Latest news with #AlyshaFluno
Canada News.Net
5 days ago
- Business
- Canada News.Net
Weight-loss drug prices prompt rethink of US health benefits
NEW YORK CITY, New York: Rising spending on weight-loss and specialty drugs is prompting a majority of large U.S. employers to scale back health benefits in 2026, as budgets come under pressure, a new Mercer survey released on July 16 shows. Among companies with 500 or more employees, 51 percent said they plan to increase cost-sharing for workers in 2026 — such as by raising deductibles or out-of-pocket maximums — up from 45 percent who plan similar increases in 2025. Soaring costs of GLP-1 weight-loss drugs, such as Wegovy, are at the heart of employer concerns. According to Mercer, 77 percent of employers now rank Wegovy as a top cost concern. "More clients are saying ... 'I don't know how much longer we can sustain covering these medications,'" said Alysha Fluno, a pharmacy innovation leader at Mercer. While some companies initially offered coverage for GLP-1 drugs in hopes of lowering long-term health costs tied to obesity, surging prices are causing second thoughts. "Some employers facing big cost increases in 2026 may feel this coverage is out of reach," Fluno said. Competition from new drugs in the coming years may give pharmacy benefit managers (PBMs) more leverage to negotiate lower prices. The current GLP-1 drugs list costs over US$1,000 per month, though many insured patients pay less. The Mercer report says prescription drug costs jumped eight percent last year, and overall health benefit costs are expected to rise 5.8 percent in 2025. Employers are also rethinking their relationships with PBMs — middlemen between drugmakers and insurers — amid concerns over transparency and pricing practices. Thirty-four percent are considering switching PBMs, and 40 percent are exploring alternative drug pricing models. The scrutiny follows regulatory criticism of major PBMs like CVS Caremark, Express Scripts, and Optum Rx for steering patients toward high-cost drugs — a claim the industry denies. This week, CalPERS, one of the nation's largest public healthcare purchasers, announced it would switch PBMs in 2026, citing the need for better oversight and transparency.
India Today
7 days ago
- Business
- India Today
US employers to cut health benefits amid soaring weight-loss drug costs: Survey
More than half of large US employers are planning to scale back healthcare benefits in 2026, as rising costs — driven largely by expensive weight-loss and speciality drugs — strain corporate budgets, according to a new survey by consulting firm survey, released on Wednesday, found that 51 per cent of companies with 500 or more employees intend to increase cost-sharing, such as higher deductibles and out-of-pocket maximums --- that's a notable jump from the 45 per cent of employers who said they would take similar measures for dramatic rise in popularity — and cost—of GLP-1 weight-loss drugs like Novo Nordisk's Wegovy has become a key pressure point, the consultancy said. "More clients are saying ... 'I don't know how much longer we can sustain covering these medications'," said Alysha Fluno, a pharmacy innovation leader at Mercer, in an some employers have covered GLP-1s hoping for long-term health savings, rising prices are forcing a rethink: "Some employers facing big cost increases in 2026 may feel this coverage is out of reach," Fluno Wegovy and Eli Lilly's Zepbound are listed at USD 1086 and USD 1059, respectively, but many patients pay less through their health to the survey, prescription drug costs jumped 8% last year. Mercer has forecast a 5.8 per cent rise in overall health benefit costs for 2025. Employers are also eyeing alternatives to traditional pharmacy benefit managers (PBMs), according to such as CVS Caremark, Cigna's Express Scripts, and UnitedHealthcare's Optum Rx act as middlemen between drug companies and consumers. They negotiate volume discounts and fees with drug manufacturers on behalf of employers and health plans, create lists of medications that are covered by insurance, and reimburse pharmacies for say they take an undisclosed cut of the discounts they receive rather than sharing them with patients and survey found 40 per cent of employers are considering alternative contracting models for their prescription medicine benefits, such as those that price drugs based on their cost to the pharmacy.- EndsWith inputs from Reuters
Yahoo
16-07-2025
- Health
- Yahoo
Employers are scrambling to cut costs and health care benefits are on the chopping block
Good morning! Health care costs have been rising for years, and finding a way to shoulder that burden and keep benefit prices low has been top of mind for employers. But companies are reaching their limit, and becoming more willing to push costs onto their employees, according to a new report. Around 51% of companies say they're likely or very likely to make design changes to their plans in 2026 that will place a larger burden on employees, according to a new study from HR consulting firm Mercer. That's up from 45% last year. Their methods are expected to include raising deductibles and out-of-pocket maximums for employees. Health care costs for workers are already up. The average costs of those benefits are expected to grow by 5.8% this year, up from 4.5% last year, according to the report. That's after accounting for any cost-reduction strategies, without which employers estimate that prices could actually rise around 8% this year. This increase in health care costs is largely due to an increase in prescription drug prices. Well over half of employers (61%) are now actively looking for some type of alternative to typical pharmacy benefit contracts. The increased popularity of GLP-1 weight-loss medications, which can cost around $1,000 per month per patient, is also contributing to higher benefit costs. Most organizations (77%) ranked managing the costs of these drugs as their highest priority when it comes to pharmacy benefits. But while the employers said they were more likely to add the coverage for 2025 than drop it, it's unclear if that will be the case next year, according to the report. 'While the trend over the past couple of years has been to add coverage for GLP-1s approved for weight-loss, some employers facing large cost increases in 2026 may feel this coverage is out of reach,' says Alysha Fluno, pharmacy innovation leader at Mercer. 'Employers are weighing the immediate costs of covering these drugs against the potential for generating savings down the road once their workforce's health improves.' In the future, employers may require more documentation from employees who use GLP-1s, increase the eligibility requirements, or limit the number of providers and pharmacies for the medication, according to the report. 'While short-term cost containment actions might be needed to address current budget realities, we also see some employers using longer-term strategies, such as offering narrow network plans, that emphasize high-quality, high-value care,' says Ed Lehman, Mercer's U.S. health and benefits leader. 'These strategies may improve health outcomes or make health care more affordable for employees.' Brit This story was originally featured on Solve the daily Crossword
