The Challenges of High-Cost Therapies in Employee Benefit Programs

OAKLAND, Calif., Jan. 15, 2025 /PRNewswire/ -- The Integrated Benefits Institute (IBI) today unveiled a report on employers' challenges in incorporating high-cost therapies, such as cell and gene therapies (CGTs) and GLP-1 medications, into their employee benefit plans.

The report reveals that 33% of employers currently include CGTs in their benefit plans, with 36% actively evaluating CGT strategies. Notably, 58% of non-adopters plan to implement CGT benefits in the next 24 months. Most (90%) employers link CGT benefits to enhanced employee productivity and recognize CGTs' lifesaving potential to avert costly long-term interventions (91%).

Key findings indicate that stop-loss (SL) coverage strongly predicts CGT benefit adoption. Organizations with high revenue and SL coverage boast a 72% adoption rate, while small organizations without SL coverage have a 28% adoption rate.

Dr. Sera-Leigh Ghouralal, Senior Researcher at IBI, stated, "There is a strong relationship between organizational readiness and the adoption of these innovative therapies. Organizations with robust stop-loss coverage and ethical frameworks are over twice as likely to implement CGT benefits. Our findings also suggest that enhancing knowledge about CGTs is crucial for improving access to these potentially life-saving treatments."

Among consultants, 80% express the need for better information regarding CGT benefits. Additionally, 59% report their clients are hesitant to embrace these benefits, while 69% identify cost amortization as essential for adoption. This disparity between client understanding and action presents a significant challenge.

Eighty-seven percent of organizations provide some GLP-1 coverage to varying degrees: 35% cover diabetes only, 23% include obesity care and cardiovascular risk reduction, and 29% offer comprehensive coverage across all conditions. Among the 11.7% of organizations lacking GLP-1 coverage, 43% plan to implement coverage within 12 to 24 months, while 47% have no plans to include it.

While initial costs may appear high, the long-term advantages - such as reduced disability claims and improved productivity - offer compelling returns on investment. Organizations can lead the evolving employee benefits landscape by addressing knowledge gaps, fostering a supportive culture, and considering financial implications.

For a full report copy, please contact Colby Gray at [email protected].

About Integrated Benefits Institute

IBI is a national nonprofit research organization and business association serving over 1,600 employer and supplier members. The IBI's research, tools, and data resources help companies link health-related programs to outcomes that maximize productivity and business performance. For additional information, visit www.ibiweb.org and follow us on https://www.linkedin.com/company/92241/LinkedIn and X.

MEDIA CONTACT
Colby Gray, CD+M Communications
Integrated Benefits Institute
207.536.4646
[email protected]

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SOURCE Integrated Benefits Institute