About 165 million Americans rely on employer-sponsored health insurance, but workers may still not be able to get the coverage they want — especially for drugs like Novo Nordisk’s weight-loss drug Wegovy and diabetes drug Ozempic.
A recent report from a consulting firm shows that about a third of employees are looking for more resources to fight obesity gallagher. Glucagon-like peptide-1 treatments such as Wegovy and Ozempic are thought to mimic the hormone produced in the gut to suppress appetite in humans game changer in this regard.
These blockbuster weight-loss pills are soaring in popularity in the U.S., but still aren’t universally covered — even though, according to Trilliant Health’s Trends Shaping 2024, “Americans today are experiencing higher rates of obesity and diabetes, and behavioral health There are more problems than ever before.” “Healthy Economy” Report.
Cost is a key issue.
Although research shows that weight-loss drugs may have significant health benefits beyond shedding excess pounds, a group representing U.S. insurance companies says concerns about obesity drugs remain. high price Participation pays for these medications, which cost nearly $1,350 per patient per month.
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Several studies have shown that the price tags of GLP-1 drugs, along with the large number of workers who could benefit from their use, are a significant driver of rising health care costs. According to recent reports, prescription drug costs have risen 8.6% last year, in part due to a surge in use of GLP-1 drugs. Mercer.
“Is this important? Yes,” said Sunit Patel, Mercer’s chief U.S. health actuary.
patients taking these medications Months or even years of continuous treatment are required.
“It becomes a lifelong drug,” said Gary Kushner, chairman and president of the Kushner Companies, a benefits design and management company. “It’s a pretty expensive commitment.”
Cost is key factor in coverage
Currently, less than half (42%) of companies are covered Expensive weight loss pills to some extent. Another 27% are considering adding insurance coverage in the next year, according to the survey Mercer.
Still, “not everyone who wants it can get it,” Patel said.
On the other hand, 3% of employers have recently eliminated coverage for these drugs, and 10% of companies that currently cover these drugs are considering eliminating them in 2025.
To improve access to weight-loss drugs, many businesses will have to pay more, at a time when health care costs are already Post-pandemic highsAccording to consulting firm WTW (formerly Willis Towers Watson), insurance costs will increase significantly for employers and employees by 2025. U.S. employers expect their health care costs to increase 7.7% in 2025, compared with 6.9% in 2024 and 6.5% in 2023.
A Kaiser Family Foundation survey shows employers’ top concern is covering increasingly popular weight-loss drugs also found.
“Employers are challenged to incorporate these potentially important treatments into their already expensive benefit plans,” KFF Vice President Gary Claxton said in a press statement.
Packaging of the weight loss pills Wegovy, Ozempic and Mounjaro.
Image Alliance | Getty Images
Obtaining weight loss purposes is a problem
Currently, some employers only cover GLP-1 drugs specifically used to treat diabetes, while others cover certain GLP-1 drugs used for weight loss, but only if they have been approved by the U.S. Food and Drug Administration (FDA) Approved for this use – excludes Ozempic, which is only FDA approved to treat type 2 diabetes.
“Most employers cover Ozempic to treat diabetes, but they don’t necessarily cover it as an anti-obesity drug,” said Seth Friedman, Gallagher’s pharmacy and health plan practice leader.
This makes it more difficult for employees to determine whether they can obtain the drug and whether it will be covered by insurance. “They saw it was covered, but they were denied it,” Friedman said.
A 2023 survey by the International Foundation of Employee Benefit Plans found that 76% of companies surveyed offered coverage for GLP-1 drugs for diabetes, while only 27% offered coverage for weight loss, leaving many employees turned away Outside the door.
“Obviously there’s a demand for them, and not for diabetes, but for weight loss,” Kushner said.
“Looking ahead to 2025, about half of large employers will cover the cost of weight-loss drugs,” said Beth Umland, director of health and benefits research at Mercer. However, “even if they do, there are guardrails around it, who You can use it.”
The need for these treatments is only expected to increase – But added coverage control also helps control costs.
Almost all employers have some kind of “utilization management” limit Gallagher’s Friedman said those measures are already in place, such as prior authorization requirements.
For some companies, this may mean employees must first try other methods of losing weight, or meet with a nutritionist and participate in a weight-loss management program. Others may require a body mass index (BMI) threshold of at least 30, depending on how the plan is developed, Friedman said.
This information is available during the open enrollment period, which typically lasts until early December.
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