When Hamas launched its attack against Israel last week, the mobilization that followed was not only a military one, but a corporate response as well. Global businesses moved swiftly to protect their employees in harm’s way, sending workers home, donating medical supplies and food, and setting up relief funds. Many also made public declarations of their position on the war. “We stand with our employees, their families and the people of Israel during this time of great suffering and loss,” said JPMorgan Chase CEO Jamie Dimon. Condemning the war but acknowledging that the underlying conflict is politically fraught, Goldman Sachs CEO David Solomon told employees in a memo: “The dynamics in the Middle East have always been difficult and complex. But these attacks are terrorism and violate our most fundamental of values.”

While the attack was a tragic surprise, the phenomenon of corporations being compelled to take a stand on complicated issues, both at home and abroad, is becoming almost routine. In handling these situations, the stakes can be high. Household brands with solid reputations–like Disney, Bud Light, and Target–can be suddenly cast in a different light among large groups of stakeholders.

Corporations now see these spectacles as major risks to be prepared for, like natural disasters, so many of them are creating a new kind of corporate function that brings together leaders from multiple departments including HR, communications, and diversity, equity and inclusion (DEI). The emerging role is the “social issues working group,” which can go by different names but is essentially a way to pull together an organization’s experts to anticipate emerging issues and help the company formulate the best possible response when situations escalate and headlines break out.

How do they work in action? When the Human Rights Campaign issued an emergency declaration this summer following a wave of anti-trans legislation in the U.S., the accounting firm Baker Tilly was quick to consider its employees’ safety. Their advisors travel all over the world, including to states where anti-LGBTQ+ sentiment was deepening, so the company convened its Societal Issues Management Working Group, a cross-functional team of representatives tasked with responding to social issues.

“Our first task was to send a note to our LGBTQ+ team member network, Pride, to let them know that we were aware of the emergency declaration and how we aimed to respond,” Shane Lloyd, the group’s leader, told From Day One. “Our second task was to update our travel policy to include information to allow our team members to ascertain travel risk as a component of their planning. Our last task was to inform our leaders to ensure they were aware of how to support team members who raised any safety concerns surrounding work-related travel.”

The response was swift: The team had already been monitoring public events, and the infrastructure to care for its employees was well established since forming the group in 2022.

Both consumers and employees have come to expect companies to weigh in on a wide range of public events and socio-political issues – like voting rights, climate change, racial equity, pay equity, support for the LGBTQ+ community, and reproductive healthcare access – a plethora of issues that have become politicized enough to divide people into principled, even enraged factions.

But highly public fiascos have some companies approaching such matters with caution. In every corporate blunder is a cautionary tale about how to engage in this kind of discourse. The goal of these new task forces is to prevent public backlash and respond quickly, thoughtfully, consistently, and firmly. Here are some guidelines for how they operate:

Approach Social and Political Matters with Caution

Motivating corporate involvement in public matters is what Wharton School of Business professor Stephanie Creary calls “‘social authorization,” or outside forces that license a company to take action on an issue. It’s what spurred Nike to back pro football player Colin Kapernick in his protest against racial injustice and Gillette to run an ad campaign espousing the values of the #MeToo movement.

Social authorization has been an especially motivating force since the summer of 2020 – when workers and consumers looked to businesses to change the way they interact with society amid racial justice movement and the spread of Covid – but responding to external pressure is not without complication, risk, and incredible stress on the part of corporate leaders.

Some that have waded into the unpredictable waters of socio-political discourse have faced an angry public, and it has cost them the trust of their employees and their customers. In 2021, Georgia-based companies Delta Air Lines and the Coca-Cola Co. faced pressure from both the left and the right to take a firm position on a state voting rights bill. When the companies publicly opposed, Senator Marco Rubio accused them of being “woke corporate hypocrites.”

Companies that pledged to cover abortion access following the Dobbs decision in 2022 were caught in both the culture wars and legal battles.

In April, when Bud Light sponsored one Instagram post and one Instagram story from Dylan Mulvaney, a transgender social media influencer, the brand’s partnership with a member of the LGBTQ+ community enraged far-right Bud Light drinkers, and the demographic vowed to boycott the beer in videos encouraging violence against queer people. In response, Anheuser-Busch’s CEO Brendan Whitworth released a public statement distancing the company from Mulvaney, betraying the trust of the LGBTQ+ community and its allies. In June, retailers Target and Kohl’s were caught in a similar battle over the display of Pride Month merchandise.

