By JOHN SAMARAS
Most employers still won’t cover GLP-1s for weight loss, and some of them now tell the employee where to buy them without the plan. The International Foundation of Employee Benefit Plans’ 2026 survey, published in July, found that 60 percent of employers cover the drugs for diabetes only and 36 percent for both diabetes and weight loss. Among the employers that exclude weight loss, 27 percent steer employees to a direct-to-consumer platform and 21 percent to their FSA, HSA or integrated HRA.
The same survey shows why. For its respondents, GLP-1s went from 6.9 percent of annual claims in 2023 to 11.4 percent in 2026. In a Business Group on Health survey reported by Reuters in June, 10 percent of large employers that cover them plan to drop them in 2027. Cigna stopped covering them for its own employees in July.
What the employee walks into
I record the published cash price of every US GLP-1 telehealth program every Monday, and this is the market those employees are sent to. At the maintenance dose, Novo Nordisk sells its Wegovy pen direct for $349 a month and its Wegovy pill for $299. The pill’s $149 price covers only the starter doses. The cheapest month on my chart, checked September 28, 2026, is $149 with auto-refill for compounded semaglutide, a pharmacy-made version that is not FDA-approved and is not Wegovy or Ozempic.
The tax treatment is one sentence in IRS Publication 502: you can include “amounts you pay to lose weight if it is a treatment for a specific disease diagnosed by a physician (such as obesity, hypertension, or heart disease).” Prescribed drugs qualify. The 2026 limit on a health FSA is $3,400.
Run through an FSA, a $149 month costs an employee in the 22 percent bracket about $105, because the dollars skip federal income tax and the 7.65 percent payroll tax. The employer skips its own 7.65 percent on the same dollars. The federal government gives up that revenue on a drug the plan declined to cover.
The tax break has no formulary
A covered drug passes through a formulary, a prior authorization and a pharmacy network. The cash benefit passes through none of them. Publication 502 turns on whether a drug was prescribed, and a compounded product qualifies on the same terms as a branded pen.
Screening the seller becomes the employee’s job. On September 29 the Justice Department announced the extradition of one of two men charged with selling counterfeit Ozempic to US distributors “at deeply discounted prices,” with fake boxes, inserts, labels and needles. The FDA’s own advice for buying medicine online lists “deep discounts or prices that seem too good to be true” as a warning sign.
The record goes too
On the plan, a fill leaves a claim with the drug, the dose and the date. On the cash route that record sits in a telehealth app or in the FSA administrator’s receipts, and it doesn’t reach the medical claims.
Stopping is the event a plan would most want to see. In the STEP 1 trial extension, people had regained about two-thirds of the weight they lost within a year of stopping semaglutide. Some of the prices employees budget against also carry an end date. Walgreens’ weight-management page, read September 26, lists four drugmaker offers, three of them with an end date: Foundayo pills from $149 a month, the first two months of Wegovy injections from $199, and Zepbound KwikPens from $299. All three say “Through December 31, 2026,” and the Foundayo and Zepbound offers list higher prices for the doses that follow.
Open enrollment asks employees to size their 2027 FSA in November, against prices that expire on December 31.
Three things a plan sponsor can do
Keep the record. A plan that sends employees to cash can still count the cash fill toward the deductible in exchange for the receipt, which names the drug, the dose, the date and the pharmacy.
Print the maintenance price in the benefits guide, not the starter price, so the FSA election covers the dose people stay on.
Give employees the FDA’s four signs of a legitimate online pharmacy: it requires a prescription, lists a US street address and phone number, has a licensed pharmacist to answer questions, and holds a state board of pharmacy license.
John Samaras is the founder of GLP Chart, which verifies the cash price of every US GLP-1 telehealth program every Monday.
The price data above is free to reuse under CC BY 4.0, with a link and no registration. The October release of my GLP-1 Cash Price Index, covering September, publishes today at https://glpchart.com/price-index/ with the CSV and the JSON beside it. If you want a different cut, by state, by drug or by program, ask and you will have it inside a day.
