GLP-1s — Insured Benefit or Healthy Lifestyle Incentive

Keep covering GLP-1s as an insured benefit, or design an incentive structure that supports a healthy lifestyle leading to metabolic health. Use the sliders to see the financial business case for each.

Illustrative model · set the inputs to your own book

Assumptions

Employees in the program enrolling each year180

Current — insured benefit

Current Benefit — GLP-1 covered gross / mo$1,300

Current Lifestyle Modification Program cost weight-loss program · /mo$25

Future — healthy lifestyle incentive

Future Benefit — Metabolic Health Incentive gross / mo$300

Future Lifestyle Modification Program cost — Year 1 / mo$150

Future Lifestyle Support Program cost — Year 2+ / mo$75

Outcomes & value

% of employees in program who achieve success55%

Persistence — success maintained year over year what the scaffolding buys80%

Value of Improved Productivity per employee / year$3,000

Average cost of care per member / year$10,000

% cost-of-care savings per success30%

Years for care savings to fully mature claims lag behind weight loss3 yrs

Success, persistence, productivity and care savings ship as placeholders, not estimates. Set them with an actuary against your own FMLA and claims history. Drag productivity and care savings to zero: the hard-dollar cost reduction stands on its own.

Program cost — apples to apples, four years

Insured benefit — today

$11.45M

GLP-1 drug + lifestyle program, 4 years

$2.86M / year, flat

Uncontrolled — in-house pharmacy plus community-PCP leakage at full price
No outcome tracking; no way to show anyone got healthier

→

Healthy lifestyle incentive — proposed

$5.76M

incentive + lifestyle program, 4 years

Year 1 $972K → Year 4 $1.84M / yr

Grows with the supported population, not with drug trend
Protocol-based qualification + outcome re-qualification
Scaffolded & tracked — productivity + care captured

Cost only — no savings counted yet. Four-year difference: $5.69M less spent.

The business case

4-year net value

$9.53M

$15.28M of value against $5.76M of program spend

ROI on program spend166%$2.66 per $1

Spend reduction vs. coverage$5.69Mover four years

Year 4 net value$2.50M$1.02M of it hard-dollar

Four-year build — value compounds as successes accumulate

No cost trend assumed. Growth comes from more people succeeding and staying successful — and from care savings maturing as they do. Program expense grows alongside, because every persisting success keeps being supported.

Year	Successes / supported	Current spend avoided	Productivity	Cost of care	Mix	Expense	Net value	Cumulative

Current spend avoided Productivity Cost of care

The trade — four-year totals

Program expense

Healthy lifestyle incentive$4.09M

Lifestyle program (Yr 1 + Yr 2–4)$1.67M

Total 4-year expense$5.76M

Savings & returns

GLP-1 benefit avoided$11.23M

Current program avoided$216K

Productivity gained$2.43M

Cost of care reduced$1.40M

Total 4-year savings$15.28M

Net four-year value: $9.53M

How the two approaches actually work

Dimension	Insured benefit	Lifestyle incentive
Coverage	Plan pays for the drug, including full-price leakage	Coverage replaced by a metabolic-health incentive
Drug access	Uncontrolled — in-house pharmacy and outside PCPs	Employee buys direct with the incentive
Who qualifies	Nominally the program population; leakage is the norm	Clinical-protocol gate + outcome re-qualification
Clinical support	A weight program may exist, but isn't tied to the drug	Scaffolding required to keep the incentive
Persistence	Unsupported — most stop before benefits appear	Scaffolding holds people long enough to matter
Outcomes / ROI	Unmeasured — no proof of health improvement	Tracked; productivity + care value captured, data owned

How it's built — gross, no cost trend. Current cost = employees × (GLP-1 benefit + current program) × 12. Future cost scales with the population actually being supported: each year's new enrollees at the Year-1 rate, plus every persisting success at the Year-2+ rate, since the scaffolding is what keeps the incentive. Expense therefore grows as successes accumulate rather than staying flat — holding it flat while the benefits compound would inflate the return materially. Current spend avoided is the whole current benefit — drug plus the existing lifestyle program — and is held flat by contrast, treating the plan's GLP-1 outflow as a steady-state population rather than one accumulating cohort. Compounding comes from the cohort: each year adds new successes (employees × % success) while prior successes carry forward at the persistence rate. Productivity = value/employee × active successes, realized immediately. Cost of care = savings % × average care cost × active successes, phased in by cohort tenure over the maturity period, since claims fall well after weight does. Net value = 4-year savings − 4-year expense, and is the headline because it is the figure that does not move with how the spend is framed. ROI = net value ÷ 4-year expense: the investment is the whole future package — the incentive plus the program — and the return includes the avoided drug benefit, because the incentive is what replaces coverage. That is why the comparison holds even at 0% success: switching from covering the drug to funding an incentive that buys it directly costs less on its own, and the program is what adds the productivity and care savings on top. Success, persistence and both soft-value defaults are placeholders, not claims — set them with an actuary against your own FMLA and claims data.