House lawmakers in Washington are closing in on the signatures they need to force a vote on a bill to eliminate rules that reduce Social Security benefits for certain retirees who also receive pension income.

On Thursday morning, Reps. Abigail Spanberger, D-Va., and Garret Graves, R-La., marked the 206 signatures a discharge petition had thus far collected with a press conference outside the Capitol building alongside organizations representing police, firefighters, postal workers, teachers and other government employees often affected by those rules.

By Thursday afternoon, the number of signatures had climbed to 217. To force a vote on the bill, the lawmakers need 218 signatures.

The bipartisan bill — the Social Security Fairness Act — would repeal rules known as the Windfall Elimination Provision, or WEP, and the Government Pension Offset, or GPO, that currently reduce Social Security benefits for almost 3 million Americans.

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“We have taken on, on a bipartisan basis, something that’s just completely unjust, that has been going on for over four decades,” Graves said.

“This is a situation where you have some of the most important occupations, some of the most important contributors to our community, that are being discriminated against,” he said.

The Windfall Elimination Provision reduces Social Security benefits for individuals who receive pension income from public roles that did not contribute Social Security payroll taxes — but who also paid into the program and qualified for benefits through other work. The WEP affects about 2 million Social Security beneficiaries.

The Government Pension Offset, meanwhile, reduces spousal benefits for federal, state or local government employees who did not contribute to Social Security payroll taxes. The GPO affects almost 800,000 retirees.

The rules can force affected workers to make tough retirement decisions.

That includes Lois Carson, president of the Ohio Association of Public School Employees, who said during Thursday’s press conference that the rules affected the decisions she made to support her family after her husband passed away. While Carson was able to receive income from his pension, she was not able to access Social Security survivor benefits, as she and her husband both worked as public employees.

“I continue to work after 37 years, because if I retire, I’m going to lose half of my funding because of this law,” Carson said.

Carson cited a friend who lost the $1,200 monthly Social Security benefit checks she received on her husband’s record after she retired from her job as a public-school employee.

The bill to repeal the WEP and GPO rules is the “most bipartisan and co-sponsored bill in the United States Congress,” Rep. Greg Landsman, D-Ohio, said Thursday.

The House version of the bill currently has 327 co-sponsors.

If the bill is put up for a vote in the House, it may pass experts say.

However, it remains to be seen whether it would also be put up for a vote in the Senate, where the bill has 62 co-sponsors.

Time constraints may limit the effort’s progress, Emerson Sprick, associate director for the Bipartisan Policy Center’s economic policy program, recently told CNBC.com.

“Both the Senate and the House have a lot of work to do before the end of the year,” Sprick said.

While experts agree the WEP and GPO rules could be adjusted to be fairer, some say eliminating them altogether may not be the answer.

The Congressional Budget Office has estimated the move would cost around $196 billion over 10 years. The comes as the program already faces a trust fund shortfall, with the program’s combined funds projected to run out in 2035, when 83% of benefits will be payable.

Others have voiced concerns that repealing the rules would result more a more generous income replacement formula for workers with combined public and private work compared to others who contribute to Social Security for their entire careers.

“To the extent that people have worked both in covered and non-covered employment, in general they should be receiving some Social Security benefit,” said Paul Van de Water, a senior fellow at the Center on Budget and Policy Priorities.

“The question is how much,” he said.

A version of this article first appeared in CNBC’s Healthy Returns newsletter, which brings the latest health-care news straight to your inbox. Subscribe here to receive future editions.

Good afternoon! Roche is one of several drugmakers hoping to join the booming weight loss drug market, which Novo Nordisk and Eli Lilly are currently dominating.

But can the Swiss company develop drugs that can compete with that duopoly? 

The answer isn’t clear yet. 

We need to see more data from longer and larger clinical trials, which will likely take years for Roche to conduct. 

