How to get coverage to pay for semaglutide and tirzepatide

First - I am sorry if you are not a decision maker on the benefits plans but this article is not for you. If you do own a company and want to cover Semaglutide and Tirzepatide for you and your employees then please read on.

In recent years, the landscape of healthcare has shifted significantly, with more employers seeking innovative ways to offer better benefits to their employees while managing costs. One particular area of interest for employers and employees alike is the ability to cover essential and sometimes expensive treatments, such as those involving semaglutides. These medications, which are used to manage diabetes and obesity, have become increasingly popular. Employers may not be aware that they can use Health Reimbursement Arrangements (HRAs) to help employees cover the cost of these medications. Here’s how.

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What Are Semaglutides?

?Semaglutides are a class of medications primarily used to treat Type 2 diabetes by helping to regulate blood sugar levels. More recently, they have also gained FDA approval for weight management, offering a dual benefit for individuals dealing with obesity and related metabolic disorders. Popular brands include Ozempic and Wegovy, both of which have been transformative for patients but come with a hefty price tag, making access a challenge for some employees.

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What Is an HRA?

?A Health Reimbursement Arrangement (HRA) is an employer-funded health benefit plan that reimburses employees for qualified medical expenses, including prescription drugs, co-pays, and insurance premiums. Unlike Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs), an HRA is solely funded by the employer, giving them more flexibility to design the benefit structure.

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Using an HRA to Pay for Semaglutides

?To cover semaglutides through an HRA, the employer needs to ensure that the medication is classified as a qualified medical expense under IRS guidelines. Because semaglutides are FDA-approved for the treatment of Type 2 diabetes and weight management, they typically fall under the category of eligible prescription drugs.

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Steps for Employers

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????? 1.?? Set Up an HRA Plan: Contact James Knox at Eagles and we will build a specific HRA that is built to pair with your existing health plans. These can also be done to cover other high cost medications.

????? 2.?? Determine Contribution Amounts: Employers need to decide how much they will contribute to the HRA each year. These funds are used to reimburse employees for their out-of-pocket expenses related to semaglutides and other qualified medical expenses.

????? 4.?? Submit Reimbursement Claims: When an employee incurs an expense, such as purchasing a semaglutide prescription, they can submit the receipt for reimbursement through the HRA. The employer then reimburses the employee up to the amount available in their HRA. Eagles handles all of the claims process so - Including providing a debit card to pay for the Rx directly (so no out of pocket costs and waiting for reimbursement).

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Compliance and Considerations

?When designing an HRA that covers semaglutides, employers must ensure they remain compliant with IRS regulations and healthcare laws. Here are some considerations:

??? ??????? Annual Limits: Employers can set a limit on how much they are willing to contribute to each employee’s HRA annually. This gives the employer control over healthcare costs while still offering valuable benefits.

?? ??????? Tax Advantages: HRAs provide tax advantages for both employers and employees. Employer contributions are tax-deductible, and employees receive reimbursements tax-free for qualified expenses.

?? ??????? Prescription Necessity: Some HRAs may require that employees provide a doctor’s note or prescription to ensure the semaglutides are being used for an approved medical condition, such as diabetes or obesity.

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The Advantages of Covering Semaglutides

?????? 1.?? Health and Wellness Benefits: By offering semaglutide coverage through an HRA, employers can significantly improve the health and wellness of their workforce. Employees managing chronic conditions like diabetes or obesity are likely to experience better overall health, leading to increased productivity and fewer sick days.

????? 2.?? Cost Control: HRAs allow employers to limit their healthcare spending by setting clear annual reimbursement limits. This helps control costs while still offering high-value benefits to employees.

????? 3.?? Attraction and Retention: Offering benefits like semaglutide coverage can make an employer more attractive in a competitive labor market. Employees, especially those managing chronic health conditions, will appreciate the comprehensive support for their health needs.

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Conclusion

?Incorporating semaglutides into an HRA plan allows employers to offer a valuable benefit while managing healthcare costs effectively. As these medications become more widely used for diabetes and obesity management, offering support through HRAs can enhance employee wellness and strengthen an employer’s overall benefits package. By following the steps outlined above and ensuring compliance with healthcare regulations, employers can provide significant health support to their employees, improving both well-being and workplace productivity.