In July came a precedent-shattering case that employers are still processing: the Supreme Court’s decision ending affirmative action in higher education. Thirteen state attorneys general responded by sending a letter to CEOs, warning them against using DEI in hiring decisions.

The corporate landscape is riddled with mines. In attempting to save face with one segment of consumers, companies alienate another and become entangled in a war between cultural, social, and political opinions.

Take a Position and Stand Firmly

Alison Taylor, clinical associate professor at New York University’s Stern School of Business and the author of the forthcoming book: Higher Ground: How Business Can Do the Right Thing in a Turbulent World, believes that some CEOs lean on public statements only to stave off reputational risk. Executives often feel pressured to take on political matters for PR, responding to the loudest agitators on social media. The result is often shallow and poorly coordinated positions.

Taking a position and then reneging, or even gently backing away, is how companies get in trouble, Taylor told From Day One. “It’s not necessarily that you made the call in the first place and experienced the backlash. It’s if you then look like you have no moral compass, and you’ll respond to whoever’s yelling at you – that’s how you make the situation worse.”

Some companies choose to stay out of politicized issues to avoid being accused of “virtue signaling,” or paying lip service to vulnerable groups for the PR boost, which is what happened to many companies that made public statements about systemic racism in 2020.

Increasingly, employees and consumers expect employers to enter public discourse on thorny matters. Public trust for business is greater than its trust for NGOs, government, and media, according to Edelman’s latest trust barometer report. And though trust for businesses is highest, people say they still want more involvement from businesses on issues like climate change and economic inequality.

Yet the public is obsessed with corporate hypocrisy, said Taylor. Once a position is taken, that position must be defended. “You’re going to have to answer questions about political spending and decision making and your internal commitments. It’s very dangerous to say something about the end of Roe v. Wade if you don’t have a robust diversity strategy and you’re not providing reproductive rights.”

Though there is some debate about whether rage against corporate involvement is damaging to businesses long-term, ABC News reported that after months of dipping sales, Bud Light lost shelf space at retailers like Walmart and 7-Eleven, “demonstrating the longevity of an anti-trans consumer movement that erupted in April.” In July, the company laid off roughly 380 workers.

The drama surrounding Target and Bud Light led the Wall Street Journal to write in June that “companies that embraced social issues are having second thoughts.” But many leaders aren’t having second thoughts. The people who lead DEI and ESG initiatives do so often because they care deeply about these issues.

Those who don’t want to stand back are steeling themselves before backlash happens, even before newsworthy events occur, with their newly emerging social issues working groups designed to respond to public events quickly and consistently.

Don’t Wait to React. Anticipate Controversy as It Brews

In 2021, the consulting firm Deloitte set up the Responsible Business Practices Working Group, a cross-functional team of 20 representatives from across the company – including HR, DEI, the general counsel’s office, risk, crisis communications, client services, government relations, and from Deloitte’s foundation.

“We make sure that we take care of our people first,” Deloitte’s chief purpose and DEI officer Kwasi Mitchell told From Day One. “Be that through specific evaluation of our policies or outreach to those communities directly. We also think about the people who have been impacted in society, so we might make a donation to an organization that is helping those directly impacted. And lastly, we are thoughtful with respect to our communications with our employee resource groups that may be impacted.”

Though they are prepared to be reactive, the hallmark of social issues working groups like Deloitte’s is that they are proactive, ever-studying what’s going on in politics, social matters, health, and law. If you’re not working this way, said Mitchell, it’s easy to fall into traps that so many companies do.

“We have not been in any situations where someone can say ‘We didn’t think about that,’” said Lloyd at Baker Tilly. “I like the emphasis on process, because there’s an assumption that companies are responding to all manner of societal issues.” But it’s impossible to respond to every controversy, he said. There’s enough going on in the U.S., and multinational companies will be pulled in all directions.

Lloyd, who is also the company’s head of DEI and societal impact, believes that some issues that have been highly politicized still require a company to take a stand. Earlier this year, the company sponsored a report by the think tank Coqual about gender in the workplace, which specifically addresses the physical and psychological safety of transgender people.