Time of India
16-07-2025
- Health
- Time of India
Many US employers plan to pare health benefits as weight-loss spending soars
New York: More than half of large U.S. employers plan to scale back healthcare benefits next year as rising costs from weight-loss and specialty drugs squeeze budgets, according to a new survey released by consulting firm Mercer on Wednesday. Among employers with 500 or more workers, 51% said they planned to increase cost-sharing in 2026, including raising deductibles and maximum out-of-pocket costs for workers. That is up from 45% of large employers who said they would increase cost-sharing for 2025. Concern over the cost of GLP-1 weight-loss drugs like Novo Nordisk's Wegovy has surged, with 77% of employers naming them a top issue, the consultancy said. "More clients are saying ... 'I don't know how much longer we can sustain covering these medications'," said Alysha Fluno, a pharmacy innovation leader at Mercer, in an interview. While some employers have covered GLP-1s hoping for long-term health savings, rising prices are forcing a rethink: "Some employers facing big cost increases in 2026 may feel this coverage is out of reach," Fluno said. Greater competition in the weight-loss drug market in coming years will give pharmacy benefit managers more negotiating power with drugmakers and drive meaningful cost reductions, said Fluno. Novo's Wegovy and Eli Lilly's Zepbound are listed at $1086 and $1059, respectively, but many patients pay less through their health plans. Prescription drug costs jumped 8% last year, according to the survey. Mercer has forecast a 5.8% rise in overall health benefit costs for 2025. Employers are also eyeing alternatives to traditional pharmacy benefit managers (PBMs), according to Mercer. PBMs such as CVS Caremark, Cigna's Express Scripts and UnitedHealthcare's Optum Rx act as middlemen between drug companies and consumers. They negotiate volume discounts and fees with drug manufacturers on behalf of employers and health plans, create lists of medications that are covered by insurance, and reimburse pharmacies for prescriptions. Drugmakers say they take an undisclosed cut of the discounts they receive rather than sharing them with patients and payers. Regulatory scrutiny and calls for transparency are fueling interest in new models and emerging PBMs, with 34% of employers considering a switch. The survey found 40% of employers are considering alternative contracting models for their prescription medicine benefits, such as those that price drugs based on the wholesale price that retail pharmacies pay for them. Regulators have criticized the three largest pharmacy benefit managers for steering patients toward more expensive drugs and inflating prices to generate revenue gains, an accusation that the industry denies. California pension fund CalPERS, the second-largest public purchaser of health benefits in the U.S., announced on Tuesday that Caremark would replace UnitedHealth's Optum Rx as the fund's PBM in 2026. CalPERS said its five-year contract with Caremark requires the PBM to boost transparency and oversight.
Reuters
16-07-2025
- Business
- Reuters
As weight-loss spending soars, US employers plan to pare health benefits
NEW YORK, July 16 (Reuters) - More than half of large U.S. employers plan to scale back healthcare benefits next year as rising costs from weight-loss and specialty drugs squeeze budgets, according to a new survey released by consulting firm Mercer on Wednesday. Among employers with 500 or more workers, 51% said they planned to increase cost-sharing in 2026, including raising deductibles and maximum out-of-pocket costs for workers. That is up from 45% of large employers who said they would increase cost-sharing for 2025. Concern over the cost of GLP-1 weight-loss drugs like Novo Nordisk's ( opens new tab Wegovy has surged, with 77% of employers naming them a top issue, the consultancy said. "More clients are saying ... 'I don't know how much longer we can sustain covering these medications'," said Alysha Fluno, a pharmacy innovation leader at Mercer, in an interview. While some employers have covered GLP-1s hoping for long-term health savings, rising prices are forcing a rethink: "Some employers facing big cost increases in 2026 may feel this coverage is out of reach," Fluno said. Greater competition in the weight-loss drug market in coming years will give pharmacy benefit managers more negotiating power with drugmakers and drive meaningful cost reductions, said Fluno. Novo's Wegovy and Eli Lilly's (LLY.N), opens new tab Zepbound are listed at $1086 and $1059, respectively, but many patients pay less through their health plans. Prescription drug costs jumped 8% last year, according to the survey. Mercer has forecast a 5.8% rise in overall health benefit costs for 2025. Employers are also eyeing alternatives to traditional pharmacy benefit managers (PBMs), according to Mercer. PBMs such as CVS Caremark, Cigna's Express Scripts and UnitedHealthcare's Optum Rx act as middlemen between drug companies and consumers. They negotiate volume discounts and fees with drug manufacturers on behalf of employers and health plans, create lists of medications that are covered by insurance, and reimburse pharmacies for prescriptions. Drugmakers say they take an undisclosed cut of the discounts they receive rather than sharing them with patients and payers. Regulatory scrutiny and calls for transparency are fueling interest in new models and emerging PBMs, with 34% of employers considering a switch. The survey found 40% of employers are considering alternative contracting models for their prescription medicine benefits, such as those that price drugs based on the wholesale price that retail pharmacies pay for them. Regulators have criticized the three largest pharmacy benefit managers for steering patients toward more expensive drugs and inflating prices to generate revenue gains, an accusation that the industry denies. California pension fund CalPERS, the second-largest public purchaser of health benefits in the U.S., announced on Tuesday that Caremark would replace UnitedHealth's Optum Rx as the fund's PBM in 2026. CalPERS said its five-year contract with Caremark requires the PBM to boost transparency and oversight.