But the company last week presented more early-stage data more early-stage data on its experimental obesity injection and pill, which some analysts said raised concerns about how competitive those products can be if they enter the space.

Some analysts said the new results showed that both drugs – which Roche acquired through its nearly $3 billion acquisition of Carmot Therapeutics in December – caused a higher rate of side effects than expected.

“Investor excitement for Roche’s obesity franchise may now take a pause, in our view, given both acquired [drugs] showed higher-than-anticipated [gastroinsteinal] side effects,” Jefferies analysts said in a note on Wednesday, noting that the trials aggressively increased patients’ dosages of the drug. 

For example, Roche on Wednesday unveiled tolerability data from a phase one trial on its oral drug, CT-996, which is being developed to treat obesity and diabetes. The drugmaker previously said the once-daily obesity pill helped patients lose up to 7.3% of their weight within four weeks compared to 1.2% among those who received a placebo.

That “competitive” weight loss appears to be driven by “rapid” dose increases, which caused a high frequency of gastrointestinal side effects, according to the Jefferies analysts. But they noted that those side effects could be mitigated by a more gradual dosage ramp-up.

“The true competitive profile [of the drug is] not yet visible until the presentation of data” from larger phase two trials, the analysts wrote. 

JPMorgan analysts were less optimistic in a Wednesday note: “We are concerned about the ability to titrate away the high rates” of gastrointestinal side effects, they wrote.

The analysts said a group of patients who eventually received the lowest maximum dose of the pill – 90 milligrams – still saw high rates of nausea “with limited weight loss efficacy.”

Another group of patients who took the highest maximum dose of the drug – 120 milligrams – with slightly lower dose increases over time had nausea rates of 83%, vomiting of 33% and diarrhea of 50%, according to the JPMorgan analysts. The tolerability of the drug under that dosing approach “looks uncompetitive,” they said. 

The analysts said those rates are significantly higher than those seen with Novo Nordisk’s oral semaglutide, the active ingredient in the weight loss drug Wegovy, and Eli Lilly’s experiment obesity pill, orforglipron. 

But the “whole point” of the study on the pill was to “fail fast” and determine whether unexpected safety or efficacy issues exist, Manu Chakravarthy, Roche’s head of product development for cardiovascular, renal and metabolic, said on CNBC’s “Fast Money” on Thursday. 

That’s why the company went “a little bit quicker in the titration scheme than you normally” do in later-stage trials, he noted. 

He added that the rates of gastrointestinal side effects are “very much in line” with other drugs of the same class as Roche’s pill, which mimics a hormone in the gut called GLP-1 to suppress appetite and regulate blood sugar. 

“So nothing unexpected that we saw in safety, which actually gives us a lot of confidence to…move the program forward into phase two,” Chakravarthy said, noting that Roche plans to start mid-stage studies in 2025. 

He added Roche doesn’t believe slowing down titration will make the company’s injection or pill less effective. That’s because both products showed similar weight loss trajectories, even with slower or lower dose increases, according to Chakravarthy.

“If anything, when we slow down the titration, we would expect the accountability to be even further improved,” Chakravarthy told CNBC.

In May, Roche said its injection, CT-388, helped patients with obesity lose 18.8% more weight compared to those who received a placebo after 24 weeks in the phase one trial. The company hopes that the drug will eventually demonstrate 25% weight loss in late-stage trials, Chakravarthy told Fierce Biotech on Wednesday. 

Feel free to send any tips, suggestions, story ideas and data to Annika at annikakim.constantino@nbcuni.com.

Smart ring maker Oura is pushing beyond sleep, exercise and stress tracking and into a brand new market: Metabolic health. 

Oura announced last week that it has agreed to acquire Veri, a company that uses continuous glucose monitors to help users eat healthier and lose weight. Oura did not disclose the terms of the deal. 

