In Women’s Health, a New Coalition Aims to Keep Up the Progress
BY Abigail Abrams July 17, 2024Women’s health care, long neglected by medical researchers and tech innovators in the U.S., is starting to get its due. A new coalition of digital health companies aims to harness the energy around women’s health to boost the accessibility and affordability of their care by working with employers to improve corporate benefits and workplace support.The group, called the Women’s Health Coalition for Digital Solutions, combines the mental-health platform Talkspace and the family-health company Ovia Health with other startups aimed at everything from fertility to menopause to nutrition and fitness.In its first year, the collective is focused on awareness and de-stigmatization efforts as well as using its members’ influence to advocate for workplace health equity. In future years, the coalition’s founders say they would like to encourage more investment in women’s health technology and enhance the patient experience by exploring integration among their many services.The idea for the group came about when Talkspace, which has expanded its business-to-business offerings in the last few years, was looking for partners, and executives saw a growing customer need in the realm of women’s health.“Women are busy. We manage our homes, we manage our work life, we’re managing our own personal happiness,” said Natalie Cummins, chief business officer at Talkspace. “What we’re hearing from our customers is that three barriers that still exist are stigma, access, and affordability.” She and other coalition partners are quick to note stats that show while women live longer than men, they spend 25% more time in “poor health” and they pay $15 billion more per-year in out-of-pocket health care costs than employed men. So Talkspace sought out other virtual health providers who shared their goal of helping people access care remotely, and intentionally put together a group that serves each point in a woman’s life cycle. In addition to Talkspace and Ovia Health the founding members include Conceive, which offers fertility and pregnancy support; Evernow, which offers menopause care; Nurx, a telehealth company that prescribes birth control, acne treatment, and other medications; FitOn, a fitness app; and Nutrium, which provides nutrition counseling. The coalition is part of a growing trend of employers prioritizing fertility and other family-building benefits in the last few years. The percentage of U.S. organizations offering such benefits increased from 30% in 2020 to 40% in 2022, according to the International Foundation of Employee Benefits Plans. The focus has expanded to include menopause, which has been poorly understood and little-discussed in the workplace. About 15% of companies surveyed by Mercer in 2023 provided menopause-specific benefits—up from just 4% in 2022. “We are seeing people respond to us in a way that is really taking menopause seriously as they should,” says Donna Klassen, a clinical social worker and co-founder of advocacy group Let’s Talk Menopause. She is particularly eager to see efforts aimed at changing the culture and policies around menopause in the workplace, as research has shown that menopause symptoms–and the stigma around them–can negatively impact both women and employers. Researchers at Mayo Clinic found that menopause symptoms cost the U.S. $1.8 billion in lost work time per year, for example. “When people have support at work, they are less likely to feel that they want to leave,” Klassen said. She emphasized the importance of trusted information as more women and their employers address menopause publicly. “People want their questions answered, and doctors don’t always have the time,” she said. “So let’s make sure you’re getting your information from credible sources.” Let’s Talk Menopause offers workshops and other educational programs to individuals and companies seeking to learn about menopause.That kind of education is key to the new coalition’s goals too. It’s “really an opportunity to drive some of the thought leadership with people who have been in this industry for a while and who are invested in improving the lives of women,” said Corrinne Hobbs, general manager and VP of enterprise and strategic partnerships at Ovia Health.Corrinne Hobbs, general manager and VP of enterprise and strategic partnerships at Ovia Health (Photo courtesy of Ovia Health)As the group develops, Hobbs says she sees the coalition companies being in a good position to provide services, advice, and research for companies that want to improve their benefits or policies in ways that support women’s health. Their effort comes as the U.S. continues to see the consequences of the Supreme Court’s decision overturning the federal right to abortion, which has led to other restrictions on reproductive health around the country. Cummins, Hobbs, and other coalition partners say they are not wading into national politics, but are focused on enhancing access to women’s health care for as many people as possible. They were pleased to see President Joe Biden’s executive order expanding research on women’s health earlier this year, for example, and are hoping this is a sign of progress. “For many years, women were thought of as tiny men and weren’t really required to be in clinical research,” said Lauren Berson, CEO and founder of Conceive, the fertility-support app that’s one of the coalition’s founding members. As part of the effort from the federal government, the National Institutes of Health will focus new research on menopause and an array of other health issues that affect women, including Alzheimer’s and conditions like endometriosis and fibroids.Conceive is especially focused on equipping its users with the science and information they need to navigate the experience of getting pregnant. “There’s just so much more we can do together when we think about the lack of research and the lack of infrastructure,” Berson said.The members of the new coalition say they have already heard from companies who want to join the group, but they know there is still a long way to go. Some first steps for employers looking to support women’s health, they say, are to design benefits plans that reduce the out-of-pocket costs for women, remove barriers to seeking care, and ensure benefits cover the full spectrum of employees’ experiences. “Ensuring that your workplace supports women is crucial,” says Hobbs of Ovia Health. “So what does that look like? Improving the parental leave policy, flexible work initiatives, ERGs to really understand the needs of employees and then also minimizing the caregiver burden at home.” Abigail Abrams is a health writer and editor. Currently she is the senior manager of content operations for Atria. Previously, she was a staff writer on health and politics for TIME magazine. Her freelance work has appeared in the Washington Post, the Guardian, and other publications.(Featured photo by SDI Productions/iStock by Getty Images)
Workers Want Weight-Loss Drugs, But How Can Employers Pay the Bills?