Devise a Repeatable Process for Responding to Every Issue and Event

Deloitte’s process is rigorous as well, a five-question framework adapted from a Harvard Business Review article: What would our internal stakeholders think? What would our external stakeholders think? What is the overall cost to society? Would the company’s core values be challenged if we did not act? And finally, can we actually influence the issue?

The question of influence is one corporate leaders are grappling with. The expectation that businesses will involve themselves in public debate is still new, and many companies are still trying to figure out how, and if, they have the weight to change anything.

“When you think about the history of business and the history of separating business from societal issues, the fact that companies are starting to hire someone called a director of employee activism helps us to understand that this is a tide that is turning,” Wharton’s Creary said in a 2022 interview.

There are matters to which Deloitte has chosen a light touch, like voting rights. The team decided that it might sign a public letter or make a donation, “but we haven’t put the infrastructure in place to impact that issue longer term.” Mitchell learned through multiple surveys that politics is a topic Deloitte employees prefer to leave outside the office, so their involvement in political matters has been lean.

In considering an issue, Mitchell’s team answers each question in the HBR story and awards an overall score, then debates the course of action with the CEO. With a diverse group and systematic analysis, they present better proofs for their decisions. “As we analyze things and put it in front of our CEO and his core leadership team, they can see that we brought the full perspective of the firm,” he explained.

That formula seems to leave most people satisfied with the process, even if some don’t get the result they hoped for. At least everyone feels heard and there is consensus reached on how the decision was made. “What’s been really interesting is that people say, ‘I don’t necessarily agree with where we landed, but I understand where we landed,” Mitchell said.

He estimates the team has worked on 40 or 50 topics over the last two years, including voting rights and reproductive rights. Before the working group was formed, Mitchell said opinions came from all directions, and it was difficult to understand if it was a reflection of the whole community, or just a vocal minority. “You also have a fair number of people who don’t feel that empowered, who might have a distinct [point of view] who would not necessarily elevate that to leadership right away.”

Take a Position You Can Support Inside and Outside the Organization

That these groups are cross-functional indicates maturity in corporate coordination. Corporate America has developed dozens of functions – PR for messaging, HR for culture, government affairs for lobbying – but it’s a mistake to separate these functions, said Taylor. “If you’re going to commit to something like transgender rights, then you’ve got to be prepared to reflect it in your culture, your HR decisions, and your leadership. If you’re being discriminated against, it’s not just political, it’s personal. It’s about culture. It’s about HR. It’s about political spending. It’s about values.”

Look for Outside Help When You Need It

While some companies assemble internal teams, others look outside the organization to bolster response plans. One such organization is Open to All, a nonprofit coalition of businesses that commit to inclusion of all people.

Calla Rongerude, Open to All’s managing director, estimates that one-third to one-half of Open to All members have internal DEI councils, but attrition in DEI teams has driven leaders to their organization. “DEI budgets are shrinking, roles and departments are shrinking, and so are resources both in staffing and budget, but then you have this really heightened, polarized political environment. I’ve been working on nondiscrimination for almost 20 years, and I’ve never seen it this volatile before,” she said.

Open to All is set up to act quickly. When a new law is passed or a Supreme Court decision handed down, the organization assembles its policy contacts to brief members on the implications and dispel bad information stirred up in the chaos.

“We also have our coalition of nonprofit organizations that can come in when there is a big moment – whether it’s Pride backlash, anti-trans legislation, affirmative action, or Dobbs – and talk about how companies can meet the moment,” said Rongerude. “They’re not just guessing in a conference room. They can actually talk to people who are doing this work on a public policy level.”

Members of Open to All come together for purpose, setting aside business matters. “We have Gap and Levi’s and American Eagle. They’re all selling jeans, but when they’re working with us, they’re talking about how they can revamp their loss prevention policies so they’re eliminating bias at the returns counter. They put the competition aside.”

Acknowledge the Limits of Social Issues Working Groups

As effective as these task forces can be, and as reassuring it may feel to have one, there are limits. A social-issues working group can’t eliminate risk, Mitchell is emphatic about that. “Large organizations will always wade into some aspects of risk with respect to the way they operate their businesses or how they respond to a specific issue,” he said. “What this group helps you do is be thoughtful on a wide range of the risks that you might wade into.”

The processes these groups exercise produce confidence and consistency, Mitchell said. It compels the business to ask how its decisions will affect employees, clients, and public stakeholders. “We try to have it framed from all of those lenses, just to make sure that we’re consistent in our actions on a daily basis.”