A continuous glucose monitor, or a CGM, is a small sensor that pokes through the skin to track a user’s real-time glucose levels. Glucose is a sugar we get from food, and it’s the body’s main source of energy. Everyone’s glucose levels fluctuate, but consistently high levels can lead to more serious health problems like metabolic disease, insulin resistance and heart disease.

CGMs have historically been prescribed to patients with diabetes, but Abbott and Dexcom have recently released over-the-counter versions that are available to any adults that don’t take insulin. Both companies offer the sensors for less than $100 a month.

Oura is the latest company looking to stake its claim on this emerging market. 

The company’s smart ring can already help users track their sleep, heart health, exercise and stress, so expanding to metabolic health was a natural next step, Oura CEO Tom Hale wrote in a blog post. Around 97% of Oura members have said they want to understand how their bodies respond to food, Hale added.

The company had previously agreed to integrate its data into Veri through a partnership last year. As part of the deal, a “significant portion” of Veri’s employees, including its founders, will join Oura. Existing Veri customers can use its platform through the end of the year. 

Oura’s acquisition of Veri is just the beginning of the company’s plans in the metabolic health market, Hale said. 

“Our ambition is to create an ecosystem of other inputs, such as CGMs, that feed into the Oura experience to make it even more personalized and actionable,” he said.

As a first step, Oura will introduce a new feature called “Meals” through Oura Labs in the fall, according to a release. Oura Labs is where users can test out new features and offer feedback before they launch more broadly. The Meals feature will allow users to track what they eat to gain insights about how it affects their sleep, recovery and stress. 

Feel free to send any tips, suggestions, story ideas and data to Ashley at ashley.capoot@nbcuni.com.

A version of this article first appeared in CNBC’s Inside Wealth newsletter with Robert Frank, a weekly guide to the high-net-worth investor and consumer. Sign up to receive future editions, straight to your inbox.

The tightening presidential race has touched off a wave of tax planning by ultra-wealthy investors, especially given fears of a higher estate tax, according to advisors and tax attorneys.

The scheduled “sunset” of a generous provision in the estate tax next year has taken on new urgency as the odds of a divided government or Democratic president have increased, tax experts say. Under current law, individuals can transfer up to $13.61 million (and couples can send up to $27.22 million) to family members or beneficiaries without owing estate or gift taxes.

The benefit is scheduled to expire at the end of 2025 along with the other individual provisions of the 2017 Tax Cuts and Jobs Act. If it expires, the estate and gift tax exemption will fall by about half. Individuals will only be able to gift about $6 million to $7 million, and that rises to $12 million to $14 million for couples. Any assets transferred above those amounts will be subject to the 40% transfer tax.

Wealth advisors and tax attorneys said expectations of a Republican sweep in the first half of the year led many wealthy Americans to take a wait-and-see approach, since former President Donald Trump wants to extend the 2017 tax cuts for individuals.

Vice President Kamala Harris has advocated higher taxes for those those making more than $400,000.

With Harris and Trump essentially tied in the polls, the odds have increased that the estate tax benefits will expire — either through gridlock or tax hikes.

“There is a little increased urgency now,” said Pam Lucina, chief fiduciary officer for Northern Trust and head of its trust and advisory practice. “Some people have been holding off until now.”

The sunset of the exemption, and the response by the wealthy, has broad ripple effects on inheritances and the trillions of dollars set to pass from older to younger generations in the coming years. More than $84 trillion is expected to be transferred to younger generations in the coming decades, and the estate tax “cliff” is set to accelerate many of those gifts this year and next.

The biggest question facing wealthy families is how much to give, and when, in advance of any estate tax change. If they do nothing, and the estate exemption drops, they risk owing taxes on estates over $14 million if they die. On the other hand, if they give away the maximum now, and the estate tax provisions are extended, they may wind up with “givers’ remorse” — which comes when donors gave away money unnecessarily due to fears of tax changes that never happened.

“With givers’ remorse, we want to make sure clients look at the different scenarios,” Lucina said. “Will they need a lifestyle change? If it’s an irrevocable gift, can they afford it?”