BY Abigail Abrams April 15, 2024When consumers see splashy TV commercials for weight-loss drugs, they often find the the pitch irresistible. But for HR and benefits executives, they may trigger an uneasy feeling. That's because the revolutionary weight-loss drugs like Wegovy bring with them both magic and mystery–the magic is how well they can work; the mystery is how to pay for them.GLP-1, or glucagon-like peptide-1, drugs have historically been used to treat diabetes. But the development of stronger drugs like Novo Nordisk’s Ozempic in recent years, and now the approval of Wegovy and Eli Lilly’s Zepbound specifically for weight management, has led to a sharp increase in demand. That’s particularly true as more research emerges showing the drugs may also reduce the risk of cardiovascular disease, stroke, and potentially bring other long-term health benefits. Yet the medications can cost as much as $1,000 to $1,500 per month–a price that few Americans can afford unless they have generous health-insurance coverage.And unlike expensive drugs for rare conditions, the potential number of patients for GLP-1s is vast. More than 40% of Americans have obesity, according to the Centers for Disease Control and Prevention, and that is expected to reach 50% by 2030.Many doctors are thrilled about the potential for GLP-1s to change how obesity is treated, but that puts employers–where nearly half of Americans get their health insurance–in a tricky position. Here’s what employers need to know as they consider coverage for these drugs in the quickly changing landscape:High Costs, Low CoverageWhile employer health plans widely cover GLP-1s for the purpose of treating diabetes, coverage for weight-loss purposes is much more spotty right now. A survey last fall by the International Foundation of Employee Benefit Plans found that 27% of 205 employers covered GLP-1s for weight loss and another 13% did not yet cover them but were considering adding coverage. Meanwhile, Willis Towers Watson (WTW), a global insurance benefits-consulting company that serves many large employers, found about 38% of employers it surveyed cover the weight-loss drugs. Those that do cover them are seeing significant cost increases. The retail price for Wegovy comes out to $15,000 to $16,000 per year, and after rebates and discounts from manufacturers, health plans still pay about $9,000 per year, says Cody Midlam, a director at WTW’s pharmacy practice. The cost per member per month for GLP-1s has doubled each of the last three years, according to WTW’s analysis, amounting to an extra $11 per member per month last year, or about 9% of all pharmacy costs.Companies are aware of the research showing the drugs’ effectiveness at tackling obesity. Yet while doctors say that helping people lose weight could lead to less cardiovascular disease, fewer mental health issues, and savings from avoiding knee replacements or other surgeries related to obesity, long-term data on clinical outcomes remains limited. With high employee turnover in many industries, it’s tough for these employers to factor in potential future savings in healthcare costs over the life of the employee.“Those outcomes take a very long time to manifest,” says Midlam. “It’s not something that’s easily measurable on a short timescale when plan decisions are being made.” Andrew Witty, CEO of UnitedHealth Group, the largest U.S. insurer, said his corporate clients see the benefits, but first have to deal with the short-term costs. “We’re very positive about the potential for another tool in the toolbox to help folks manage their weight. We recognize that has potential benefits,” Witty said in the third-quarter earnings call last year. “But we’re struggling.”Employers Meet the DemandDespite the high costs and headlines about some insurance plans scrapping GLP-1 coverage, plenty of employers see the upside to covering the new obesity medications. Ninety-nine percent of companies already covering GLP-1s said they planned to continue doing so next year, according to a fall survey from Accolade, a healthcare navigation and advocacy company. Employers reported that after they added GLP-1 coverage, they saw higher employee satisfaction, increased engagement in other well-being programs, and improvements in other or comorbid health conditions. Midlam of WTW says his firm’s corporate clients want to “avoid member disruption” wherever possible.Doctors agree that should be a priority. Dan Azagury, M.D., medical director for the Stanford Lifestyle and Weight Management Center, says GLP-1s have been a “game changer” for many of his patients. “If you stop it overnight, whether it’s insurance, or financial, or shortages, the rebound is ferocious,” he said. “So it’s really very frustrating that they encounter that situation.” Some companies have expressed concerns about the idea of paying for a drug that employees essentially have to take forever to maintain its benefits. But while side effects, including vomiting and gastrointestinal issues, can be unpleasant for some people, doctors like Azagury say they know how to help patients manage them, and that