Emily McCrary-Ruiz-Esparza is a freelance journalist and From Day One contributing editor who writes about work, the job market, and women’s experiences in the workplace. Her work has appeared in The Washington Post, the BBC, Quartz, Fast Company, and Digiday’s Worklife, among others.

(Featured photo by Leo Patrizi/iStock by Getty Images)

ADHD in the Workplace: What You Should Know–and What Can Help

Pete came to our weekly psychotherapy session frustrated with work. He had just returned to his office, post pandemic, and found the new, open plan noisy and overwhelming. Pete, which is not his real name, has attention-deficit/hyperactivity disorder (ADHD) and is easily distractible and sensitive to noise. He had trouble concentrating, was irritated by the constant chatter of colleagues, and, as a result, was feeling less productive.“Could you talk to your manager about getting some accommodations?” I asked.“No way!” he said. “That would be a career killer.”Pete’s wariness is not uncommon. A few of my psychotherapy patients with ADHD have confided in their managers, but most feel it’s unwise to do so. They fear they will be stigmatized and sidelined.Edward Hallowell, M.D., agrees with their concern. The founder of the Hallowell ADHD Centers and one of the leading authorities on the disorder, explained to From Day One: “We’re not there yet. Most corporate professionals think of ADHD as some kind of mental illness.”Given that ADHD is not well-understood in the workplace, how can employees speak up about their needs in a way that feels safe? And how can managers and HR leaders better understand how to respond to those needs–whether employees want to name their ADHD, or not? A well-accommodated employee is, after all, a happier and more productive one. “It’s in everyone’s best interest to remove obstacles to someone’s performance,” said Hallowell. Here’s what experts recommend:Know What It IsADHD is a neuro-developmental disorder characterized by symptoms of restlessness, impulsivity and difficulty sustaining attention to boring tasks. It tends to run in families and is often inherited from a parent. There are three types: inattentive (dreamy and distractible), hyperactive-impulsive (restless and talkative), and a combination of the two. Most adults with ADHD have the inattentive type. Though it was long considered to be a childhood disorder affecting mostly boys, research has shown that it persists into adulthood—about 30% to 70% of children with ADHD continue to have symptoms later in life.Ned Hallowell, M.D., a pre-eminent expert on ADHD (Photo courtesy of the Hallowell ADHD Centers)An undiagnosed adult may think of themselves as spacey, messy, or undisciplined—and they often suffer from low self-esteem. A recent study found that only 10% to 25% of adults with ADHD receive an accurate diagnosis and adequate treatment. “They are often inaccurately diagnosed with anxiety or depression, which are really just the fallout of untreated ADHD,” said Ari Tuckman, a psychologist in West Chester, Penn., who specializes in the treatment of ADHD. As Hallowell puts it: “It’s like driving on square wheels.” In dealing with tasks, you will make progress, but it may take longer.And That the Diagnosis Is On the RiseWhile children are still the most likely group to be identified with the disorder, the number of adult diagnoses has been rising for decades. The pandemic accelerated the trend: the overall incidence in adults (30 to 49 years old) nearly doubled from 2020 to 2022, fueled mainly by an increase in diagnoses among women, according to Epic Research, a medical-record software company. While it’s not clear exactly why women are being diagnosed more often, experts theorize that it may be due to increasing smartphone and technology use, which can amplify distractibility and stress, as well as a greater awareness that ADHD can be also be a women’s issue. As more adults are diagnosed, they—like Pete—often face workplaces that are not ADHD-literate.How It Affects Work Performance–But Not Always in a Bad WayPeople with the disorder may have difficulty with organization, time management and procrastination—all of which can make it hard to meet deadlines and work within teams. They find tedious tasks, such as scheduling and filling out expense reports, unusually challenging and have a different sense of time than others. “People with ADHD have more difficulty seeing time and feeling the future,” notes Tuckman,More than half (56%) of adults with ADHD said they believe the disorder “strongly impacts their ability to succeed at work,” according to a 2008 survey by McNeil Pediatrics. A more recent survey by Akili, a therapeutic-technology company, interviewed 500 adults with ADHD and found that employees with ADHD felt the disorder had a negative impact on their career. And yet, people with ADHD often display qualities that work in their favor, notes Hallowell, who himself has ADHD. He sees the condition as a trait, not a disorder, that has positive benefits like creativity, humor, and spontaneity. “There’s more to it than most people realize,” he said. “ADHD is terrible term. We have an abundance of attention. Our challenge is where to put our focus.” People with ADHD can spend hours on topics that interest them and see details that others might miss, a trait sometimes called hyperfocus. Many successful people have talked openly about their ADHD, including