October 2026 Update
Weight Loss Drugs: A Point of View for Professional Service Firms in the U.S., UK, and Canada

The Professional Services Practice at Aon first examined weight-loss GLP-1s in a 2023 Insight. This update explores how regulatory, pricing and insurance developments are reshaping access and coverage in the U.S., Canada and the UK and what these changes may mean for professional service firms evaluating their employee benefit strategies.

Overview

Obesity, defined by the World Health Organization as any Body Mass Index (BMI) value equal to or greater than 30, is one of the world’s most common chronic medical conditions and a risk factor for several of the world’s most common causes of premature death: heart disease, stroke, diabetes, and certain cancers. Historically, the most prescribed methods to prevent and treat obesity were non-pharmaceutical interventions like diet and exercise.

Drugs indicated for weight loss had been launched before, but they were challenged by limited efficacy and adverse side effects. This poor experience, combined with a commonly held view of obesity as a “lifestyle choice,” led many public and private insurance plans around the world to categorically exclude weight loss drugs.

The approval of Wegovy (semaglutide) by the U.S. FDA (June 2021), UK MHRA (September 2021), Health Canada (November 2021), and the European Medicines Agency (January 2022), followed by the U.S. approval of Eli Lilly’s Zepbound (tirzepatide) for weight loss in November 2023 raised hopes for people living with obesity. After nearly three years of supply constraints, the FDA and Health Canada declared the shortages of key GLP-1 products resolved in early 2025, and brand-name products are now widely stocked.

Even with supply restored, the drugs’ high cost – often exceeding $1,000 per month before rebates – continues to present a conundrum for employers, insurers, and governments, particularly as utilization has surged. A Gallup survey conducted in mid-2026 found that roughly 11% of U.S. adults reported currently taking a GLP-1 for weight loss (up from about 3% in 2024), and the national adult obesity rate had fallen from its 2022 peak of 39.9% to 36.8%.

The landscape has also been reshaped by pricing and policy developments led by the U.S. federal government, certain Canadian provinces, and NHS England.

United States

In November 2025, the U.S. federal government reached agreements with Novo Nordisk and Eli Lilly to lower prices through Medicare, Medicaid, and direct-to-consumer channels. A Medicare “GLP-1 Bridge” pilot took effect July 1, 2026, allowing eligible beneficiaries to access covered weight-loss GLP-1s for a $50 monthly copay through the end of 2027. Both manufacturers have also launched direct-to-employer purchasing models that let self-insured plan sponsors bypass traditional pharmacy benefit managers, though this approach can present care coordination and compliance challenges.

Since many U.S. professional service firms self-insure their employee health benefit plans and therefore have significant influence over their provisions, coverage for weight-loss GLP-1s has become far more common than it was just a few years ago. For example, in our July 2026 survey of large law firms, 57% now provide some coverage for GLP-1 weight loss medications. Coverage is more prevalent among those firms with self-insured medical plans and is also correlated with firm size.

The firms that cover these medications are increasingly focused on managing utilization and cost. Roughly two-thirds of firms providing coverage are actively weighing changes for their 2027 plan years. The most common lever is tighter utilization management. Others are increasing cost sharing, from higher copays to lifetime maximums. A few are exploring carve-outs or alternative channels, such as individual market, direct-to-consumer, or specialist vendor arrangements.

Outright removal remains rare but is now on the table after a large law firm terminated its weight-loss GLP-1 coverage this year. Meanwhile, among firms that have not historically offered coverage, essentially none are firmly planning to add it for 2027. We’ve observed similar trends among accounting and consulting firms.

Even firms that exclude weight-loss GLP-1s from their prescription benefits should account for potential “off-label” use via a diabetes indication, though pharmacy benefit managers are developing methods to curtail that pathway.

Canada

Canadian firms, their insurers, and the provinces continue to grapple with off-label use of diabetes-indicated GLP-1s to treat obesity, though the supply picture has eased considerably and prevalence of coverage is increasing.

Zepbound launched for weight management in mid-2025. In 2026 Health Canada approved a weight loss generic semaglutide called Sevmia, only months after Canada became the first G7 country to approve a generic semaglutide for diabetes. While generic entry is expected to put downward pressure on prices, brand list prices in Canada have not yet fallen.

