Winter 2023
2024 Maxor Formulary Updates
Maxor PBM has released summaries of their 2024 formulary updates which will be effective January 1, 2024. The summaries include medications that are new exclusions and medications that are moving from preferred to non-preferred. We have conducted a disruption analysis based on these changes and there are no TPSC members that will be negatively impacted. The Preferred and Advantage formulary changes can be found below.
Advantage Formulary Updates
Preferred Formulary Updates
MaxorPlus Advantage Formulary with Exclusion List
MaxorPlus Preferred Formulary
GLP-1 Coverage in Employer Plans Could Nearly Double in 2024
The increase in interest and utilization of GLP-1 medications for diabetes management and weight loss has some HR representatives hesitant to add coverage of these medications to their benefits. Despite the assumption that this would primarily be due to cost concerns, the survey data points to lack of information as the highest barrier to including coverage. Even though hesitancy remains, 43% of employers plan to offer GLP-1 medications in 2024 compared to the 25% that offer them now.
Are you looking for more information and guidance on how GLP-1 medications could affect your plan? TPSC Benefits is here to help you navigate the uncertainties of high-cost medications and create a custom solution that works for you.
Law Alert—Longstanding Internal Revenue Service Position Called into Question
Class action lawsuits are on the rise surrounding plan language on forfeitures. The grievances call into question whether or not plan fiduciaries have violated duties of prudence and loyalty under ERISA law by using forfeitures to lower employer contributions instead of using them to reduce administrative expenses paid by participants enrolled in the plan. At this time, the IRS has not issued a statement on their position on the use of forfeitures, however, it may be time for plan sponsors to review their forfeiture provisions and decide if any action is needed in light of these pending cases.
TPSC is keeping a pulse on legislative updates and changes to keep your plan in compliance. If you have any questions, please reach out to your account representative today!
List Price of Weight Loss Drug Ozempic—U.S. Compared to Peer Nations
| Ozempic (semaglutide, injection) |
Rybelsus (semalglutide, tablets) |
Wegovy (semaglutide, injection) |
Mounjaro (tirzepatide, injection) |
|
|---|---|---|---|---|
| U.S. | $936 | $936 | $1,349 | $1,023 |
| Japan | $169 | $69 | - | $319 |
| Canada | $147 | $158 | - | - |
| Switzerland | $144 | $147 | - | - |
| Germany | $103 | - | $328 | - |
| Netherlands | $103 | $203 | $296 | $444 |
| Sweden | $96 | $103 | - | - |
| United Kingdom | $93 | - | - | - |
| Australia | $87 | - | - | - |
| France | $83 | - | - | - |
Note: List prices in $USD based on web searches as of August 15, 2023. Prices are for one-month supply of Ozempic 1mg, Rybelus 7mg, Wegovy 2.4mg, and Mounjaro 15mg. Some drugs are not available in all countries and prices were unable to be found in other countries. Some drugs are approved for diabetes and prescribed off-label for weight loss.
Source: KFF analysis of country websites (see Methods section) PNG
KFF recently published pricing information on top weight loss drugs in the U.S. compared to peer nations. The medication, Ozempic, a diabetic drug which has gained attention due to its off-label use for weight loss, has a list price that is more than 5 times higher than the next highest price in Japan. It is also worth noting that the U.S. also has the highest obesity rate compared to peer nations at 33.6%, which is another contributing factor in the high overall healthcare spending in the U.S. Read the full article below.