Approximately 165 million Americans depend on employer-sponsored medical insurance, and yet employees should not be getting the coverage they need — especially with regards to medications like Novo Nordisk's weight-loss drug Wegovy and diabetes drug Ozempic.
About one in three employees are searching for more resources to combat obesity, in line with a recent report from a consulting firm Gallagher. Glucagon-like peptide-1 treatments comparable to Wegovy and Ozempic, which mimic hormones produced within the gut to suppress an individual's appetite, are being considered Game changer on this front.
These blockbuster weight-loss drugs are growing in popularity within the U.S. but still aren't widely covered — although “Americans today have higher rates of obesity and diabetes and more behavioral health problems than ever before,” says 2024 Trends Shaping “ from Trilliant Health of the healthcare industry” report.
Costs are a key issue.
Although research shows that obesity medications can have significant health advantages beyond shedding unwanted kilos, organizations representing U.S. insurers have said concerns remain high price involved in covering the price of those medications, which cost nearly $1,350 monthly for a single patient.
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Several studies show that the worth of GLP-1 drugs, in addition to the massive variety of employees who could potentially profit from their use, are a significant factor in higher healthcare costs. According to a recent report, prescription drug costs have already increased 8.6% up to now 12 months, driven partly by a rise in using GLP-1 drugs Mercer.
“Does that matter? Yes,” said Sunit Patel, Mercer’s chief U.S. actuary.
Patients taking these medications You will need to finish months, if not years, of continuous treatment.
“It becomes a lifelong medication,” said Gary Kushner, chairman and president of Kushner & Company, a advantages design and administration firm. “It’s a pretty expensive commitment.”
Cost is an important think about coverage
Currently, lower than half – 42% – of firms provide some level of coverage for expensive weight-loss medications. According to the survey, one other 27% are considering expanding insurance coverage in the approaching 12 months Mercer.
Still, “not everyone who wants it can get it,” Patel said.
On the opposite hand, 3% of employers have recently removed coverage for these drugs, and 10% of firms that currently cover them are considering eliminating them in 2025.
To improve access to weight-loss medications, many firms would should pay much more—and health care costs are already skyrocketing Post-pandemic highAccording to WTW, a consulting firm formerly generally known as Willis Towers Watson, employers and employees will spend significantly more on coverage in 2025. U.S. employers expect their healthcare costs to rise 7.7% in 2025, in comparison with 6.9% in 2024 and 6.5% in 2023.
According to a survey by the Kaiser Family Foundation, one among employers' top concerns was learn how to cover increasingly popular weight-loss medications also found.
“Employers face the challenge of integrating these potentially important treatments into their already costly benefit plans,” KFF Vice President Gary Claxton said in a news release.
Access to weight reduction is an issue
Currently, some employers only cover GLP-1 drugs exclusively for the treatment of diabetes, while others only cover certain GLP-1 drugs for weight reduction in the event that they are approved by the Food and Drug Administration for that purpose – which excludes Ozempic only Approved by the FDA for the treatment of type 2 diabetes.
“Most employers cover Ozempic for diabetes, not necessarily as an obesity drug,” said Seth Friedman, practice leader for pharmacy and medical insurance at Gallagher.
This makes it even harder for workers to seek out out whether or not they have access to the drug and whether it is roofed by their insurance. “They see it’s covered, but they get rejected,” Friedman said.
A 2023 survey by the International Foundation of Employee Benefit Plans found that 76% of firms surveyed offered GLP-1 drug insurance for diabetes, while only 27% offered weight reduction insurance – discouraging many employees.
“Obviously there is a demand for them, not for diabetes, but for weight loss,” Kushner said.
“Looking forward to 2025, about half of large employers will cover weight loss medications,” said Beth Umland, research director for health and advantages at Mercer. But “even if they do, there are guardrails as to who can use it.”
The demand for these treatments is high only a rise is predicted – but the extra controls on insurance coverage also help keep costs under control.
Almost all employers have some sort of “workload management” restrictions According to Gallagher's Friedman, not all the crucial measures, comparable to a pre-approval requirement, are in place yet.
For some firms, this will mean that employees must first try other weight reduction methods or meet with a nutritionist and enroll in a weight reduction program. Others may require a body mass index (BMI) threshold of at the very least 30, depending on how the plan is structured, Friedman said.
This information is obtainable during open enrollment, which generally runs through early December.
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