Advisors say clients should make sure their gift decisions are driven as much by family dynamics and personalities as they are by taxes. While giving the maximum of $27.22 million may make sense today from a tax perspective, it may not always make sense from a family perspective.

“The first thing we do is separate out those individuals who were going to make the gift anyway from those who have never done it and are only motivated to do it now because of the sunset,” said Mark Parthemer, chief wealth strategist and regional director of Florida for Glenmede. “While it may be a once-in-a-lifetime opportunity as it relates to the exemption, it’s not the only thing. We want individuals to have peace of mind regardless of how it plays out.”

Parthemer said today’s wealthy parents and grandparents need to make sure they are psychologically comfortable making large gifts.

“They’re asking ‘What if I live so long I outlive my money,'” Parthemer said. “We can do the math and figure out what makes sense. But there is also a psychological component to that. As people age, a lot of us become more concerned about our financial independence, regardless of whether the math tells us we’re independent or not.”

Some families may also fear their kids aren’t ready for such large amounts. Wealthy families who planned to make big gifts years from now are feeling pressure from the tax change to go ahead with it now.

“Especially with families with younger children, a primary concern is having donors’ remorse,” said Ann Bjerke, head of the advanced planning group at UBS.

Advisors say families can structure their gifts to be flexible — gifting to a spouse first, for instance, before it goes to the kids. Or setting up trusts that trickle out the money over time and reduce the changes of “sudden wealth syndrome” for kids.

For families that plan to take advantage of the estate tax window, however, the time is now. It can take months to draft and file transfers. During a similar tax cliff in 2010, so many families rushed to process gifts and set up trusts that attorneys became overwhelmed and many clients were left stranded. Advisors say today’s gifters face the same risk if they wait until after the election.

“We’re already seeing some attorneys start to turn away new clients,” Lucina said.

Another risk with rushing is trouble with the IRS. Parthemer said the IRS recently unwound a strategy used by one couple, where the husband used his exemption to gift his kids money and gave his wife funds to regift using her own exemption.

“Both gifts were attributed to the wealthy spouse, triggering a gift tax,” he said. “You need to have time to measure twice and cut once, as they say.”

While advisors and tax attorneys said their wealthy clients are also calling them about other tax proposals in the campaign — from higher capital gains and corporate taxes to taxing unrealized gains — the estate tax sunset is far and away the most pressing and likely change.

“In the past month, inquiries have accelerated over the [estate exemption],” Bjerke said. “A lot of people were sitting on the sidelines waiting to implement their wealth-planning strategies. Now, more people are executing.”

Seniors looking to reduce expenses while also boosting their quality of life may find the idea of settling abroad appealing, financial experts say.

To that point, nearly one-third of retirees have relocated either domestically or outside the country after leaving the workforce, according to a new CNBC survey, which polled more than 6,600 U.S. adults in early August.

Some of the top reasons for retiree moves were a lower cost of living, a more comfortable lifestyle or better weather, the survey found.   

While many older Americans have opted for a less expensive city or state, others are choosing to spend their golden years abroad. 

More than 450,000 retirees were receiving Social Security benefits outside the U.S. as of December 2023, according to the latest Social Security Administration data. That’s up from less than 250,000 retirees in December 2003.   

“Each year, there are more and more,” said certified financial planner Leo Chubinishvili of Access Wealth in East Hanover, New Jersey. “And I think that will continue to grow.” 

Despite cooling inflation, higher costs are still prompting significant changes to retirement plans, a 2024 survey from Prudential Financial found.

Meanwhile, roughly 45% of U.S. households are predicted to fall short of money in retirement by leaving the workforce at age 65, according to a Morningstar model that analyzed spending, investing, life expectancy and other factors. 

But some retirees can stretch their nest egg by living somewhere with a lower cost of housing, health care and other expenses, depending on their needs, Chubinishvili said.