they are seeing more patients have a positive response to GLP-1s than to previous generations of weight loss medications. Holistic Care, Not Just PrescriptionsEven when employers decide they want to help their employees lose weight, there are still lots of details to consider. As companies approach designing their insurance plans for 2025 and beyond, they are trying to figure out how many employees are likely to use GLP-1 drugs if coverage is offered, whether there should be limits on who can get the drugs, and what kind of requirements they should use to prove the drugs are medically necessary. Most companies that cover GLP-1s use some cost-control strategies, according to the International Foundation of Employee Benefit Plans survey. Many use prior authorization, step therapy during which patients must try lower-cost drugs first, or specific eligibility requirements.Typically, eligibility requirements have been tied to the standards on the FDA labels for these medications. But some employers are considering restrictions such as only covering the drugs for people with obesity but not those who are overweight, says Tracy Spencer, a pharmacy practice leader for benefits consultant Aon. If they add those limits, she warns that employers should be aware that could change or jeopardize the rebates they get from the drug manufacturers, so they need to predict whether the savings they get from limiting the drugs’ use will offset the loss of the rebates.Benefits consultants like Aon and WTW are also seeing employers shift the way they look at GLP-1 drugs to view them as one piece in a broader strategy to address cardio-metabolic issues.That might mean employers choose to cover the drugs for targeted indications, such as covering Wegovy not for weight loss on its own, but for people with increased risk of cardiovascular disease, which Medicare recently announced it would do. It can also mean pairing GLP-1 coverage with required lifestyle modifications or participation in a virtual weight-loss or coaching program. Employers often have access to virtual health programs through their pharmacy benefit managers, and many have tried these to target diabetes in recent years. The biopharmaceutical company Moderna, which offers coverage of GLP-1s for diabetes and weight management, is one company that has tried this strategy. “In 2023 we saw a spike related to weight-loss management: We looked at claims data, and after mental health, obesity and weight management were the second drivers,” Jeffrey Stohlberg, Moderna’s director of corporate benefits, said at a From Day One conference earlier this year. So the company started using the virtual weight-loss management program Wondr Health, where an employee can work with a physician specializing in weight loss. “It’s not a path to GLP-1s, but [the physicians] can provide medication for that person,” Stohlberg said. Labcorp also announced in February that it would provide U.S. employees on GLP-1s with virtual care and medication management through WeightWatchers for Business. Other companies such as Omada Health and telehealth providers like Teladoc and Ro have launched similar offerings over the last year. Medical providers agree that a holistic approach is needed, but Angela Fitch, M.D., president of the Obesity Medicine Association and co-founder and chief medical officer of the obesity-focused primary care startup knownwell, worries that requiring a standard weight-management program for every person is another barrier and potentially a waste of money if the program doesn’t have solid evidence behind it.“You can offer lifestyle [strategies] in addition to medication,” she said, “but it should be driven by that shared decision making discussion with the clinician.” If insurers want to make sure patients are getting holistic care, she would rather have them require patients to get their prescriptions from a qualified physician who does a true evaluation so that solutions can be personalized. In her role with the Obesity Medicine Association, Fitch often advises employers on their health plan designs, so she understands that costs are a major concern for companies. But in her primary-care practice and others like it, she says her staff are “burning out” as they spend hours each day trying to navigate all the new and often strict and confusing insurance requirements for these medications. “We have got to deal with costs,” Fitch said. “But it should be transparent and flexible.” She worries that overly rigid restrictions are “adding to the bias and stigma of obesity” by signaling to patients that their weight is their responsibility to treat on their own. Her major advice is to view obesity with the nuance that people view other chronic conditions. “You do not need a GLP-1 management solution. You need a comprehensive obesity-care solution.”Abigail Abrams is a health writer and editor. Currently she is the senior manager of content operations for Atria. Previously, she was a staff writer on health and politics for TIME magazine. Her freelance work has appeared in the Washington Post, the Guardian, and other publications.