Hoping your company will begin paying for anti-obesity medications like Wegovy? You may be in luck. <\/p>\n
A growing number of employers are considering covering the blockbuster weight-loss drugs, several surveys show. Workers will learn whether they\u2019ll gain such coverage for the coming year during open enrollment, which launches this month at many companies. <\/p>\n
GLP-1 drugs, which treat diabetes, obesity and certain other conditions, have become super popular since they came on the market a few years ago because they help patients shed pounds. While employers typically cover the medications for diabetes, fewer of them do so for weight loss, in part because of the drugs\u2019 high prices \u2014 which have also limited Americans\u2019 access to them. <\/p>\n
The list price for Wegovy, for instance, is about $1,350 for a four-week supply. Nearly 40 million people with employer coverage are estimated to be eligible for anti-obesity medications based on their body mass index, according to KFF, a health policy research organization. <\/p>\n
\u201cIt could have a huge impact on premiums given the cost of the drugs,\u201d said Matthew Rae, the associate director of KFF\u2019s Program on the Health Care Marketplace. <\/p>\n
Still, more than a quarter of employers are considering adding coverage for GLP-1 drugs for weight loss in 2025 or 2026, according to a national survey conducted this year by Mercer, a human resources consulting firm. <\/p>\n
Roughly the same share say they are somewhat or very likely to begin covering these medications for weight loss within the next 12 months, according to KFF\u2019s annual Employer Health Benefits Survey. <\/p>\n
The chances of your employer covering an anti-obesity drug depends on its size \u2014 bigger organizations are much more likely to offer the benefit than smaller ones. <\/p>\n
Workers are eligible for the GLP-1 medications for obesity treatment at 67% of the large companies in the Business Group on Health\u2019s 2024 report, which surveyed mostly firms with more than 10,000 employees. <\/p>\n
Mercer\u2019s report, which looked at employers with at least 500 workers, found that just over half are providing such coverage this year. But only 18% of firms in KFF\u2019s survey, which includes those with 200 or more employees, cover GLP-1 drugs primarily for weight loss. <\/p>\n
Even employers that provide coverage for anti-obesity drugs often put up guardrails, such as requiring employees to receive prior authorization or to try other weight-loss methods first. Some have higher thresholds for body mass index than the Food and Drug Administration\u2019s definition of at least 30 for adults or mandate that workers participate in weight management programs. <\/p>\n
\u201cEven as more employers are adding the coverage, more employers are also adding controls on the coverage to really target it to the people who need it the most and will benefit the most,\u201d said Beth Umland, director of research, health and benefits, at Mercer, which found that 35% of employers in its 2023 survey had some type of guardrails. <\/p>\n
Though many workers are clamoring for anti-obesity drug coverage, providing the benefit is simply too difficult or costly for some companies. Mercer\u2019s study found that 10% of employers that covered the medications in 2024 were considering dropping coverage and 3% recently discontinued it or plan to do so. <\/p>\n
Earlier this year, Eileen Pabon, who manages benefits and wellness for DSV Air & Sea US, was shocked to find out that the company\u2019s prescription drug costs had soared by $400,000 over several months. She learned that several employees who did not have diabetes had started taking GLP-1 drugs. DSV, a global transportation company based in New Jersey, had not put any restrictions on its coverage. <\/p>\n
So the firm, which provides health insurance to about 8,000 people, began requiring a diabetes diagnosis. <\/p>\n
\u201cIt just wouldn\u2019t be financially wise for us to cover it for weight loss only,\u201d she said. \u201cIt would force us the raise the cost of health insurance coverage for the employees.\u201d <\/p>\n
The cost of family health insurance benefits at work hit nearly $25,600 this year, up 7% from a year ago, according to KFF\u2019s annual survey. It\u2019s the first time the total premium crossed the $25,000 threshold. <\/p>\n
Workers were responsible for about $6,300 of that tab, while employers shelled out nearly $19,300. <\/p>\n
Over the last five years, the 24% rise in family health insurance premiums has been roughly in line with the 23% jump in inflation and 28% increase in workers\u2019 wages, KFF found. <\/p>\n
The average annual premium for single coverage was nearly $9,000 this year, up 6% from the prior year. Employees paid about $1,370, while their employers picked up nearly $7,600. <\/p>\n
