According to a poll that was published on Wednesday in Health Affairs, fewer than 5% of major US corporations cover the popular but costly weight reduction medications Wegovy and Zepbound in their health insurance policies.
A third of the big companies who do offer coverage claim that it has a “significant impact” on the amount of money that is spent on prescription drugs under their plans.
Employers are now “trying to thread the needle,” according to report author Matthew Rae, associate director of KFF’s health policy research program on the health care marketplace. “They’re attempting to determine the ideal ratio between the benefits to workers, any health improvements, and the price of these medications. And none of those issues have been resolved as of yet.
KFF estimates that 154 million individuals receive health insurance through their work. Responses to the study, which was conducted from January through July, came from over 2,100 companies with 200 or more employees that provide health insurance.
Less than one in five employers stated they do offer coverage, with half stating they don’t cover the medications and nearly a third (31%), saying they are unsure.
According to Rae, the results weren’t any better when the researchers focused on the biggest American companies, those with 5,000 or more employees: Nearly two-thirds say they don’t cover the medications, while more than a quarter say they do.The results are “disheartening,” according to Dr. Susan Spratt, an endocrinologist and senior medical director for Duke Health’s Population Health Management Office in North Carolina. She also noted that many patients who require the meds aren’t receiving them.
“Those who are wealthy are able to pay the $1,000 monthly cost of this medication,” the speaker stated. “By making it more difficult for patients to obtain life-changing medication, we are merely exacerbating health disparities.”
For adults in the United States, the Centers for Disease Control and Prevention estimate that 40% of people are obese. Over the last ten years, rates of obesity have stayed constant, while those of severe obesity have gone from 7.7% to 9.7%.
The temptation is to blame employers and insurance companies for the lack of coverage, but Dr. Christopher McGowan, a gastroenterologist who operates a weight reduction clinic in North Carolina, said that this criticism is being “misdirected.”
A month’s supply of Zepbound from Eli Lilly and Wegovy from Novo Nordisk can cost more than $1,000 each. Studies have indicated that companies, as well as state and federal governments, may incur major expenses related to medication coverage. Predicted to cost the state more than $600 million over the next five years, North Carolina said earlier this year that it will no longer pay the weight reduction medications for its employees.
“Cost is the main source of the issue. Simply said, McGowan stated. “Providing coverage for everyone in need without significantly raising rates or putting health plans at risk of bankruptcy is not economically feasible.”
Employers cannot bear the cost at this time, according to Rae.
He stated that the average health insurance premium, which is paid for by both employers and employees, is $25,000 for a family of four and little over $8,000 for an individual. “It’s going to have a big effect if a third of your employees are using a $10,000 drug.”
Requests for comments from Eli Lilly and Novo Nordisk were not answered.
Rae stated that while some employees’ access to the weight reduction medications may be restricted, businesses who cover the pharmaceuticals will still save money because nearly half of them have conditions attached to their coverage.
Before or during taking the medication, the criteria may include visiting with a dietician or taking part in a lifestyle or weight-loss program.
Just over 3% of big companies that don’t now cover GLP-1 medications for weight reduction said they’re “very likely” to start doing so in the upcoming year. Approximately 25% indicated that they are somewhat inclined to do so.
The medications are well-liked by employers despite their astronomical cost.
According to the poll, almost half of all major companies stated that covering GLP-1 medications will be “very important” or “important” for their employees’ satisfaction with their health plan.
