Whether you can obtain it or not, Ozempic is increasing the cost of your healthcare.

• Despite 165 million Americans having employer-sponsored health insurance, workers may still not receive the desired coverage, particularly for drugs like Wegovy and Ozempic.
• Currently, less than half of employers cover the expensive weight-loss medications.
• Even those that do, have guardrails in place that restrict access.

Despite 165 million Americans having employer-sponsored health insurance, workers may still not receive the desired coverage, particularly for drugs such as Wegovy and Ozempic.

A recent report by consulting firm Gallagher found that one in three employees are seeking more resources to combat obesity. Glucagon-like peptide-1 treatments, such as Wegovy and Ozempic, are considered game changers in this area as they mimic hormones produced in the gut to suppress a person's appetite.

Despite the increasing popularity of blockbuster weight-loss drugs in the U.S., they are not universally covered, even though Americans have higher rates of obesity, diabetes, and behavioral health conditions than ever before, according to Trilliant Health's "2024 Trends Shaping the Health Economy" report.

Cost is a key issue.

Despite evidence indicating that obesity drugs can provide additional health advantages beyond weight loss, U.S. insurer organizations have expressed reservations about the high cost of covering these medications, which amount to approximately $1,350 per month for a single patient.

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The high cost of GLP-1 medications, which many people use, is a significant factor in rising healthcare costs, research indicates. Prescription drug expenses increased by 8.6% last year, in part because of the growing popularity of GLP-1 drugs, according to a recent report by Mercer.

Yes, said Sunit Patel, Mercer's U.S. chief health actuary, "Is that significant?"

Continuous treatment for several months, if not years, is necessary for patients taking these medications.

"Gary Kushner, chair and president of Kushner & Company, stated that a drug becomes a lifelong commitment, which is quite expensive."

Cost is a key factor in coverage

According to a survey by Mercer, only 42% of companies currently cover expensive weight-loss drugs to some extent, while 27% are considering adding coverage in the upcoming year.

"Not everyone who desires it can acquire it," Patel stated.

While some employers have removed coverage for these drugs, 10% of companies that currently cover them are considering removing them for 2025.

In order to enhance access to weight-loss drugs, many businesses would need to pay even more, as healthcare costs are already reaching a post-pandemic high and are projected to increase by 7.7% in 2025, compared to 6.9% in 2024 and 6.5% in 2023, according to WTW, a consulting firm formerly known as Willis Towers Watson.

A Kaiser Family Foundation survey revealed that among employers' top worries was how to cover weight loss drugs that are increasingly in demand.

Gary Claxton, KFF's vice president, stated in a press release that employers face the challenge of integrating these potentially important treatments into their already costly benefit plans.

Access for weight-loss use is an issue

While some employers cover GLP-1 drugs exclusively for diabetes treatment, others cover specific GLP-1s for weight loss only if they are FDA-approved for that use, excluding Ozempic, which is only approved for Type 2 diabetes treatment.

According to Seth Friedman, pharmacy and health plans practice leader at Gallagher, while most employers cover Ozempic for diabetes, it may not be covered as an anti-obesity medication.

"They see that it's covered but are still rejected," Friedman said.

According to a 2023 survey by the International Foundation of Employee Benefit Plans, 76% of companies surveyed offered GLP-1 drug coverage for diabetes, while only 27% offered coverage for weight loss, leaving many workers without access.

Kushner stated that there is a demand for them, not for diabetes, but for weight loss.

"According to Beth Umland, Mercer's research director of health and benefits, by 2025, approximately half of large employers will cover weight loss drugs. Nevertheless, there are restrictions on who can utilize them."

The increase in demand for these treatments is only expected, but the added controls for coverage are also helping to control costs.

According to Friedman of Gallagher, nearly all employers have some sort of "utilization management" restrictions, such as a prior authorization requirement.

Some companies may require workers to attempt other weight-loss methods, meet with a dietician, and enroll in a weight-loss management program before implementing a plan. Others may set a BMI threshold of at least 30, depending on the plan's design, according to Friedman.

During open enrollment, typically running from early December, this information is available.