Will direct-to-employer GLP-1s be the start of something new? 

There’s been a lot going on in the US pharmacy market over the past few years, and that’s putting it mildly. One major development has been the growing role of direct-to-consumer drug sales, facilitated on websites set up by several pharma manufacturers. The administration has announced plans to implement its own site, TrumpRx, early in 2026.  

These direct-to-consumer programs, which allow patients to buy certain drugs at pre-negotiated discounted prices, do not integrate with employer plans. Insured patients go “off the plan” when they purchase medications through these sites, meaning that the cost doesn’t apply to their plan deductibles and their use of the medication isn’t added to their medical records. For these and other reasons, many observers feel these direct-to-consumer options primarily benefit patients without coverage. 

New direct-to-employer options

Now there’s a new wrinkle: direct-to-employer sales. Two major manufacturers have announced that they will roll out direct-to-employer programs for their very popular GLP-1 drugs for obesity management starting in 2026. 

While details are vague, under these programs, members get the drug directly from the manufacturer, bypassing the employer’s Pharmacy Benefit Manager and carriers. Pricing is negotiated upfront. No rebate will be applied to lower the member’s out-of-pocket cost, nor will the employer have to wait six months after the medication is dispensed for a rebate.   

The manufacturers will partner with third parties, such as Waltz Health, to handle medical appropriateness review and other logistics typically handled by a PBM. 

The manufacturers have noted that this initiative is intended to increase GLP-1 usage for obesity management. According to Mercer’s National Survey of Employer-Sponsored Health Plans, currently 49% of large employers cover GLP-1s for obesity through their health plans. 

Wave of the future? Other considerations

There are several considerations when evaluating a direct-to-employer option: 

• How does pricing actually compare? Employers will want to assess whether the direct-to-employer prices will be better than their current net prices, after rebates and negotiations with their PBM. 
• Recognizing that greater transparency is a key selling point with employers for the new DTE programs, PBMs have made some moves to address concerns regarding price opacity in their delivery models.  
• Depending on the employer’s PBM contract, pursuing an alternate delivery option may result in the PBM revising contract terms – for example, by lowering rebate payments – negating some savings. 
• The likely impact of making GLP-1 medications available at a lower cost is higher utilization. For employers that currently cover GLP-1s, the overall impact of a direct-to-employer program might still be higher net costs to the plan.  

The direct-to-employer programs are not live yet, and without a complete understanding of how they will work — and how PBMs will respond — it’s difficult to predict how much traction they will get. What seems likely, however, is that the emergence of direct-to-employer offerings is a market response to perceived employer sentiment that the current rebate-driven delivery model may need a major overhaul.