Demand for GLP-1 coverage among employees remains high, as does uncertainty about how to meet those needs while keeping rising healthcare costs at bay.
That strain may be causing a plateau in the number of employers that offer GLP-1 coverage. According to a new report from Business Group on Health, about 1 in 10 employers that currently cover the medication for weight loss won’t do so next year. That finding is in line with new Mercer research that found that, despite nearly half of employers now covering the drugs for weight loss, about 6% will eliminate that benefit this year, and 5% plan to make cuts in 2027.
Others are taking a more middle-of-the-road approach by not eliminating coverage outright, but rather tightening restrictions. According to Mercer, more than one-quarter of employers that offer coverage have or plan to expand eligibility requirements.
A new report from Goldman Sachs Ayco suggests a new term for the balance employers are trying to find between investment and cost: “GLP-1 plus.” It’s a strategy, the organization says, that closely ties eligibility with adherence to broader lifestyle requirements.
While three-quarters require employees to meet body mass index requirements, about 51% are expanding eligibility, pairing BMI metrics with other measures like enrollment in health programs.
“While BMI thresholds remain the primary gatekeeper for coverage,” researchers say, “we are seeing an increasingly popular trend of multi-factor qualification.”
This approach emphasizes medication as just one component of a broader health strategy, a holistic view that, they say could lead to longer-term healthcare savings for employers.
For those that only require single-factor qualification, BMI threshold is most important, followed by documented medical necessity and enrollment in a nutrition or weight-loss program.
“This underscores the growing focus on holistic patient engagement to ensure clinical efficacy and return on investment in the benefit,” researchers say.
Where is GLP-1 coverage headed?
Despite evolving employee expectations for coverage, Goldman Sachs found employers remain cautious. Of those that don’t currently cover the drugs for weight loss, 54% say they’re unlikely to do so soon, while just 6% are likely to add coverage in the near term.
“This resistance,” researchers write, “likely stems from concerns regarding high annual costs and the lack of immediate ROI.”
About 60% of survey respondents are not considering changes to their GLP-1 coverage in the near term, researchers say, suggesting these organizations are either satisfied with their current “restrictive posture” or are being intentional about changing plans until more data emerges about both costs and health outcomes.
Those that are eyeing a shift are evenly split between enhancing and diminishing coverage, highlighting the complexities facing HR and benefits leaders.
Understanding the market and the cost-reduction strategies is key in this environment, researchers say.
“Some employers have expressed an interest in setting up direct-to-consumer channels, enabling employees’ access to the medication through an added benefit with employer funding,” they write. “This can be a cost-effective way of helping employees access the drug without medical plan coverage, while also ensuring employer guardrails apply.”
Credit: Source link