Despite the regulatory developments, public coverage remains narrow. Provincial drug plans, including Ontario’s ODB, Quebec’s RAMQ, and B.C.’s PharmaCare, still cover GLP-1s almost exclusively for type 2 diabetes and rarely, if ever, for weight loss. As a result, coverage decisions for weight loss largely fall to employers.

According to a IFEBP survey conducted earlier in 2026, a growing minority (37%) of Canadian employer plans now include some GLP-1 weight-loss coverage. Access often runs through insurer-led vendor ecosystems such as Sun Life’s Lumino with Pillway dispensing. Coverage prevalence has grown dramatically since 2024 and another 17% of survey respondents said they are considering adding coverage. As adoption grows, firms that don’t cover these drugs will face increasing pressure from plan members.

Coverage for GLP-1 weight-loss drugs is typically subject to a prior authorization review based on clinical criteria like body mass index, which our 2026 Request For Information showed essentially all major health insurers in Canada being able to support. Like their U.S. counterparts, Canadian plans are increasingly using prior authorization requirements to curtail off-label use.

United Kingdom

Unlike in Canada, prescription drug coverage is a component of the UK’s national single-payer system, and NHS access has expanded significantly. In addition to Wegovy, the NHS now funds Mounjaro for weight management following NICE’s technology appraisal, with a phased rollout that began through specialist weight-management services in early 2025 and reached GP prescribing in June 2025.

Access remains tightly rationed. In primary care, eligibility is currently limited to the highest need patients, typically a BMI of 40 or higher (37.5 for some ethnic backgrounds) plus four or more weight-related conditions, while specialist services can reach a somewhat broader group (BMI of 35 or higher with at least one comorbidity). Treatment must be paired with a reduced-calorie diet, increased physical activity, and wrap-around lifestyle support. Because the NHS aims to treat only about 220,000 patients in the first three years of what could be a 12-year rollout, many eligible patients still wait or pay privately.

The private market has also shifted. Whereas UK insurers historically excluded weight loss drugs outright, Vitality became the first major private medical insurer to offer discounted access to Wegovy and Mounjaro to eligible members in 2025, and Bupa has extended its weight-management plan – including medication where clinically appropriate – to insurance customers, allowing corporate clients to add the benefit to employee schemes from January 2026 renewals. Coverage models still vary widely, so many members prescribed these medications continue to rely on NHS eligibility or out-of-pocket private prescriptions.

Aon’s Perspective

At Aon, we view obesity as a chronic medical condition rather than a lifestyle choice and we therefore greet innovations in the treatment of obesity with enthusiasm.

In January 2026, we released the second phase of a multi-year study of U.S. commercial (non-Medicare/Medicaid) health claims, drawing on data from roughly 50 million lives and more than 192,000 GLP-1 users. The research was designed to help professional service firms and other employers move past the sticker shock of these medications and understand their longer-term return on investment.

The findings are encouraging for plan sponsors willing to take a multi-year view. While costs rise in the first year of therapy, that curve bends as therapy continues. After the first year, medical cost growth for those weight-loss users slowed to about 2%, compared with 6% for non-users, with hospitalizations for major adverse cardiovascular events falling 37% among users over two years.

Two themes stand out for professional service firms.

First, adherence is the linchpin of value: users maintaining at least 80% adherence realized the largest gains. Second, the clinical benefits are especially pronounced for women, who made up most weight-loss users in our study and showed approximately 50% lower incidence of ovarian cancer, 14% lower incidence of breast cancer, and a 47% reduction in cardiovascular-related hospitalizations relative to female non-users. This is an important consideration for the many professional service firms with substantial and growing female populations.

None of this makes coverage a one-size-fits-all decision. The right approach depends on the unique makeup of a firm’s population, its budget, and its talent strategy, and it must weigh a first-year cost increase against benefits that accrue over several years. What our research does provide is an independent, data-driven basis for that conversation, and our practitioners are ready to help firms model the trade-offs and design a compliant, sustainable strategy.

Contact

For more information about benefit plan strategies, emerging human capital trends, and how Aon can help, please contact Mark Scarafone and Jake Delman.


Mark Scarafone
Senior Vice President and Health & Benefits Leader
Radnor, PA







Jake Delman
Senior Consultant
Washington, DC

About Aon

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