Less than a fifth of large companies in the United States include coverage for the famous, but expensive, weight loss drugs Wegovy and Zepbound in their health insurance plans, according to a survey published Wednesday in Health.
Among the big companies that cover them, a third say the coverage has a “significant impact” on their plans’ prescription drug spending.
“Employers are really trying to thread the needle right now,” said study author Matthew Rae, associate director for the health care market program at KFF, a nonprofit group that researches the issues. of health policy. “They are trying to figure out what is the right balance between the benefits for employees, the potential health benefits and the cost of these drugs. And at this point, all of these things are not resolved.”
About 154 million people get health insurance through their work, according to the KFF. The survey, taken from January to July, included responses from more than 2,100 employers that have at least 200 workers and that offer health benefits.
Half of employers said they don’t cover drugs, while nearly a third — 31% — said they don’t know if they do; less than 1 in 5 said they provide coverage.
Rae said that when the researchers looked specifically at the largest U.S. companies — those with 5,000 or more workers — those didn’t fare much better: More than a quarter said they cover drugs and nearly two-thirds said they don’t. no.
Dr. Susan Spratt, an endocrinologist and senior medical director for the Office of Population Health Management at Duke Health in North Carolina, called the results “discouraging,” adding that many people who need the medications don’t. they didn’t get it.
“People who are rich can afford to pay $1,000 per month for this medication,” he said. “We are only widening health disparities by making it more difficult for patients to access life-changing medications.”
About 40% of adults in the United States are obese, according to the Centers for Disease Control and Prevention. While obesity rates have remained stable over the past decade, severe obesity rates have increased, from 7.7% to 9.7%.
Dr. Christopher McGowan, a gastroenterologist who runs a weight loss clinic in North Carolina, said there is a tendency to blame employers and insurance companies for the lack of coverage, but that the blame has been “misdirected “.
Wegovy, from Novo Nordisk, and Zepbound, from Eli Lilly, can cost more than $1,000 for a month’s supply. Research has shown that drug coverage can have significant cost implications for employers, as well as state and federal governments. Earlier this year, North Carolina announced it would stop providing coverage for weight-loss drugs for its employees after it was projected to cost the state more than $600 million over the next five years. .
“The root of the problem is cost. Plain and simple,” McGowan said. “It is economically impossible to provide coverage for everyone who needs it without drastically hiking rates or putting health plans at risk of bankruptcy.”
Rae said that right now, the cost is unsustainable for employers.
“The average health insurance premium is $25,000 for a family of four, just over $8,000 for a single person,” he said, a cost covered by employers and employees. “If you have a third of your workers taking a $10,000 drug, that’s obviously going to have a significant impact.”
Novo Nordisk and Eli Lilly did not respond to requests for comment.
The survey found that about half of employers who cover weight loss drugs have certain requirements associated with their coverage, which Rae said would limit access for some employees but save money.
Requirements may include meeting with a dietitian or participating in a lifestyle or weight loss program before or while taking the drug.
Among large companies that do not currently cover GLP-1 weight loss drugs, only about 3% said they are “very likely” to do so in the next year. About a quarter said they are somewhat likely to do so.
Despite the exorbitant cost, employers have a positive view of the drugs.
The survey found that among all large companies, almost half said that it will be “very important” or “important” to cover GLP-1 drugs for the satisfaction of their employees with their health plan.
