County employees who take popular GLP-1 medications for weight loss, such as Ozempic and Wegovy, will have to dig into their own pockets to continue using them next year after the county commission voted last week to end coverage for the drugs. All 4,000-plus employees will also be paying higher healthcare premiums, deductibles and copays, as the county tries to keep pace with ballooning healthcare costs. The popularity of GLP-1 drugs has exploded over the past several years in an unprecedented manner. “In the modern era of pharmaceutical history, no other prescription drug class has achieved the same combination of hyper-rapid patient adoption, cultural dominance, and multibillion-dollar revenue growth as GLP-1 receptor agonists,” according to Intuitionlabs. Initially developed to treat type 2 diabetes, GLP-1 drugs were later approved for weight loss by the FDA. They typically cost between $1,000 and $1,400 per month and are self-administered weekly via injector pens or subcutaneous injections with a syringe. When GLP-1 medications first gained popularity in 2023, 37 Indian River County employees were taking them for weight loss. That number jumped to 202 the following year, and by 2025 there were 293 county employees had prescriptions. Nationwide, 16 percent of Americans are taking GLP-1s, more than double the percentage just a year ago, and the number of users could reach as many as 50 million by 2080, according to a report from National Public Radio. There currently are 260 county employees taking glucagon-like peptide-1 medications. Eliminating coverage for the drugs will save the county about $3.3 million next fiscal year. Premium increases and changes to plan benefits will save another $2 million, and there are other changes that will bring additional savings, but the county will still have to budget an additional $7 million for its employee health insurance program next year The cost of providing employee healthcare benefits began climbing significantly last year, causing the county’s health insurance costs to go $2 million over budget. This year, costs are projected to be $8.1 million over budget. If coverage had continued as is, healthcare spending would have climbed to $36.9 million next year – $11.4 million over long-term budget projections. Commissioners agreed they can’t continue to kick this can down the road for another year. “As a commissioner, this is one of the hardest things we have to do,” said Joe Earman during the June 16 county commission meeting. “It’s always a tough subject.” It’s complicated to design healthcare plans that meet the needs of the county’s more than 4,000 members, while not breaking the bank, said Suzanne Boyll, the county’s human resources director. “Our plans need to be affordable – both for the members and for the county – and also competitive to attract quality employees,” Boyll said. “But in the end, it needs to be sustainable. And that’s where we were running into problems.” This time last year, commissioners asked staff to sharpen their pencils and figure out what is causing the cost overruns and to find ways to bring health insurance spending back in line. They discovered two key areas where costs had mushroomed – high-cost medical claims, such as cancer treatments and unplanned surgeries, and the skyrocketing popularity of GLP-1 medications. To take some of the sting out of yanking GLP-1 coverage, staff will engage Rightway Healthcare, which manages the county’s prescription benefits for employees, to help GLP-1 users transition to direct-to-consumer programs offered by the drugs’ manufacturers. They include Lilly, which makes ZepBound, and Novo Nordisk, which manufactures Wegovy and Ozempic. Self-pay options generally cost from $150 to $500 per month, as opposed to the $1,000 to $1,400 insurance providers have to pay for a month’s supply. Commissioners also voted to increase employee premiums by 25 percent, which will save the program around $2 million. County staff initially recommended raising premiums by 25 percent for current employees and by 31 percent to 33 percent for the 286 retired employees still enrolled in the county healthcare program. But after discussion by commissioners and comments from the public, the board elected to cap the increase at 25 percent for all program members. Annual deductibles will increase from $1,000 to $1,500 for individuals with Silver plans, and from $600 to $750 for individuals with Gold plans. Deductibles for families will increase from $2,000 to $3,000 for Silver plans, and from $1,200 to $1,500 for Gold plans. Deductibles for emergency room visits will increase from $250 to $500 for everyone with Gold plans. ER deductibles will remain the same – $500 – for those with Silver plans. Premium and plan changes will save the county about $2 million, Boyll said. Commissioners also asked staff to do more to help retirees age 65 and older understand that transitioning off county coverage and on to Medicare will save them money in most cases. Staff will provide information about local agencies and nonprofits that will help retirees navigate the Medicare system. GLP-1 medications work by mimicking one of the body’s natural hormones – glucagon-like peptide-1 – which regulates appetite and blood sugar. The drugs also slow digestion so users feel fuller longer, curbing hunger signals in the brain. In theory, covering weight-loss therapies should lead to better outcomes in other areas of a member’s health, because excess weight is linked to numerous serious health problems, including diabetes, heart disease, stroke and liver disease. This theory is backed up by a number of substantial studies, including a 2018 study of 17,209 adults with employer-sponsored insurance published by the National Library of Medicine. The study found that employees who lost 5 percent of their BMI spent 7 percent less overall on their health, and those who lost 25 percent of their BMI spent 30 percent less on total healthcare costs. But the benefits have not kicked in yet for Indian River County employees. Cancelling coverage for the weight-loss drugs brings the county into the employer health plan mainstream. As of late 2025, only a small number of employer health plans covered GLP-1s for weight loss. Nearly 6 million Americans lost coverage for the drugs last year, as insurers updated their policies, according to KFF Health News, a national nonprofit organization that provides in-depth journalism about health issues. The FDA recently approved two oral GLP-1 medications that are ingested daily and cost between $149 and $299 for a 30-day supply. They are not as effective as the injected versions of the drugs.