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Glucagon-like peptide-1 receptor agonists – better known as GLP-1s – have quickly become a prominent part of the healthcare landscape, with millions embracing this new class of drugs for the treatment of obesity and diabetes. An estimated 12% of adults in the U.S. are actively taking a GLP-1 medication,1-2 with prescription volumes quadrupling between 2021-2026.3
While data within the workers’ comp industry is still emerging, early indicators point to limited utilization with disproportionate financial impact.
The Workers Compensation Research Institute (WCRI) reports that GLP-1s are appearing in a small number of claims and their high monthly cost contributes disproportionately to drug spend, with estimates that requests for GLP-1s will increase further as oral formulations are approved.4 A Healthesystems analysis similarly shows that from 2022-2025, both spending and the number of prescriptions for GLP-1 drugs in workers’ comp increased five-fold, indicating that while GLP-1s make up only a small portion of prescriptions in workers’ comp, they are experiencing rapid growth.5
Considering how prevalent GLP-1s have become – and how their prevalence could continue to grow in an evolving environment – how should the workers’ comp industry approach these medications?
While GLP-1 utilization is already high in the general population, utilization could continue climbing for various reasons, including additional indications and increased access. If so, the trickle down into workers’ comp could increase as well.
Clinical researchers have continued to study GLP-1 drugs for additional uses, which could result in broader utilization over time.
In addition to ongoing clinical research, several GLP-1 medications are FDA-approved to help reduce major adverse cardiovascular events (MACE),6-9 and some cardiology guidelines and professional societies are recommending the use of GLP-1s10
While no GLP-1s are approved to treat cancer, some studies found that cancer progression was lower in GLP-1 users when comparing their medical records against various other populations, or that cancer risk was reduced among GLP-1 users.11-14 Additionally, many types of cancers become more common in the presence of obesity, which GLP-1s can mitigate15
Early research indicates that GLP-1s may potentially reduce substance cravings and dopamine signaling associated with SUDs,16-17 and one analysis of approximately 600,000 veterans with type 2 diabetes found that GLP-1s were associated with a 14% reduced risk of developing SUDs18
Phase II clinical trials found that lixisenatide therapy resulted in less progression of motor disability than placebo at the 12-month mark19
One study reviewed health data from 400,000 patients who took antidiabetic medication from 2007-2025 and found that individuals taking GLP-1 medications were less likely to develop Alzheimer’s compared to patients taking DPP-4 inhibitors.20 However, Phase III clinical trials found that semaglutide did not significantly reduce Alzheimer’s progression21
An early cohort study of 31 patients evaluated the effectiveness of liraglutide as an add-on treatment for unresponsive migraines in patients with obesity, resulting in an average 9.1 decrease in days per-month with headache22
Several factors that previously limited consumer access to GLP-1s are evolving:
The FDA declared various GLP-1 shortages resolved.23-24 Previously, so many of these drugs were in such major shortage that the FDA relaxed restrictions on the creation of compound medications for GLP-1s – restrictions intended to ensure safe and effective therapy. However, now that the shortages have ended the FDA has reaffirmed those compounding restrictions25
While GLP-1s have historically been limited to injectable formulations, the FDA approval of new oral options6,26 is likely to increase utilization by reducing barriers to administration
CMS reached an agreement with drug manufacturers to cap the prices of certain GLP-1s to approximately $274 per month by 2027 for Medicare beneficiaries27
Meanwhile the White House launched a direct-to-consumer website that either gives discounts for cash purchases of certain GLP-1 medications, or directs patients to manufacturer coupons that offer similar discounts28
Questions remain regarding if and when workers’ comp programs should cover GLP-1 drugs, in large part because obesity itself is often not considered a compensable condition. This creates variability in how stakeholders approach these therapies and suggests that, even where coverage is not required, programs should begin establishing clearer parameters for evaluation and management.
In doing so, there are both benefits and concerns to consider.
