Medications known as GLP-1s (glucagon-like peptide-1 receptor agonists) have gained attention for helping people manage weight and related health conditions. Many health plans, including BCBS, Priority Health and UHC in Michigan, do not cover GLP-1 drugs when prescribed specifically for weight loss, which can leave employees wondering what, if any, alternatives exist.

The good news is that insurance coverage isn’t the only path. There are legitimate, medically supervised ways to access these medications on a self-pay basis. This overview explains what GLP-1s are commonly prescribed for and outlines options employees may consider if insurance coverage is limited or unavailable.

When Can GLP-1 Medications Be Prescribed?

GLP-1 medications are FDA-approved for certain medical conditions, and providers may also prescribe some of them off-label based on clinical judgment.

Common diagnoses include:

• Type 2 diabetes

• Obesity (generally a BMI of 30 or higher)

• Overweight (BMI of 27 or higher) when combined with a related health condition such as high blood pressure, high cholesterol, sleep apnea, or insulin resistance

Some GLP-1 medications approved for diabetes are often prescribed off-label for weight loss. This is a common and legal practice when a provider believes it is appropriate for a patient’s health needs.

GLP-1 Medications You May Hear About

You may recognize some of these brand names:

• Wegovy® (semaglutide) – approved for weight management

• Saxenda® (liraglutide) – approved for weight management

• Zepbound® (tirzepatide) – approved for weight management

• Ozempic® (semaglutide) – approved for Type 2 diabetes; commonly used off-label for weight loss

• Mounjaro® (tirzepatide) – approved for Type 2 diabetes; commonly used off-label for weight loss

• Trulicity® and Victoza® – primarily prescribed for diabetes, with potential weight-related effects

These medications generally work by helping regulate appetite, slowing digestion, and increasing feelings of fullness. Results and side effects vary from person to person. Many users report reduced appetite and weight loss, while others experience nausea or gastrointestinal discomfort, especially during early dose increases. Most people experience only mild side effects with GLP-1 medications, but in rare cases, more serious side effects can occur.

What to Do If Your Health Plan Doesn’t Cover GLP-1s for Weight Loss

If your plan excludes weight-loss medications, you still have several legitimate self-pay options that involve licensed clinicians and regulated pharmacies.

Telehealth and Virtual Care Programs

Several telehealth companies offer medical evaluations for weight management and GLP-1 prescriptions without involving your insurance.

Examples include (but are not limited to):

• National telehealth providers such as Hims & Hers, CareVolidate/CareGLP, Ro, Sprout, MEDVi, SkinnyRx, MyStart, Noom, etc. or retail-based programs affiliated with major pharmacies.

• TrumpRx is a federal prescription drug pricing initiative designed to help individuals access lower-cost medications by reducing supply-chain markups. It does not provide medical care or prescriptions, but it may help locate more affordable pricing once a valid prescription is obtained. This program is expected to rollout in spring 2026.

Reported pricing projections suggest:

• Injectable GLP-1 medications may be available at significantly reduced monthly cash costs compared to typical retail pricing.

• Oral GLP-1 options, as they become available, may be priced even lower.

• Patents expire starting in 2026 in countries like India, China, Brazil and Canada. Patents in the US remain in place until the late 2020’s at the earliest. When a medication comes off patent, cheaper generics/biosimilars tend to come to market.

A Note About Compounded GLP-1 Medications

Some pharmacies offer compounded versions of GLP-1 medications. These are not FDA-approved and can vary in strength, formulation, and quality. If you are considering compounded medications, it’s important to discuss the risks and benefits with a licensed healthcare provider and use a reputable pharmacy.

Avoid online sellers that do not require a prescription. Counterfeit and unsafe products remain a concern in this space.

Helpful Tips for Employees

• Ask your provider to document your diagnosis clearly; this can help with eligibility across programs.

• Compare self-pay pricing between telehealth services, retail pharmacies, and discount programs.

• HSA and FSA funds may be used for eligible prescription expenses.

• Medication works best when paired with nutrition, physical activity, and lifestyle support.

Bottom Line

While insurance coverage for GLP-1 weight-loss medications remains inconsistent, employees are not without options. Telehealth platforms and cash-pricing programs can help bridge the gap—often with more predictable costs and ongoing clinical support.

We know that as HR professionals, you’re probably receiving a lot of questions about GLP-1s. Please feel free to share this blog with your employees. As always, if you have any questions, please reach out to your Rose Street Advisors’ Relationship Manager.

