My resting glucose dropped 11 points in the six months after I added a structured metabolic protocol built around time-restricted eating, zone 2 cardio, and strategic supplementation. It took daily tracking, continuous glucose monitoring, and roughly 200 hours of experimentation. A GLP-1 drug could have done most of that in weeks. I know this because I have watched the biomarkers of three friends on semaglutide, and their HRV, fasting glucose, and inflammatory markers improved faster than mine did. I am genuinely impressed. And I am furious that insurance systems are pulling coverage for these drugs at the exact moment the long-term data is turning in their favor.
Everyone is focused on the premium shock. I get it. The numbers are real and they are ugly. But the framing is wrong. Employers and insurers are treating GLP-1 costs like a liability when the emerging evidence says they are an investment with a measurable, compounding return.
The Short-Term Math Everyone Is Doing
The premium hit is real. I am not going to pretend otherwise. GLP-1 costs now comprise around 20% of total prescription drug spend, and total GLP-1 spend increased roughly 50% in 2025 alone. Aon projects underlying employer healthcare costs will rise 9.5% in 2026, with pharmacy costs increasing 13 to 15% annually. GLP-1s are driving much of that growth.
So what are employers doing? They are running away. States like Idaho, Louisiana, Massachusetts, California, New Hampshire, Pennsylvania, and South Carolina have all dropped or restricted GLP-1 coverage. Nearly two-thirds of patients discontinue treatment before 12 weeks. Only 1 in 12 members remain on treatment after three years. Employers look at these numbers and see waste. I look at them and see an adherence problem masquerading as a cost problem.
The Long-Term Math Almost Nobody Is Running
Aon's January 2026 study of 192,000 GLP-1 users found something that should reframe this entire conversation. For patients using GLP-1s for diabetes with at least 80% adherence, medical cost growth was nine percentage points lower than non-users at 30 months. For weight-loss users who maintained consistent use, cost growth was seven percentage points lower. Female GLP-1 users experienced a 47% reduction in hospitalizations for major cardiovascular events, roughly 50% lower incidence of ovarian cancer, and 14% lower incidence of breast cancer compared to non-users.
Read that trajectory. We are not talking about a marginal improvement. We are talking about the kind of downstream cost reduction that, over five to ten years, could dwarf the upfront pharmacy spend. Obesity contributes to more than 60 chronic conditions and results in 66% higher annual healthcare costs for affected individuals. The ROI on this protocol is insane, if you have the patience to let it compound.
And that is the real problem. Insurance operates on a 12-month accounting cycle. Health operates on a lifetime. Employers who drop coverage now are optimizing for next year's premium and guaranteeing worse outcomes (and higher costs) five years from now. It is the equivalent of canceling your gym membership because the monthly fee is too high, then paying for a triple bypass at 58.
The Harvard economist who estimated that 30% of premium increases are GLP-1-driven also noted that the biggest adjustment may already be priced in and that the real question is whether these drugs generate savings in other areas. Semaglutide will be under patent in the U.S. until 2032, but patents are already expiring in Canada, India, Brazil, and China this year. Nearly 150 new obesity drugs are in development. Oral GLP-1 pills just hit the market. The pricing pressure is coming. The only question is whether employers bail out now, right before the cost curve bends.
The EBRI simulation makes this explicit: drop GLP-1 prices to $200 a month and the premium impact falls to 1 to 3.9%. We are not far from that reality. The Medicare pricing deal already brings costs to $245. Generic competition globally is accelerating. If you are an employer making coverage decisions today based on 2025 pricing, you are solving last year's problem.
Here is what I would do if I ran benefits for a large employer. I would not drop coverage. I would tighten it. Cover GLP-1s for clinically eligible patients only. Require pairing with a structured lifestyle program (nutrition coaching, exercise protocol, behavioral support). Mandate 80% adherence for continued coverage. This is exactly how I approach any protocol in my own stack: the intervention works, but only if you do the work around it. Maya Okafor would tell you to just walk and eat vegetables first. She is right for most people. But for the 57 million privately insured adults who are clinically eligible for these drugs, walking is not going to cut it alone.
Alex will want a 30-year longitudinal study before calling this settled. I respect that timeline. But Aon is already showing cost savings at 18 to 30 months. The SELECT trial showed a 20% reduction in major cardiovascular events. The signal is strong, consistent, and directionally obvious. Waiting for perfect certainty while pulling coverage is not caution. It is negligence dressed up as fiscal responsibility.
The employers who hold the line on coverage right now, with smart guardrails, will have healthier, cheaper-to-insure workforces in 2030. The ones who cut coverage will be paying for the cardiovascular events, the diabetes complications, the hospitalizations that these drugs prevent. Protocol of the week: stop optimizing for next quarter's P&L and start optimizing for the decade.