Costs are expected to continue their upward march in 2025, due in part to rising prescription drug expenses and health care prices overall, according to surveys from several consulting firms. Inflation in the health care sector typically lags the general economy since insurers and providers usually negotiate multi-year contracts. <\/p>\n
The total cost of health benefits per employee is expected to rise 5.8%, on average, in 2025, even after employers implement cost-reduction measures, according to Mercer. It\u2019s the third year in a row that costs climbed at least 5%. <\/p>\n
Due to the tight labor market, employers have been reluctant to push costs onto their workers in recent years. But fewer can continue absorbing the expenses, Mercer found. Some 53% said they will make cost-cutting changes to their plans \u2014 such as raising deductibles and increasing other out-of-pocket costs \u2014 in 2025, up from 44% this year. <\/p>\n
Employers are also looking at reining in spending on prescription medications, said Eric Miller, a consulting actuary with Segal, a benefits consulting firm that works mainly with large public sector employers and unions. Outpatient drug costs are expected to climb 11.4% next year, surpassing the 8% increase projected for medical plan costs, according to Segal\u2019s most recent survey. <\/p>\n
The changes include adjusting the list of preferred brand name medicines that are covered and favoring the use of biosimilars, which are typically less expensive than complex biologic medications, he said. <\/p>\n
Some employers, however, are still concerned about making their workers pay more for health care. Take Marroquin Industries Corp in Hawthorne, California. The company, which supplies machine automation and controls and employs nine people, is expecting its premiums will increase between 5% and 8% for 2025, similar to the price hikes of recent years. <\/p>\n
While employees will see their monthly premiums rise accordingly, Marroquin won\u2019t increase their share of the premium or boost their deductibles or out-of-pocket costs, nor will it slim down benefits. The company is worried about losing its staff to larger competitors, said Vicky Cathcart, Marroquin\u2019s business manager. <\/p>\n
Instead, it will have to raise the price of its products, as well as accept having a smaller profit margin. <\/p>\n
\u201cEssentially, our customers are paying for it,\u201d Cathcart said. <\/p>\n<\/p>\n
Hoping your company will begin paying for anti-obesity medications like Wegovy? You may be in luck. A growing number of employers are considering covering the blockbuster weight-loss drugs, several surveys show. Workers will learn whether they\u2019ll gain such coverage for the coming year during open enrollment, which launches this month at many companies. GLP-1 drugs, …<\/p>\n","protected":false},"author":1,"featured_media":1462,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"loftocean_post_primary_category":0,"loftocean_post_format_gallery":"","loftocean_post_format_gallery_ids":"","loftocean_post_format_gallery_urls":"","loftocean_post_format_video_id":0,"loftocean_post_format_video_url":"","loftocean_post_format_video_type":"","loftocean_post_format_video":"","loftocean_post_format_audio_type":"","loftocean_post_format_audio_url":"","loftocean_post_format_audio_id":0,"loftocean_post_format_audio":"","loftocean-featured-post":"","loftocean-like-count":0,"loftocean-view-count":526,"tinysalt_single_post_intro_label":"","tinysalt_single_post_intro_description":"","tinysalt_hide_post_featured_image":"","tinysalt_post_featured_media_position":"","tinysalt_single_site_header_source":"","tinysalt_single_custom_site_header":"0","tinysalt_single_custom_sticky_site_header":"0","tinysalt_single_custom_sticky_site_header_style":"sticky-scroll-up","tinysalt_single_site_footer_source":"","tinysalt_single_custom_site_footer":"0","footnotes":""},"categories":[35],"tags":[],"class_list":["post-1461","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-news"],"_links":{"self":[{"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/posts\/1461","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/comments?post=1461"}],"version-history":[{"count":0,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/posts\/1461\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/media\/1462"}],"wp:attachment":[{"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/media?parent=1461"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/categories?post=1461"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/retirednurseblog.com\/index.php\/wp-json\/wp\/v2\/tags?post=1461"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}