Should your company cover weight loss drugs with your health insurance?

Less than a fifth of large U.S. employers include coverage for the popular but expensive weight-loss drugs Wegovy and Zepbound in their health insurance plans, according to a survey published Wednesday in Health Affairs.

Among large companies that do cover them, a third say the coverage has a “significant impact” on their plans’ prescription drug spending.

“Business owners are really trying to thread the needle right now,” said study author Matthew Rae, associate director of the health care market program at KFF, a nonprofit group that researches health policy issues. .

“They are trying to find the right balance between employee benefits, potential health benefits and the cost of these drugs. And right now, all those things are not resolved,” he added.

About 154 million people have health insurance through their work, according to KFF. The survey, conducted between January and July, included responses from more than 2,100 companies with at least 200 workers and that offer health benefits.

Half of the companies stated that they do not cover medications, while almost a third – 31% – said they did not know if they covered them; Less than 1 in 5 added that they did cover them.

Rae added that when researchers looked specifically at the largest companies in the United States – with 5,000 or more workers – they didn’t fare much better: Dr. Susan Spratt, an endocrinologist and medical director of the Office of Health Management at the Population at Duke Health in North Carolina called the results “disheartening” and added that many people who need these medications do not receive them.

“The rich can afford to pay the $1,000 a month that this medication costs,” he said. “We are only increasing health disparities by making it difficult for patients to access a potentially life-changing medication.”

About 40% of American adults are obese, according to the Centers for Disease Control and Prevention (CDC). Although obesity rates have remained stable over the last 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 employers and insurance companies tend to be blamed for the lack of coverage, but that blame is being “misdirected.”

Wegovy, from drugmaker Novo Nordisk, and Zepbound, from Eli Lilly, can cost more than $1,000 for a monthly supply.

Research has shown that coverage of these drugs can have significant economic implications for companies, as well as state and federal governments.

Earlier this year, North Carolina announced it would stop providing weight-loss drug coverage to 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 explained. “It is economically impossible to cover everyone in need without dramatically raising rates or putting health plans at risk of bankruptcy.”

Rae said the cost is unsustainable for business owners right now.

“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 both employers and employees. “If you have a third of your workers taking a $10,000 drug, it’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 companies that 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 during treatment.

Among large companies that do not currently cover weight loss drugs, only 3% said they were “very likely” to do so in the next year. About a quarter said they were somewhat likely to do so.

Despite their exorbitant cost, businessmen have a positive opinion of these drugs.

The survey found that among all large companies, nearly half said it would be “very important” or “important” to cover medications for their employees’ satisfaction with their health plan.