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Mike Hill, Total Control Health Plans<\/p>\nCompanies are increasingly implementing options to mitigate the high cost they pay for prescription drugs for their employees.\u00a0<\/p>\n
Mike Hill, Total Control Health Plans<\/p>\n
In an annual client survey by Holland-based benefits firm Total Control Health Plans LLC, more employers than last year reported that they do not cover popular GLP-1 drugs to treat obesity. More employers also are directing their workers to shop around for the lowest-cost pharmacy when they need to have a prescription filled.\u00a0<\/p>\n
\u201cPrescription drugs are a commodity, and there are drastically different prices for the same commodity,\u201d said Total Control Health Plans founder Mike Hill. \u201cWhen (employers are) trying to figure out how do we solve this health care cost issue, they have changed the trajectory of their plan. The pain is getting so great. In the grand scheme of things in terms of disrupting a plan, that\u2019s an easy lever to pull because it solves the problem in many cases and it doesn\u2019t disrupt many folks.\u201d\u00a0<\/p>\n
Hills cites a nonprofit organization in the Holland area that got a 34% increase this year for employee health benefits that drove the cost of employee health coverage from $450,000 in 2024 to $700,000 in 2025. Much of the increase was for prescription drug benefits, he said.\u00a0<\/p>\n
Keep up with all things West Michigan business. Sign up for our free newsletters today<\/a>.<\/p>\n \u201cThe primary driver was \u2018you have a handful of $100,000 prescription drugs,\u2019 and that\u2019s the justification for the increase,\u201d Hill said.\u00a0<\/p>\n Of the companies answering this year\u2019s Total Control Health Plans survey, just 15% cover GLP-1 drugs for weight loss. That\u2019s down from 24% a year earlier for GLP-1s such as Wegovy, Ozempic and Maunjaro that typically cost $700 to $2,000 a month.\u00a0<\/p>\n Companies are generally still covering the use of GLP-1s for treating diabetes, sleep apnea and other conditions.\u00a0<\/p>\n Rebekah Gregg, chief operating officer for Plano, Texas-based Pharmaceuticals Strategies Group, noted in a presentation at a Total Control Health Plans benefits seminar in Grand Rapids that GLP-1 drugs are \u201creally effective, and they\u2019re really expensive.\u201d\u00a0<\/p>\n Gregg said that lower-cost generic versions of GLP-1s are six years away \u201cat best,\u201d as more medical conditions are getting approved for their use, such as cardiovascular and fatty liver disease. In the meantime, companies who self-fund their health insurance are going to have to address the drugs and decide whether to cover them, she said.\u00a0<\/p>\n \u201cYou\u2019re going to have to actively manage that GLP-1 spend and plan for it,\u201d Gregg told attendees at the Total Control Health Plans seminar.\u00a0<\/p>\n Michigan\u2019s largest health insurer, Blue Cross Blue Shield of Michigan, decided last year<\/a> to stop paying for GLP-1 obesity drugs starting in January 2025.\u00a0<\/p>\n In the last few years, Blue Cross Blue Shield and other health insurers\u00a0have blamed the high costs of prescription medications, particularly specialty drugs, for driving up premiums by double-digit rates.\u00a0<\/p>\n Blue Care Network, the 290,000-member Blue Cross Blue Shield HMO subsidiary, paid $370.6 million in prescription drug claims through the first half of 2025, a 16.1% increase over the same period in 2024, according to a quarterly financial report to state regulators.\u00a0<\/p>\n At Grand Rapids-based Priority Health, prescription drug claims paid by its 725,000-member commercial HMO product have increased 11.5% this year to $433.1 million.\u00a0<\/p>\n In other areas of the Total Control Health Plans survey, the number of employers whose health benefits do not cover high-cost gene therapies increased from 36% in 2024 to 40% in 2025.\u00a0<\/p>\n As pharmacy costs keep rising, employers answering the survey also\u00a0indicated that they are more frequently adopting and promoting prescription cost-savings programs. \u00a0<\/p>\n Among survey respondents, 47% promote using GoodRX to compare pharmacy prices. Another 15% direct their employees to Mark Cuban\u2019s Cost Plus Drugs to shop for the lowest price, nearly double the rate from a year earlier.\u00a0<\/p>\n Another 17% of survey respondents said they are promoting the use of foreign pharmacies for employees to buy prescription drugs.\u00a0<\/p>\n The number of companies who said they do not presently promote any method to reduce prescription drug claims declined from 25% in 2024 to 17% this year.\u00a0<\/p>\n More from Crain\u2019s Grand Rapids Business:<\/p>\n Leader Publications sold as Kentucky media firm expands in Southwest Michigan<\/a><\/p>\n DFCU Financial searches for Grand Rapids market leader to grow business lending<\/a><\/p>\n![\"\"](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2025\/09\/IMG_3188-scaled.jpg.optimal.jpg\")
Rebekah Gregg, chief operating officer for Pharmaceuticals Strategies Group, discusses the efficacy and cost of GLP-1 drugs during a presentation at a Total Control Health Plans benefits seminar in Grand Rapids. Credit: Mark Sanchez, Crain\u2019s Grand Rapids Business<\/p>\n