Michael Phelps, Simone Biles, James Carville, astronaut Scott Kelly and JetBlue founder David Neeleman.How to Get DiagnosedIf you persistently miss deadlines, are chronically late, and feel like staying organized is a big effort, first ask a trusted friend or colleague if they find you more scattered than others. Then, make an appointment to see a psychologist or psychiatrist who specializes in treating the condition. There is no one standardized test—instead a professional will take a thorough history and may ask family members and friends to complete questionnaires about your behavior. You may be asked questions like, How often do you misplace items, feel bored and restless, or lose track of what needs to be done? If you meet the criteria, your doctor may talk to you about medication, therapy or coaching and, if needed, provide a diagnosis so you can receive accommodations at school or at work.Understand What HelpsMost people diagnosed with ADHD rely on medication to control their symptoms. Typical medications include stimulants such as Ritalin and Adderall, which increase the levels of the neurotransmitters dopamine and norepinephrine in the brain. There are also non-stimulant drugs such as Strattera. Stimulant medications that treat ADHD are the “most effective of medications in psychiatry,” said Tuckman, and help tame distractibility and impulsivity. About two thirds of people with ADHD diagnoses are prescribed stimulant medications, and that percentage has remained fairly consistent since 2013, according to Epic Research. Some people can help manage their symptoms by exercising regularly, getting proper sleep, and implementing strict organization and reminder systems. Or they hire very competent assistants.Once you are diagnosed and have figured out the best treatment, it’s like “getting fitted for the right eyeglasses,” said Dr. Hallowell. “Things come into sharper focus.”How to Make the Workplace More ADHD-FriendlySmall modifications can go a long way to helping people with ADHD perform better on the job. Tuckman suggests considering adjustments in the three domains described below. As an employee, you can make tweaks on your own or ask your manager for help. As for managers, if you have a worker who is struggling with organization and meeting deadlines, you could take the lead at putting these practices into place.Make distractions softer. Quiet spaces, headphones, and working on off-hours (say, early or late), can help mitigate the clatter of a bustling office. Often working from home is a good solution.Make important information stand out from the chatter. Putting assignments in writing, recording meetings, and highlighting deadlines can help workers whose focus is not great to stay on task.Bring the future closer to the present. Those who struggle with adhering to deadlines will benefit when big projects are broken into smaller chunks, and check-ins are on the calendar with frequent reminders of when tasks are due.So, Should You Tell Your Boss?If you have ADHD, you may be covered under the Americans with Disability Act (ADA). However, you might not want to play that card unless you absolutely must, says Belynda Gauthier, a retired HR director and past president of Children and Adults with ADHD (CHADD). “The first time I did a presentation on ADHD in the workplace, I launched into detail about how the employee should approach his supervisor or manager and suggested that he might want to go directly to HR first. An audience participant interrupted to tell me that her HR office actually is the problem for her. Oops! I took this to heart, did some serious thinking, and revamped my presentation. I no longer recommend revealing one’s diagnosis until and unless it’s necessary.” Indeed, 92% of surveyed adults with ADHD believe that their colleagues hold misconceptions, the most common of which is “people with ADHD just need to try harder.” A better strategy might be to simply approach your manager with a positive attitude and a few solutions. “Be sure to tell them what you are good at,” advised Hallowell.Gauthier suggests something like: “I am really enjoying processing these widgets, and I think I’m doing a good job. I believe I could do an even better job if I could move to that cubicle that’s farther from the copy machine. So many co-workers use it all day and everyone stops to say hello.” Avoid the use of the word “but” to qualify your suggestions and don’t be whiney, she says. Accommodations can help, but sometimes the best solution is finding the right job in the right environment with the right supports. “When I finally figured out I had it, it was a relief,” David Neeleman said in a recent interview with Forbes. “I was just really careful to surround myself with people that could complement my ADHD. I have people around me that help implement a lot of the ideas I have.” When you can turn your intense focus on something that truly fascinates you, ADHD can be a bonus rather a deficit.Lesley Alderman, LCSW, is a psychotherapist and journalist based in Brooklyn, NY. In her therapy practice, she works with individuals and couples. She writes about mental health topics for the Washington Post and has been an editor at Money and Real Simple magazines and a health columnist for the New York Times.(Featured photo by Valentin Russanov/iStock by Getty Images)

Workers Want Weight-Loss Drugs, But How Can Employers Pay the Bills?