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As employers continue to field questions about rising ACA Marketplace premiums, there is a new development worth watching closely. On January 8, 2026, a bill was introduced in Congress aimed at addressing the expiration of enhanced ACA subsidies. If the House and Senate agree and pass this legislation, it could significantly change the landscape for individuals enrolled in Marketplace coverage.

While details are still emerging, here’s what employers should know—and why this remains an evolving situation.

A Brief Look Back: ACA Subsidies Before and After 2021

Prior to 2021, ACA premium subsidies were available only to individuals with household incomes between 100% and 400% of the federal poverty level (FPL). Many individuals above that threshold paid the full cost of Marketplace coverage, which often made premiums feel unaffordable.

The American Rescue Plan Act (ARPA), passed in 2021, temporarily expanded these subsidies by:

• Increasing subsidy amounts for those already eligible

• Extended eligibility beyond the 400% FPL cap

• Capping the percentage of income individuals would pay toward Marketplace premiums

When those enhanced subsidies expired, many individuals saw significant premium increases or lost eligibility for assistance altogether.

What the Newly Introduced Bill Could Change

If Congress passes the bill introduced on January 8, 2026, enhanced ACA subsidies could be reinstated or modified in a way that reduces premium costs for individuals enrolled in Marketplace plans.

While the intent of the bill is to improve affordability, the final impact will depend on how the legislation is passed and implemented. Until the law is finalized and guidance is issued, many key questions remain unanswered.

Key Unknowns Employers Should Be Aware Of

Even if the bill passes, there are several areas of uncertainty that employers and employees should keep in mind, including:

• Timing: When would subsidy changes take effect, and would they approve retroactively?

• Eligibility Rules: Will subsidy income thresholds mirror prior ARPA rules, or will new limits be introduced?

• Duration: Are the subsidies temporary again, or intended to be extended longer-term?

• Employee Action Required: Will current Marketplace enrollees need to reapply or update their information to access enhanced subsidies?

• Interaction With Employer Coverage: Will any guidance be issued affecting affordability determinations or employer reporting obligations?

Until regulatory agencies release formal guidance, these questions remain open.

What This Means for Employers Right Now

Until regulatory agencies release formal guidance, these questions remain open.

At this stage, employers are not requires to take any immediate action. However, proactive communication can help manage employee expectations:

• Reinforce that Marketplace premium increases alone are not a qualifying life event for employer plan enrollment

• Acknowledge that legislative changes may be forthcoming, but details are still evolving

• Encourage employees enrolled in individual coverage to stay informed and monitor official Marketplace communications

Employers should avoid making assumptions or promises until legislation is finalized and guidance is issued.

Our Team Is Monitoring Developments Closely

We understand that uncertainty around ACA subsidies can create confusion for both employers and employees. Our team is actively tracking this legislation and related regulatory guidance. As more information becomes available, we will provide timely updates and practical insights to help employers navigate the changes.

If you have questions or would like to discuss how potential ACA subsidy changes could impact your workforce, please reach out to our team. We're here to help you stay informed and prepared.

Justine Dickens

EMPLOYEE BENEFITS ADVISOR

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If you’ve been waiting to hear the status of the Earned Sick Time Act (ESTA) before updating your leave policy, you’re in good company.

We had hoped that there would be some movement on this during the end of the year lame duck legislative session but weren’t that lucky. Fortunately, the new legislature seems to be making this a priority. The House has already passed legislation that would change several key elements. Some of those items are listed below:

• Excludes employers with 50 or fewer employees.

• Excludes employeees who work less than 25 weeks per year.

• Excludes employees who regularly work less than 25 hours a week.

• Allows employers to limit the carrryover of ESTA time to 72 hours.

• Allows employers to provide paid earned sick time at the beginning of a benefit year and avoid the carryover requirement.

There are more details in the House bill, but these are the ones that we found addressed the most problematic aspects of the original bill when discussing the changes with our customers.

Now it’s up to the Senate to act before the current law goes into effect on February 21st.

If you haven’t nudged your state Senator, now is the time.

