HealthIntel Weekly: GLP-1 Coverage Expansion May Push Employer Premiums Sharply Higher

Oct 10, 2025

Welcome to HealthIntel Weekly. Every week, we pull together the latest health care reports, research, and upcoming webinars so you don’t have to dig for them.

What’s New:

If coverage of glucagon-like peptide (GLP-1) drugs expands among employment-based health plans, premiums could rise by 5.3% to 13.8% under current drug prices, depending on adherence, cost-sharing and eligibility assumptions, according to an EBRI analysis. In a scenario using a lower-priced GLP-1 costing $200 per month, premium increases ranged from 1% to 3.9%. Introducing a $90 copay helped reduce premium growth but did not offset overall cost growth, while broad eligibility or perfect adherence significantly amplified spending. The analysis noted that without strategies such as targeted eligibility, prior authorization, or new payment models, rising GLP-1 utilization could drive sustained increases on premiums for bother employers and employees.
Many Medicare Advantage and Medicaid managed care plans had limited behavioral health networks with less than 25% of the area’s workforce, according to a report from the HHS Office of Inspector General. The analysis, which examined 40 MA plans and 20 Medicaid managed care plans across 10 counties in 2024, found that nearly three-quarters of listed providers were inactive and should not have been included as network providers. Specifically, 46% did not work at any of the locations listed by the plan, 21% did not accept managed care patients, and 5% served only in administrative roles. Inactive providers cited administrative burden and low payment rates as the primary reasons for not participating.
Average premiums for Medicare Part D stand-alone prescription drug plans will decrease in 2026, even as the total number of available PDPs declines for the third consecutive year, according to a KFF analysis. Only a few nationally or near-nationally offered PDPs will reach the maximum allowable monthly premium increase of $50 under the premium stabilization demonstration. The nation’s most popular PDP, Centene Corp.’s Wellcare Value Script, will increase premiums in 32 states and Washington, D.C., while Wellcare Classic, the second most popular PDP, will reduce premiums in 47 states and the Washington, D.C.