Some retirees are also motivated to move abroad for the “cultural exchange,” said CFP Jane Mepham, founder of Austin, Texas-based Elgon Financial Advisors, where she specializes in international planning.  

“There’s a sense of adventure,” she said. “People really want to travel.”

However, retiring overseas does require advance planning. For example, you’ll need to understand visa and residency requirements, local laws, international taxes and other logistics.

Plus, you’ll need to research whether you can get into your new country’s health system or whether you’ll need to purchase private insurance. Medicare won’t cover you abroad, Mepham said.

“For many people, [living abroad] could be a money-saving option, depending on how they want to live their lives,” said CFP Jude Boudreaux, partner and senior financial planner with The Planning Center in New Orleans, who works with several expat clients.

But other factors, such as proximity to aging parents or grandchildren, can weigh heavily on the decision, said Boudreaux, who is also a member of CNBC’s Financial Advisor Council.

To that point, of retirees who moved, some 36% wanted to be closer to family, only slightly lower than the 37% seeking a lower cost of living, according to the CNBC survey.

But your retirement, including a choice to live abroad, could change later, depending on your circumstances, he said.

“Everybody makes decisions based on their life priorities,” Boudreaux said. “Being clear about that helps people make good choices.”

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Molly Richardson, 35, regularly contributes to her 401(k) plan, but the structural engineer said she isn’t too worried about retirement yet.

“It’s always something I felt like I could wait until I’m 50 to figure out,” she said.

Like many other working adults, Richardson has more pressing expenses for now, she said, such as the mortgage on her home in Jacksonville, Florida, car loans and student debt.

Still, the married mother of one admits she doesn’t have a clear savings goal once those other financial obstacles are out of the way.

“It’s hard to estimate how much we are actually going to need,” she said. “There are question marks.”

In fact, 4 in 10 American workers — 40% — are behind on retirement planning and savings, largely due to debt, insufficient income or getting a late start, according to a new CNBC survey, which polled more than 6,600 U.S. adults in early August.

Older generations closer to retirement age are more likely to regret not saving for retirement early enough, the survey found: 37% of baby boomers between ages 60 and 78 said they felt behind, compared with 26% of Gen Xers, 13% of millennials, and only 5% of Gen Zers over the age of 18.

“There are so many individuals, young, mid-career and deep into their career, that are not saving enough for a healthy and secure retirement,” said Jacqueline Reeves, the director of retirement plan services at Bryn Mawr Capital Management.

By some measures, retirement savers, overall, are doing well.

As of the second quarter of 2024, 401(k) and individual retirement account balances notched the third-highest averages on record and the number of 401(k) millionaires hit an all-time high, helped by better savings behaviors and positive market conditions, according to the latest data from Fidelity Investments, the nation’s largest provider of 401(k) savings plans.

The average 401(k) contribution rate, including employer and employee contributions, now stands at 14.2%, just below Fidelity’s suggested savings rate of 15%.

And yet, there is still a gap between what savers are putting away and what they will need once they retire.

Although many employees with a workplace plan contribute just enough to take advantage of an employer match, “9% [considering a typical 5% savings rate and 4% match], mathematically speaking, will not provide enough in that piggy bank,” Reeves said.

“They call it a ‘standard safe harbor match’ for a reason,” she added. “Further in our career, we should be saving 15% to 20%.”

“I don’t think you ever feel completely caught up,” said Lisa Cutter, 56, of Terre Haute, Indiana.

Cutter, who works as an administrator in higher education, explained that it took a while before she could put anything at all toward long-term savings.

“When I first entered the workforce, I was a classroom teacher and I had no money; I was broke,” Cutter said.

Now Cutter, who is a single mom, has to prioritize her savings. She relies on the retirement tools and calculators that come with her employer-sponsored plan to stay on track.

“I would probably like to retire around 67,” she said.

