Open enrollment trends: More employers to cover weight loss drugs next year

As many employers prepare for 2024 benefits open enrollment, two coverage offerings are showing rapid growth: new weight loss drugs such as Wegovy and Ozempic and personalized medicine, which relies heavily on genetic testing.

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Nearly half of large employers (49%) expect to cover the new weight loss medications as part of their health plans, according to the 2024 Large Employers’ Health Care Strategy and Plan Design Survey by the Business Group on Health, which queried 152 larger employers. These are the medications, known as semaglutides, that have received so much attention this year for their high effectiveness but also for their high prices. Wegovy, for example, can cost more than $1,350 per month without insurance, according to CNBC.

In 2023, 46% of major employers covered the cost of the semaglutide drugs for weight loss, up about 6 percentage points since 2015, according to a report in PharmacoEconomics.

Employers’ gradually growing interest in covering weight loss drugs comes as 51% of the global population is projected to be overweight or obese by 2035 if current health trends continue, according to a report by the World Obesity Federation. And the global economic impact of overweight and obese citizens is anticipated to reach a staggering $4.32 trillion annually by the same year.

Still, some employers have balked at coverage because of the cost and for other reasons, including drug shortages and concerns about prescribing Ozempic, a diabetes medication, for weight loss without the FDA’s approval for that usage, says Ellen Kelsay, president and CEO of Business Group on Health. Still, nearly two-thirds of the large employers surveyed (62%) are planning to cover their costs for employees within two years.

Employers are planning to exercise caution when it comes to all types of new medications, limiting coverage for the initial supply.

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“We see 79% of employers are indicating they will do this to ensure employees are getting the right medication and dosage so they don’t have any adverse effects and abandon the medication,” says Kelsay.

Precision medicine in open enrollment

Coverage of personalized—also known as precision—medicine also is growing in popularity, according to the survey, with a majority of large employers (55%) expecting to offer coverage of at least one type of precision medicine in 2024, up 5 percentage points from this year. Precision medicine can include genetic testing for certain diseases or conditions based on family history, as well as immunotherapies that aim to activate or suppress the immune system to combat disease.

Specifically, coverage of genomic testing, which looks at a person’s entire genetic makeup and can indicate conditions like cancer, will edge up 1% to 44% of employers in 2024, and by 2026, a majority of employers (52%) expect to offer it, according to the report.

In addition, nearly a quarter of employers (22%) plan to offer coverage next year of pharmacogenomic testing, which evaluates people’s genes to determine how they will respond to medications. That’s up from 20% in 2023—and expected to jump to 32% by the end of 2026, according to the survey.

Other benefits trends for open enrollment

Coverage for cancer screenings, salary-based premium contribution tiers and mental health coverage for employees’ children are among the benefits more employees will encounter this open enrollment season, according to the survey.


Starting in January, 77% of large employers expect to cover at least one type of cancer screening, in part because many employees postponed such proactive steps during the pandemic, according to the Business Group report.

“The potential for late-stage cancers that may be coming down the line in the next few years has employers focusing on providing or covering screenings,” says Brenna Shebel, vice president at Business Group on Health.

Other cancer-screening measures attracting a greater number of employers in 2024 include alternatives to colonoscopies, which 49% of employers plan to offer in 2024, up from 42% this year, according to the survey. Meanwhile, the percentage of employers promoting lung cancer screenings will nearly double in the New Year to 20% from 12%.

Contribution tiers

Some employers are also addressing health inequities within their programs this open enrollment. According to the Business Group report, 18% of employers list implementing new initiatives to reduce health inequities within their health plans as a top priority.

And in 2024, 95% of employers will implement at least one strategy to address health inequities, the report notes. For example, 86% of employers plan to work with their employee resource groups to promote benefits and wellbeing initiatives to targeted groups. Meanwhile, 44% of employers will solicit employee input to identify disparities in accessibility, participation, employee experience and outcomes.

Casey Hauch, managing director at Willis Towers Watson, says some organizations are seeking ways to help employees balance the cost of healthcare by determining the amount they’ll pay for premiums based on their salary.

“The whole notion of diversity, equity and inclusion is really about making it a more equitable playing field for people,” Hauch says.

Mental health

Employers expect to significantly increase their focus on adolescent and young adult mental health in 2024, with 24% of employers citing these plans compared to 17% for 2023, the survey found. Driving this increased interest is the ongoing mental health crisis among American youth, greatly exacerbated by the pandemic; one year after COVID-19 hit, a number of leading pediatric health organizations declared a National State of Emergency in Children’s Mental Health.

This focus comes as 63% of employers plan to expand the mental health networks they offer their employees and their families in 2024, up from 47% for this year.

Dawn Kawamoto, Human Resource Executive
Dawn Kawamoto
Dawn Kawamoto is HR Editor of Human Resource Executive. She is an award-winning journalist who has covered technology business news for such publications as CNET and has covered the HR and careers industry for such organizations as Dice and Built In prior to joining HRE. She can be reached at [email protected] and below on social media.