision between my finances and my health choices."
The structural tension here is significant. HR leaders navigating an environment of rising medical trend — Collier described it as having "made a material step up" in recent years — are under pressure to pass more costs to employees. But benefit plans built around long-term behavior change cannot function if cost-sharing levels price employees out of adherence.
Workforce composition matters too. Employers with stable, long-tenured workforces — such as large professional services firms — face a fundamentally different return on investment calculation than those in high-turnover sectors such as restaurants or hospitality. "The decision to include GLP-1s is very different than if you have a population that's very stable," Collier said. HR leaders should be making this calculation explicitly, not defaulting to a binary coverage or no-coverage decision.
The hidden ROI of second opinions
One area where Collier believes HR leaders are consistently leaving value on the table is expert second opinions. Sun Life's data on its own second opinion program is striking: 50 percent of individuals who receive an expert second opinion experience some change to their diagnosis or treatment plan. Ten percent receive a total change of diagnosis; 40 percent see a change to their treatment or diagnostic path.
"I think that is a mind-boggling number," Collier said. "It puts some financial teeth into when I say how important it is to help people through the journey. Support systems are not nice to haves. They are actually critical to getting the best outcome and the best financial picture for your employees."
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For HR directors building the business case for comprehensive health navigation benefits — independent of any single drug class or treatment category — those figures are a compelling and verifiable return on investment argument. An employee who receives a corrected diagnosis avoids unnecessary treatment costs; an employee who receives an optimized treatment plan recovers faster and returns to work sooner.
Reframing the conversation with leadership
The broader challenge Collier identifies for HR leaders is one of narrative. GLP-1s have received significant consumer media attention — much of it framed around weight loss as a lifestyle choice — and that framing has shaped how some C-suite leaders and CFOs perceive coverage requests.
"This is not just 'I'm going to be able to fit into my skinny jeans,'" Collier said. "This is going to prevent cardiovascular disease. It is going to prevent issues with your knees and your hips. You have better quality of life. You can walk your children down the aisle."
HR leaders, she argued, have both the data and the responsibility to reframe that conversation internally — connecting GLP-1 coverage to workforce productivity, disability cost reduction, and long-term plan sustainability, not just pharmacy spend.
The analogy she reaches for is smoking cessation programs from an earlier era of employer benefits. At the time, the return on investment was impossible to demonstrate in a single plan year. The payoff came in claims avoided a decade later. "The true return on investment was measured in claims avoided 10 to 15 years later, not immediately," she said. HR leaders who can make that case to their CFOs — grounded in comorbidity data, disability trends, and second opinion outcomes — are the ones most likely to build benefit plans that hold up over time.