We’ll keep you posted on additional changes as they come along. In the meantime, here’s a link to a matrix produced by the Chamber of Commerce detailing the components of the two bills:

https://www.michamber.com/wp-content/uploads/2025/01/HB-4002-vs-SB-15-Comparison-Doc_updated-1-17-25.pdf

Kevin Brozovich

SPHR | CHIEF PEOPLE ADVISOR

Meet Kevin Brozovich, energetic entrepreneur, people-focused team-builder and HR practitioner-turned consultant. For almost 10 years, Kevin was Founder and Chief People Officer of HRM Innovations, a Kalamazoo-based Human Resources consulting firm many would consider the top in the region. After pulling his hair out making daily decisions about running the business (does it matter where the coffee comes from?), Kevin joined forces with the Rose Street Advisors team so he could solely focus on what he loves most: working with clients.

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When HR Goes Wrong

I recently facilitated an HR session for Humanergy’s High Impact Leadership Training (HILT) program. During it, a leader described a situation that was occurring at their organization. While I’m usually careful never to say this, there was no way of denying what it was - bad HR. As soon as I said it, people started to chime in with times when they had experienced bad HR. Frankly, I was shocked and embarrassed by the examples they shared.

That led me to ask some of my other networks what their HR experiences have been like. The responses have been humbling. As an HR professional, I think people are hesitant to vent to me about my profession, but when I asked, the flood gates opened.

Some of the more noteworthy examples:

• An employee who suffered hearing loss due to an injury asked HR about accommodations under the ADA. HR suggested that the employee learn sign language even though none of her co-workers knew how to sign.

• A company told their existing employees that they were paying new hires more money than them so they could recruit people.

• An employee told HR they felt misled about the position HR had described when they started. HR said they wouldn’t conduct an exit interview when they left because they didn’t want the feedback.

• An HR professional who made offensive comments about an employee who was perceived to be gay.

• An HR professional who refused to act on a sexual harassment complaint because “that’s just what he does…”

• An HR professional who would openly talk about the personal and medical situations of her employees without any regard for confidentiality.

What do we do to reduce the incidents of bad HR?

• If you are working as an HR person, invest the time to learn the basic employment regulations. SHRM has good information, and many firms provide courses, webinars, or podcasts. Attend them.

• Get certified. Hit the books and take the exam. You’ll be glad you did.

• Consider your employees when making a decision. Ask “How would I feel if I were in their shoes?”

• Keep a balance. Yes, the company signs your paycheck, but if you can’t be objective when looking at an issue, you’re doing everyone a disservice.

• Ask for professional help when you are working on a sticky issue.

There will always be times when HR folks will have to make difficult and unpopular decisions, but if we’re up to date on the regulations, treat people with respect, and are cognizant of the impacts our decisions make, hopefully we can limit adding any more fuel to the “bad HR” fire.

Got a bad HR story you’d like to share? Let us know.

Dealing with a situation that has the potential of ending up as a bad HR story on Reddit? Call us. We can help.

Kevin Brozovich

SPHR | CHIEF PEOPLE ADVISOR

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How Not to Terminate an Employee

Hate having to terminate employees? When you work in HR, or leadership, it comes with the territory. That doesn’t make it easy. Still, it can be necessary. Let’s start with what not to do. Recently a friend found out that his hybrid job was eliminated when he could not login to his computer from home. When he called the IT department, he was redirected to HR. Don’t be that employer. What should you do? Being a good human is a nice start. From there, you should: Include HR. If you are a leader doing this, engage your HR resource early. HR is your friend in this situation. They’ve done this before and know how to do it safely and legally. Do terminations face to face. Remote employees are the only ones you should meet online. Terminations via text, email, or worse, social media, are never acceptable. Do explain the reason. Employees deserve to know why they are being fired. It’s much easier for them to process if they understand why. Leaving them to fill in the gaps opens the door for them to speculate about reasons that are not only inaccurate, but potentially unlawful. Treat them with respect. Losing your job is hard. Kicking the person when they are down is only going to exacerbate the situation and open the door to workplace violence. Be kind, be compassionate. Provide Assistance. Especially if you recognize an employee is in a vulnerable place, make certain to connect them with a support option. Connect them to your EAP or an outplacement service. Have a plan. No one should be fired without a well-coordinated plan to collect their things, continue their benefits, and collect their last check. Keep it calm. Terminations in the heat of the moment are never a good idea. If things are hot, suspend the employee until cooler heads can prevail. Have a difficult situation that you need to address? Give us a call, we’re happy to help.

Kevin Brozovich

SPHR | CHIEF PEOPLE ADVISOR

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