When consumers see splashy TV commercials for weight-loss drugs, they often find the the pitch irresistible. But for HR and benefits executives, they may trigger an uneasy feeling. That's because the revolutionary weight-loss drugs like Wegovy bring with them both magic and mystery–the magic is how well they can work; the mystery is how to pay for them.GLP-1, or glucagon-like peptide-1, drugs have historically been used to treat diabetes. But the development of stronger drugs like Novo Nordisk’s Ozempic in recent years, and now the approval of Wegovy and Eli Lilly’s Zepbound specifically for weight management, has led to a sharp increase in demand. That’s particularly true as more research emerges showing the drugs may also reduce the risk of cardiovascular disease, stroke, and potentially bring other long-term health benefits. Yet the medications can cost as much as $1,000 to $1,500 per month–a price that few Americans can afford unless they have generous health-insurance coverage.And unlike expensive drugs for rare conditions, the potential number of patients for GLP-1s is vast. More than 40% of Americans have obesity, according to the Centers for Disease Control and Prevention, and that is expected to reach 50% by 2030.Many doctors are thrilled about the potential for GLP-1s to change how obesity is treated, but that puts employers–where nearly half of Americans get their health insurance–in a tricky position. Here’s what employers need to know as they consider coverage for these drugs in the quickly changing landscape:High Costs, Low CoverageWhile employer health plans widely cover GLP-1s for the purpose of treating diabetes, coverage for weight-loss purposes is much more spotty right now. A survey last fall by the International Foundation of Employee Benefit Plans found that 27% of 205 employers covered GLP-1s for weight loss and another 13% did not yet cover them but were considering adding coverage. Meanwhile, Willis Towers Watson (WTW), a global insurance benefits-consulting company that serves many large employers, found about 38% of employers it surveyed cover the weight-loss drugs. Those that do cover them are seeing significant cost increases. The retail price for Wegovy comes out to $15,000 to $16,000 per year, and after rebates and discounts from manufacturers, health plans still pay about $9,000 per year, says Cody Midlam, a director at WTW’s pharmacy practice. The cost per member per month for GLP-1s has doubled each of the last three years, according to WTW’s analysis, amounting to an extra $11 per member per month last year, or about 9% of all pharmacy costs.Companies are aware of the research showing the drugs’ effectiveness at tackling obesity. Yet while doctors say that helping people lose weight could lead to less cardiovascular disease, fewer mental health issues, and savings from avoiding knee replacements or other surgeries related to obesity, long-term data on clinical outcomes remains limited. With high employee turnover in many industries, it’s tough for these employers to factor in potential future savings in healthcare costs over the life of the employee.“Those outcomes take a very long time to manifest,” says Midlam. “It’s not something that’s easily measurable on a short timescale when plan decisions are being made.” Andrew Witty, CEO of UnitedHealth Group, the largest U.S. insurer, said his corporate clients see the benefits, but first have to deal with the short-term costs. “We’re very positive about the potential for another tool in the toolbox to help folks manage their weight. We recognize that has potential benefits,” Witty said in the third-quarter earnings call last year. “But we’re struggling.”Employers Meet the DemandDespite the high costs and headlines about some insurance plans scrapping GLP-1 coverage, plenty of employers see the upside to covering the new obesity medications. Ninety-nine percent of companies already covering GLP-1s said they planned to continue doing so next year, according to a fall survey from Accolade, a healthcare navigation and advocacy company. Employers reported that after they added GLP-1 coverage, they saw higher employee satisfaction, increased engagement in other well-being programs, and improvements in other or comorbid health conditions. Midlam of WTW says his firm’s corporate clients want to “avoid member disruption” wherever possible.Doctors agree that should be a priority. Dan Azagury, M.D., medical director for the Stanford Lifestyle and Weight Management Center, says GLP-1s have been a “game changer” for many of his patients. “If you stop it overnight, whether it’s insurance, or financial, or shortages, the rebound is ferocious,” he said. “So it’s really very frustrating that they encounter that situation.” Some companies have expressed concerns about the idea of paying for a drug that employees essentially have to take forever to maintain its benefits. But while side effects, including vomiting and gastrointestinal issues, can be unpleasant for some people, doctors like Azagury say they know how to help patients manage them, and that they are seeing more patients have a positive response to GLP-1s than to previous generations