Medical cost trends have risen by 10% since 2022. But the cost trend for Rx is over 17% for the same period. Much of this increase in Rx is due to exploding sales for GLP-1s (such as Ozempic, Wegovy, Zepbound and Rubelsus) for use as weight loss drugs, driving costs to unsustainable levels for both...
Dental expenses can be a significant financial burden, especially when unexpected dental procedures arise. For those who have health savings accounts (HSAs) or medical flexible spending accounts (FSAs), there are opportunities to save money on these expenses. We answer a few common dental-related questions as it relates to your HSA or medical FSA. Can...
Did you recently elect to participate in a medical flexible spending account (FSA)? If you’re a first-time medical FSA participant, you may not be familiar with FSA definitions and rules. We’ve provided a list of the top things a first-time medical FSA participant should be aware of to take full advantage of their FSA. ...
The season for filing taxes is upon us once again. We’re getting closer to the deadline for filing for 2025. We wanted to share a few tips and reminders about the health savings account (HSA) information you’ll need for your tax return. These will help you get organized and prepared for easy and successful filing....
Saving, investing and retirement planning. These are just three of the perks you’ll experience when you participate in a health savings account (HSA). To be eligible for an HSA, there are only a few requirements, with two of the big ones being that you must be covered by a high-deductible health plan (HDHP), and you...
When managing pre-tax health accounts such as HSAs, FSAs and HRAs, it is easy to assume that all medical expenses automatically qualify for reimbursement. However, some services and products require additional documentation before they are considered eligible. That documentation is called a Letter of Medical Necessity. If you or your employees have ever been asked...
Flexible spending accounts (FSAs) provide you with a smart way to save money on healthcare and dependent care expenses (depending on the type of FSA you’re enrolled in). When you participate in an FSA, you’re putting money aside before it is taxed so you can save on eligible expenses. However, you may have a number...
Congratulations, benefits professionals! You’ve accomplished another year’s open enrollment! Whether you survived or thrived, you have an opportunity to lead your organization’s benefit evaluation. It’s time to charge full speed ahead with your open enrollment aftermath strategy. By analyzing what went right and what could be improved, you can help ensure an easier, more effective...
In 2026, the IRS explicitly warned consumers about misleading “FSA Eligible” labels, particularly from companies claiming that general wellness items like meal plans or gym memberships can be converted into medical expenses through “letters of medical necessity” obtained via online questionnaires. Retailer “FSA eligible” badges are not a legal guarantee of reimbursement. Eligibility is...
Medical cost trends have risen by 10% since 2022. But the cost trend for Rx is over 17% for the same period. Much of this increase in Rx is due to exploding sales for GLP-1s (such as Ozempic, Wegovy, Zepbound and Rubelsus) for use as weight loss drugs, driving costs to unsustainable levels for both insured and self-insured plans. Because over 45% of GLP-1 prescriptions now flow outside of the traditional PBM/retail pharmacy ecosystem, controlling eligibility is key to controlling costs.
There have been court challenges to this action. However, the First Circuit Court of Appeals handed down a decision in late April (Holland v. Elevance Health, Inc., 2026 WL 850818) that affirmed a lower court’s ruling rejecting the claim that removing these drugs violated ACA Section 1557’s anti-discrimination provisions.
Many employers have removed GLP-1s from their Rx formulary and use a GLP-1 HRA to maintain employee access to GLP-1s while controlling costs.
A GLP-1 HRA is an employer-funded Health Reimbursement Arrangement designed to specifically cover the costs of GLP-1 medications while managing skyrocketing employer expenses. It allows employers to cap their financial liability by setting a defined, annual or quarterly maximum reimbursement amount rather than having an open-ended pharmacy cost. Employees usually pay for the medication up-front (particularly with direct-to-consumer pharmacy pricing options) and submit claims to be reimbursed by the HRA. Coverage is often restricted to specific conditions, such as Type 2 diabetes or documented obesity, and may require a showing of medical necessity and/or adherence to a managed weight-loss program.
GLP-1 HRAs are just one of many innovative programs that employers are using to cope with exploding cost trends.
The information in this blog post is for educational purposes only. It is not investment, legal or tax advice. For legal or tax advice, you should consult your own counsel. To stay up to date on benefits trends and insights, subscribe to our blog.
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