Though GLP-1s should be evaluated on a case-by-case basis, examples of potential beneficial use include:
Helping injured workers reach an effective weight to qualify for surgery or other treatment milestones
To assist injured workers who have gained significant weight due to mobility limitations that resulted from injury
If obesity has severely exacerbated the impacts of an injury to the spine and/or musculoskeletal system, where weight loss could reduce stress to the injury
In first responder populations where heart conditions are considered compensable and a GLP-1 is considered beneficial, especially in the presence of comorbid obesity and/or diabetes
Catastrophic claims, particularly in the presence of comorbidities like obesity, diabetes, and heart conditions
If the effects of comorbid obesity – such as high blood pressure and other factors – severely limit drug therapy
Though GLP-1s should be evaluated on a case-by-case basis, examples of potential beneficial use include:
The WCRI reports average monthly payment per GLP-1 injection was $1,224,4 consistent with a Healthesystems analysis of $1,219.5 Given this cost profile, programs considering coverage for the treatment of obesity may benefit from defining timeframes and treatment goals tied to use. Without defined endpoints, GLP-1 therapy may extend beyond the period of injury-related need. As for the treatment of diabetes or cardiovascular conditions, treatment would likely be considered chronic or lifetime therapy.
GLP-1 medications commonly include gastrointestinal side effects, such as nausea, constipation, and diarrhea, but they also come with the potential for adverse events such as dizziness, hypoglycemia, acute pancreatitis, and acute gallbladder disease.6-9 Ongoing monitoring remains essential, particularly as long-term safety and outcomes continue to be evaluated.
Different GLP-1 medications come with different administration considerations. For instance, oral Wegovy must be taken once daily in the morning on an empty stomach with only water and no other liquids; patients must wait 30 minutes before eating or taking other oral medications.6 Meanwhile, oral Foundayo 26 can be taken at any time, with or without food.
And while oral tablets are now available, GLP-1 drugs are primarily available in injectable formulations, and effective use requires proper administration. Poison control centers noted a 1,500% increase in calls related to semaglutide injectable products in 2023, as some patients injected more medication than necessary.29
Rapid weight loss – whether involving GLP-1s or not – can result in a loss of lean body mass – including muscle, water, bone tissue, and other tissues.30-32 Research estimates that 25-40% of weight loss from GLP-1 therapy could be lean body mass.30 While a loss of fat could reduce strain on the body, degradation of lean body mass could increase the chances of reinjury, especially in older adults, those with degenerative conditions, and those with low baseline muscle mass.30 This dynamic reinforces that functional capacity – not weight alone – is likely to influence recovery and return-to-work outcomes.
Considering that GLP-1s reduce hunger to lower caloric intake, these risks are compounded if patients are not getting enough nutrients. These risks underscore the importance of pairing GLP-1 use with appropriate nutrition and strength-based interventions.
Even in scenarios where workers’ comp programs do not cover GLP-1 medications, the high and increasing utilization of these drugs in the general public creates cascading implications for workers’ comp.
Injured workers with comorbid obesity, diabetes, or certain heart conditions could be taking GLP-1 medications outside the scope of their injury. Visibility into the full medication profile for all members of the patient’s care team – from the prescriber to the workers’ comp programs – is essential for safe prescribing and effective pharmacy management that avoids known risks such as drug-drug or drug-disease interactions.
Because rapid weight loss can lead to a loss of lean body mass, the odds of sarcopenia – a degenerative disease tied to age – also increase, which means a higher risk of falls and frailty for older individuals, as well as those with a low baseline muscle mass.26 This may have implications for both safety programs and return to work readiness, especially considering that workers are staying in the workforce longer or going back to work at an advanced age.
GLP-1s are still an emerging consideration in workers’ comp, but their trajectory is becoming clearer. While utilization today is limited, their cost profile, expanding indications, and broader adoption suggest they will play a more visible role in the future. For payers, the focus is not on broad inclusion or exclusion, but on establishing clear, consistent frameworks for evaluating use – grounded in clinical relevance, functional outcomes, and duration of therapy.
As GLP-1s become more visible in workers’ comp, their management may require a more integrated approach – one that evaluates medication use alongside the broader services and supports needed to advance recovery and functional outcomes.
