What employers get wrong about GLP-1 spend

And what the evidence says works

Employer health benefit costs are projected to rise 8.2% per employee in 2027, the steepest increase since 2003. GLP-1s are a meaningful driver.¹

Most employers are responding by tightening access. Stricter qualification rules decide who gets the drug, but they do not decide what happens next, when many members stop early and the weight often returns. The spend is committed either way. The value is not.

This report from Sword Health brings together the clinical literature, current employer strategy, and early results from a live pilot that tested ongoing clinical and lifestyle support around GLP-1 prescriptions. Benefit leaders weighing 2027 coverage decisions will find a clearer way to judge a GLP-1 benefit: on persistence and outcomes, not access alone.

8.2%
Projected rise in employer health benefit cost per employee in 2027¹
64.8%
Of adults without type 2 diabetes who started a GLP-1 had stopped within 12 months²
22.4%
Higher GLP-1 reorder rate at month three³

Key learnings

Why tightening coverage rules decides who gets the drug, but not what happens afterward
Why members stop early, and how early discontinuation connects to weight regain and muscle loss.⁴ ⁵
What the clinical literature says about pairing GLP-1s with ongoing support
Early results from a live pilot on persistence and engagement, with sample sizes and limitations stated in full
Why buyers increasingly expect 50 to 100% of vendor fees at risk, and how to ask for reorder rates against a control group⁶

Get the clinical evidence and research.

Contributors to White Paper

Sword Health Innovation Team

Exploring the breakthroughs behind AI Care

Footnotes

1
Marsh. 2026 National Survey of Employer-Sponsored Health Plans, preliminary results (2027 projections). 2026. The 8.2% figure is projected after the cost controls employers already plan to use.
2
Rodriguez PJ, Zhang V, Gratzl S, et al. Discontinuation and reinitiation of dual-labeled GLP-1 receptor agonists among US adults with overweight or obesity. JAMA Network Open. 2025;8(1):e2457349. Analysis of more than 125,000 adults newly prescribed a GLP-1.
3
Sword GLP-1 wraparound pilot data, UK pharmacy partner, members enrolled since March 2026, run June 2026 at pilot week 18, as cited in Sword’s What Employers Get Wrong About GLP-1 Spend, and What the Evidence Says Works. Reorder rate measured against a matched control group (enrolled cohort n=144). Reorder rate is a leading indicator of persistence, not a measure of cost, and results are early and directional.
4
Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553-1564. See also West S, Scragg J, Aveyard P, et al. Weight regain after cessation of medication for weight management. BMJ. 2026;392:e085304.
5
Karakasis P, Patoulias D, Fragakis N, Mantzoros CS. Effect of glucagon-like peptide-1 receptor agonists and co-agonists on body composition: systematic review and network meta-analysis. Metabolism. 2025;164:156113.
6
Remarks by Abinue Fortingo, Population Health and Well-Being Consultant, Brown & Brown, on a Sword and Brown & Brown webinar on evaluating metabolic health solutions, September 2026.