of weight loss medications. Holistic Care, Not Just PrescriptionsEven when employers decide they want to help their employees lose weight, there are still lots of details to consider. As companies approach designing their insurance plans for 2025 and beyond, they are trying to figure out how many employees are likely to use GLP-1 drugs if coverage is offered, whether there should be limits on who can get the drugs, and what kind of requirements they should use to prove the drugs are medically necessary. Most companies that cover GLP-1s use some cost-control strategies, according to the International Foundation of Employee Benefit Plans survey. Many use prior authorization, step therapy during which patients must try lower-cost drugs first, or specific eligibility requirements.Typically, eligibility requirements have been tied to the standards on the FDA labels for these medications. But some employers are considering restrictions such as only covering the drugs for people with obesity but not those who are overweight, says Tracy Spencer, a pharmacy practice leader for benefits consultant Aon. If they add those limits, she warns that employers should be aware that could change or jeopardize the rebates they get from the drug manufacturers, so they need to predict whether the savings they get from limiting the drugs’ use will offset the loss of the rebates.Benefits consultants like Aon and WTW are also seeing employers shift the way they look at GLP-1 drugs to view them as one piece in a broader strategy to address cardio-metabolic issues.That might mean employers choose to cover the drugs for targeted indications, such as covering Wegovy not for weight loss on its own, but for people with increased risk of cardiovascular disease, which Medicare recently announced it would do. It can also mean pairing GLP-1 coverage with required lifestyle modifications or participation in a virtual weight-loss or coaching program. Employers often have access to virtual health programs through their pharmacy benefit managers, and many have tried these to target diabetes in recent years. The biopharmaceutical company Moderna, which offers coverage of GLP-1s for diabetes and weight management, is one company that has tried this strategy. “In 2023 we saw a spike related to weight-loss management: We looked at claims data, and after mental health, obesity and weight management were the second drivers,” Jeffrey Stohlberg, Moderna’s director of corporate benefits, said at a From Day One conference earlier this year. So the company started using the virtual weight-loss management program Wondr Health, where an employee can work with a physician specializing in weight loss. “It’s not a path to GLP-1s, but [the physicians] can provide medication for that person,” Stohlberg said. Labcorp also announced in February that it would provide U.S. employees on GLP-1s with virtual care and medication management through WeightWatchers for Business. Other companies such as Omada Health and telehealth providers like Teladoc and Ro have launched similar offerings over the last year. Medical providers agree that a holistic approach is needed, but Angela Fitch, M.D., president of the Obesity Medicine Association and co-founder and chief medical officer of the obesity-focused primary care startup knownwell, worries that requiring a standard weight-management program for every person is another barrier and potentially a waste of money if the program doesn’t have solid evidence behind it.“You can offer lifestyle [strategies] in addition to medication,” she said, “but it should be driven by that shared decision making discussion with the clinician.” If insurers want to make sure patients are getting holistic care, she would rather have them require patients to get their prescriptions from a qualified physician who does a true evaluation so that solutions can be personalized. In her role with the Obesity Medicine Association, Fitch often advises employers on their health plan designs, so she understands that costs are a major concern for companies. But in her primary-care practice and others like it, she says her staff are “burning out” as they spend hours each day trying to navigate all the new and often strict and confusing insurance requirements for these medications. “We have got to deal with costs,” Fitch said. “But it should be transparent and flexible.” She worries that overly rigid restrictions are “adding to the bias and stigma of obesity” by signaling to patients that their weight is their responsibility to treat on their own. Her major advice is to view obesity with the nuance that people view other chronic conditions. “You do not need a GLP-1 management solution. You need a comprehensive obesity-care solution.”Abigail Abrams is a health writer and editor. Currently she is the senior manager of content operations for Atria. Previously, she was a staff writer on health and politics for TIME magazine. Her freelance work has appeared in the Washington Post, the Guardian, and other publications.

Wading Into the Culture Wars, Corporations Fortify Themselves with ‘Social Issues Working Groups’

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