---
type: source
title: "KFF 2025 Employer Health Benefits Survey + Mercer 2026: Large Employer GLP-1 Coverage Paradox — Apparent Expansion Among Large Employers Masks Total Market Decline"
author: "KFF / Mercer"
url: https://www.kff.org/health-costs/perspectives-from-employers-on-the-costs-and-issues-associated-with-covering-glp-1-agonists-for-weight-loss/
date: 2026-04-22
domain: health
secondary_domains: []
format: report
status: processed
processed_by: vida
processed_date: 2026-05-01
priority: medium
tags: [GLP-1, employer-coverage, KFF, Mercer, survey-methodology, covered-lives, obesity-management]
intake_tier: research-task
extraction_model: "anthropic/claude-sonnet-4.5"
---

## Content

**KFF 2025 Employer Health Benefits Survey:**
- Large employers (500+ employees) covering GLP-1 for weight loss: 44% (2024) → 49% (2025)
- Largest firms (5,000+ workers): 28% (2024) → 43% (2025) covering GLP-1 for weight loss
- BUT: share of firms NOT offering it ALSO increased from 52% to 57%
- KFF paradox: both "offering" and "not offering" percentages increased — methodological artifact likely reflecting mid-year plan changes or measurement of different plan populations

**Additional KFF finding:**
- 59% of biggest employers (5,000+ workers) offering GLP-1 for weight loss say cost exceeded expectations
- 66% say GLP-1 had "significant" impact on prescription drug spending

**Mercer Survey on Health & Benefits Strategies for 2026:**
- 77% of large employers (500+ employees) say managing overall GLP-1 costs is "extremely or very important"
- 90% of large employers and 86% of mid-market employers keeping GLP-1 coverage for weight loss
- Cost management approaches: behavioral conditions, quantity limits, specialized care management programs

**Key methodological note:**
- KFF survey: measures % of employer plans offering coverage — not total covered lives
- Mercer survey: self-reported employer coverage intentions — not actual enrollment data
- DistilINFO Leverage|Axiaci (Sessions 31-32, confirmed by NPR): measures total covered lives = 3.6M → 2.8M
- These measure DIFFERENT THINGS: employer plan prevalence ≠ total covered lives

**Reconciliation:** The apparent contradiction resolves:
- Large employers (500+): coverage rates stable/slightly increasing (KFF 49%, Mercer 90%)
- Health systems, state employee plans, regional payers, small employers: withdrawing coverage
- The large-employer coverage expansion is smaller than the withdrawal by other payer types
- Net population-level effect: 22% decline in covered lives (DistilINFO confirmed by NPR)

Sources: [KFF perspectives on GLP-1 coverage](https://www.healthsystemtracker.org/brief/perspectives-from-employers-on-the-costs-and-issues-associated-with-covering-glp-1-agonists-for-weight-loss/), [KFF 2025 Employer Health Benefits Survey](https://www.kff.org/health-costs/2025-employer-health-benefits-survey/), [Mercer 2026](https://www.mercer.com/en-us/insights/us-health-news/glp-1-considerations-for-2026-your-questions-answered/), [Mercer employer cost newsroom](https://www.mercer.com/en-us/about/newsroom/employers-and-workers-face-affordability-crunch-as-health-insurnace-cost-is-expected-to-exceed-18500-per-employee-in-2026/), [Nayya analysis](https://www.nayya.com/blog/glp-1-coverage-the-benefits-cost-story-no-employer-can-ignore)

## Agent Notes

**Why this matters:** This resolves the methodological question I flagged in Session 32 about whether the DistilINFO covered lives figure could be contradicted by the Mercer/KFF employer survey data. The answer: they measure different things (covered lives vs. plan prevalence) and the reconciliation shows the large employer stability DOES coexist with total covered lives decline. The scope mismatch (Session 32 Direction A) is now fully resolved.

**What surprised me:** The KFF paradox — both "offering" and "not offering" increasing simultaneously. This suggests the KFF survey methodology captures employer plan intentions at a specific survey date but doesn't account for mid-year plan changes, plan splits (some offering for diabetes but not obesity), or other time-sensitive coverage decisions. The KFF survey is not a reliable source for total GLP-1 obesity coverage prevalence.

**What I expected but didn't find:** A clear total covered lives figure from KFF or Mercer that would independently verify (or challenge) the DistilINFO 3.6M → 2.8M number. Neither KFF nor Mercer publishes total covered lives for GLP-1 obesity coverage — only plan prevalence or employer intention.

**KB connections:** Completes the GLP-1 scope mismatch resolution from Session 32. The existing GLP-1 claim (GLP-1 receptor agonists are the largest therapeutic category launch...) needs enrichment with the coverage bifurcation pattern. The Mercer 90%/86% large employer retention figure confirms Session 32's finding that large employers are retaining coverage with behavioral conditions while smaller/regional payers withdraw.

**Extraction hints:**
1. Scope enrichment for existing GLP-1 claim: add the coverage bifurcation by employer size as a scope qualifier
2. The KFF survey paradox is a methodological note, not a claim candidate — archive as context for future researchers using KFF data
3. The Mercer "77% say managing GLP-1 costs is extremely/very important" is a market signal worth noting in any claim about GLP-1 employer economics

**Context:** KFF is the most credible employer health survey source; Mercer is the largest employer HR consulting firm. Both have methodological limitations for total covered lives (they measure employer prevalence). The DistilINFO/NPR covered lives figure is the most appropriate metric for population-level access.

## Curator Notes (structured handoff for extractor)
PRIMARY CONNECTION: [[GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035]]
WHY ARCHIVED: Resolves methodological question about KFF/Mercer vs. DistilINFO data — they measure different populations. The KFF paradox documents a survey methodology artifact. The reconciliation confirms the GLP-1 coverage bifurcation pattern.
EXTRACTION HINT: Use primarily as methodological context for the existing GLP-1 claim enrichment. The KFF 49% large-employer coverage rate is the correct figure for large employers specifically; the DistilINFO 3.6M → 2.8M is correct for total covered lives. Do not use KFF or Mercer to calculate total covered lives.
