GLP-1 Spending in Workers Comp Jumps 40% Annually, But NCCI Says Costs Remain Negligible

Why GLP-1 Drugs Are Showing Up in Workers Comp Claims — But Not in the Bottom Line

Workers compensation spending on GLP-1 medications — the class of drugs that includes semaglutide, marketed as Ozempic and Wegovy — has grown at nearly 40% annually since 2021, according to a report released this week by the National Council on Compensation Insurance (NCCI). That growth rate sounds alarming, but the absolute numbers tell a different story: total GLP-1 payments in 2025 reached just $1.9 million, representing about 0.02% of the $9.3 billion in overall medical payments NCCI analyzed.

The report found that the increase in spending is driven primarily by a growing number of claims involving the drugs, rather than higher payments per transaction. Average payments per transaction have remained relatively stable, ranging from $1,200 to $1,300. Claims involving GLP-1 medications also accounted for about 0.02% of total claim counts, and the drugs were most frequently associated with claims involving the lumbar spine, shoulders and knees.

About 40% of claims involving the drugs included a diabetes diagnosis, while fewer than 25% involved prescriptions in the six months preceding major surgery. NCCI said it does not expect GLP-1 medications to become a significant workers compensation cost driver because obesity is typically not a compensable injury — meaning the condition itself is not covered under workers comp, limiting the pathway for these drugs to enter the system as a primary treatment.

What NCCI's Data Reveals About the Real Cost Trajectory

Why the 40% Growth Rate Is Less Alarming Than It Looks

A 40% annual growth rate would normally trigger concern among insurers and employers managing workers comp costs. But context matters: GLP-1 spending started from a near-zero base in 2021, when the FDA first approved semaglutide for chronic weight management. Moving from 0.01% to 0.02% of medical spending over four years is a doubling in percentage terms, but the absolute dollar figure — $1.9 million out of $9.3 billion — remains negligible. The growth is real but the scale is tiny.

What the Claim Profile Tells Us About Prescribing Patterns

The finding that about 40% of GLP-1 claims include a diabetes diagnosis suggests these drugs are entering workers comp claims not as obesity treatments but as management for pre-existing metabolic conditions. That distinction matters: if the drugs were being prescribed specifically for weight loss related to a compensable injury, the cost exposure would be more direct. Instead, the data points to injured workers who happen to be on GLP-1 medications for diabetes or other conditions, with the cost incidentally captured in the workers comp claim.

The fact that fewer than 25% of claims involved prescriptions in the six months preceding major surgery further supports this interpretation. If GLP-1 drugs were being used proactively to improve surgical outcomes — a practice gaining traction in some clinical settings — that figure would likely be higher.

Why Obesity's Non-Compensable Status Limits the Cost Pathway

NCCI's conclusion that GLP-1 medications are unlikely to become a significant cost driver rests on a structural feature of workers compensation: obesity is typically not a compensable injury. Unlike conditions directly caused by workplace incidents, obesity is generally treated as a pre-existing or underlying health issue. This means there is no clear pathway for workers comp to cover GLP-1 drugs prescribed solely for weight management. The drugs can only enter the system when they are tied to the treatment of a compensable injury or a related condition — such as diabetes management during recovery.

What This Means for Insurers and Employers

For insurers, the NCCI report is reassuring in the near term but worth monitoring. The rapid growth rate — even from a small base — could accelerate if clinical guidelines evolve to recommend GLP-1 drugs more broadly for injured workers, or if obesity becomes more frequently recognized as a complicating factor in workers comp claims. For employers, the report suggests that GLP-1 costs are not currently a material driver of premium increases, but the underlying trend in claim frequency deserves attention.

For context, the broader debate around GLP-1 drugs in insurance — including whether public and private payers should cover them for weight management — is still evolving. Workers compensation operates under different rules than health insurance, and NCCI's data reflects that distinction.

What Insurers and Employers Should Take From the NCCI Report

GLP-1 medications are growing fast in workers comp claims, but from such a small base that they remain immaterial to overall costs — for now.

For insurers and employers managing workers comp programs, the NCCI report offers a clear but nuanced picture. The 40% annual growth rate is real, but the $1.9 million total in 2025 represents just 0.02% of medical payments. The structural barrier — obesity's non-compensable status — limits how much these drugs can drive costs in the current framework.

• Monitor claim frequency, not just spending. The growth is driven by more claims involving GLP-1 drugs, not higher per-transaction costs (stable at $1,200–$1,300). Track whether the number of claims with GLP-1 prescriptions continues to rise, especially in lumbar spine, shoulder and knee injury categories.
• Watch for clinical guideline changes. If medical guidelines begin recommending GLP-1 drugs more broadly for injured workers — particularly around surgical recovery — the cost pathway could widen. Fewer than 25% of current claims involve prescriptions in the six months before major surgery, leaving room for that figure to grow.
• Assess diabetes-related claims. About 40% of GLP-1 claims include a diabetes diagnosis. Understanding whether these are pre-existing conditions or newly diagnosed during recovery can help predict future cost exposure.
• No immediate action on reserves. NCCI does not expect GLP-1 drugs to become a significant cost driver given obesity's non-compensable status. This suggests no urgent need to adjust reserving or pricing assumptions based on this report alone.

Metrics to watch: NCCI's next annual report on GLP-1 spending; changes in FDA approvals or clinical guidelines for GLP-1 drugs; and any shift in state-level workers comp rules regarding obesity as a compensable condition.