CNN
—
Hoping your organization will start paying for anti-obesity medications like Wegovy? You could be in luck.
A rising variety of employers are contemplating protecting the blockbuster weight-loss medicine, a number of surveys present. Staff will study whether or not they’ll acquire such protection for the approaching yr throughout open enrollment, which launches this month at many corporations.
GLP-1 medicine, which deal with diabetes, weight problems and sure different situations, have turn out to be tremendous standard since they got here available on the market a number of years in the past as a result of they assist sufferers shed kilos. Whereas employers usually cowl the medicines for diabetes, fewer of them accomplish that for weight reduction, partially due to the medicine’ excessive costs — which have additionally limited Americans’ access to them.
The list price for Wegovy, as an example, is about $1,350 for a four-week provide. Practically 40 million individuals with employer protection are estimated to be eligible for anti-obesity medicines based mostly on their physique mass index, in response to KFF, a well being coverage analysis group.
“It might have a huge effect on premiums given the price of the medicine,” mentioned Matthew Rae, the affiliate director of KFF’s Program on the Well being Care Market.
Nonetheless, greater than 1 / 4 of employers are contemplating including protection for GLP-1 medicine for weight reduction in 2025 or 2026, in response to a nationwide survey performed this yr by Mercer, a human sources consulting agency.
Roughly the identical share say they’re considerably or very prone to start protecting these medicines for weight reduction inside the subsequent 12 months, in response to KFF’s annual Employer Health Benefits Survey.
The probabilities of your employer protecting an anti-obesity drug depends upon its dimension — greater organizations are more likely to supply the profit than smaller ones.
Staff are eligible for the GLP-1 medicines for weight problems therapy at 67% of the massive corporations within the Enterprise Group on Well being’s 2024 report, which surveyed principally corporations with greater than 10,000 workers.
Mercer’s report, which checked out employers with no less than 500 employees, discovered that simply over half are offering such protection this yr. However solely 18% of corporations in KFF’s survey, which incorporates these with 200 or extra workers, cowl GLP-1 medicine primarily for weight reduction.
Even employers that present protection for anti-obesity medicine usually put up guardrails, comparable to requiring workers to obtain prior authorization or to attempt different weight-loss strategies first. Some have increased thresholds for physique mass index than the Meals and Drug Administration’s definition of no less than 30 for adults or mandate that employees take part in weight administration applications.
“Whilst extra employers are including the protection, extra employers are additionally including controls on the protection to essentially goal it to the individuals who want it essentially the most and can profit essentially the most,” mentioned Beth Umland, director of analysis, well being and advantages, at Mercer, which discovered that 35% of employers in its 2023 survey had some sort of guardrails.
Although many employees are clamoring for anti-obesity drug protection, offering the profit is just too tough or pricey for some corporations. Mercer’s examine discovered that 10% of employers that coated the medicines in 2024 have been contemplating dropping protection and three% not too long ago discontinued it or plan to take action.
Earlier this yr, Eileen Pabon, who manages advantages and wellness for DSV Air & Sea US, was shocked to search out out that the corporate’s prescription drug prices had soared by $400,000 over a number of months. She discovered that a number of workers who didn’t have diabetes had began taking GLP-1 medicine. DSV, a worldwide transportation firm based mostly in New Jersey, had not put any restrictions on its protection.
So the agency, which supplies medical health insurance to about 8,000 individuals, started requiring a diabetes prognosis.
“It simply wouldn’t be financially sensible for us to cowl it for weight reduction solely,” she mentioned. “It will pressure us the elevate the price of medical health insurance protection for the workers.”
The price of household medical health insurance advantages at work hit practically $25,600 this yr, up 7% from a yr in the past, in response to KFF’s annual survey. It’s the primary time the entire premium crossed the $25,000 threshold.
Staff have been liable for about $6,300 of that tab, whereas employers shelled out practically $19,300.
Over the past 5 years, the 24% rise in household medical health insurance premiums has been roughly in keeping with the 23% bounce in inflation and 28% improve in employees’ wages, KFF discovered.
The common annual premium for single protection was practically $9,000 this yr, up 6% from the prior yr. Staff paid about $1,370, whereas their employers picked up practically $7,600.
Prices are anticipated to proceed their upward march in 2025, due partially to rising prescription drug bills and well being care costs general, in response to surveys from a number of consulting corporations. Inflation within the well being care sector usually lags the final economic system since insurers and suppliers normally negotiate multi-year contracts.
The entire price of well being advantages per worker is anticipated to rise 5.8%, on common, in 2025, even after employers implement cost-reduction measures, in response to Mercer. It’s the third yr in a row that prices climbed no less than 5%.
As a result of tight labor market, employers have been reluctant to push prices onto their employees in recent times. However fewer can proceed absorbing the bills, Mercer discovered. Some 53% mentioned they may make cost-cutting modifications to their plans — comparable to elevating deductibles and growing different out-of-pocket prices — in 2025, up from 44% this yr.
Employers are additionally reining in spending on prescription medicines, mentioned Eric Miller, a consulting actuary with Segal, a advantages consulting agency that works primarily with massive public sector employers and unions. Outpatient drug prices are anticipated to climb 11.4% subsequent yr, surpassing the 8% improve projected for medical plan prices, in response to Segal’s most up-to-date survey.
The modifications embrace adjusting the checklist of most well-liked model identify medicines which can be coated and favoring the usage of biosimilars, that are usually cheaper than advanced biologic medicines, he mentioned.
Some employers, nevertheless, are nonetheless involved about making their employees pay extra for well being care. Take Marroquin Industries Corp in Hawthorne, California. The corporate, which provides machine automation and controls and employs 9 individuals, is anticipating its premiums will improve between 5% and eight% for 2025, just like the worth hikes of current years.
Whereas workers will see their month-to-month premiums rise accordingly, Marroquin received’t improve their share of the premium or enhance their deductibles or out-of-pocket prices, nor will it slim down advantages. The corporate is nervous about dropping its employees to bigger rivals, mentioned Vicky Cathcart, Marroquin’s enterprise supervisor.
As an alternative, it should elevate the worth of its merchandise, in addition to settle for having a smaller revenue margin.
“Basically, our clients are paying for it,” Cathcart mentioned.