Other reports show that a retirement savings shortfall is weighing heavily on Americans as they approach retirement age.

LiveCareer’s retirement fears survey found that 82% of workers have considered delaying their retirement due to financial reasons, while 92% fear they may need to work longer than originally planned. 

Roughly half of Americans worry that they’ll run out of money when they’re no longer earning a paycheck — and 70% of retirees wish they had started saving earlier, according to another study by Pew Charitable Trusts.

And among middle-class households, only 1 in 5 are very confident they will be able to fully retire with a comfortable lifestyle, according to a recent Retirement Outlook of the American Middle Class report by Transamerica Center for Retirement Studies. The middle class is broadly defined as those with an annual household income between $50,000 and $199,999.

“America’s middle class is navigating the turbulent post-pandemic economy and high rates of inflation,” said Catherine Collinson, CEO and president of Transamerica Institute. “They are focused on their health and financial well-being, but many are at risk of not achieving a financially secure retirement.”

“If you do less at 30, you’ll still have more at 60 than if you did more at 50,” said Bryn Mawr’s Reeves.

More than any other money misstep, not saving for retirement early enough is the biggest financial regret for 22% of Americans, according to another report by Bankrate. 

But there’s no easy way to make up for lost time.

“Inflation and high prices are cited as the biggest obstacle to progress in addressing our financial regrets,” said Greg McBride, chief financial analyst at Bankrate.com. “Don’t expect an overnight fix.”

There are, however, habits that can help.

Saving for retirement can be “automated through payroll deduction, direct deposit and automatic transfers,” McBride said. “Start modestly and after a couple of pay periods, you won’t miss what you don’t see.”

In addition to automatic deferrals, Reeves recommends opting in to an auto-escalation feature, if your company offers it, which will automatically boost your savings rate by 1% or 2% each year.

Savers closer to retirement can even turbocharge their nest egg.

“Everybody hits 50 and is like, ‘wait a minute,'” Reeves said, so “there are other opportunities layered on, because many people are caught at that juncture.”

Currently, “catch-up contributions” allow savers 50 and older to funnel an extra $7,500 into 401(k) plans and other retirement plans beyond the $23,000 employee deferral limit for 2024.

It’s also important to create a separate savings account for emergency money, Collinson advised, “which will help you avoid tapping into your retirement account when disaster strikes.”

Similarly, make sure you are properly insured and employable by staying up to date on the latest technology and training, she added, to avoid potential income disruptions.

“The single most important ingredient is access to meaningful employment throughout your working years,” Collinson said.

Most experts recommend meeting with a financial advisor to shore up a long-term plan. There’s also free help available through the National Foundation for Credit Counseling.  

REGISTER NOW! Join the free, virtual CNBC’s Women and Wealth event on Sept. 25 to hear from financial experts who will help fund your future — whether you are returning to the workforce, starting a new career or just looking to improve your relationship with money. Register here.

Companies are increasing access to new blockbuster weight-loss drugs for employees, but size of employer may make a big difference in early access. Small businesses and their workers are often stuck between a rock and a hard place when it comes to this burgeoning health insurance coverage market.

Small businesses employ roughly half of the workers in the U.S. labor market, and they have been adding jobs at a faster pace than large employers. Since the first quarter of 2021, small-business hiring accounted for 53% of the 12.2 million total net jobs created across all employers, according to the U.S. Bureau of Labor Statistics, consistent with the longer-term trend.

The blockbuster obesity drugs, called GLP-1 agonists, cost roughly $1,000 per month on average — and they are typically taken for a long time. Access to these weight-loss drugs is coming from an increasing number of sources in the marketplace, drug makers are ramping up production, and use cases continue to increase, with clinical trials showing benefits for conditions from sleep apnea to heart disease risk. But many of the 100 million American adults who are obese can’t afford to pay out of pocket for drugs like Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound, and are turning to their employers for help. 

A survey last October of 205 companies by the International Foundation of Employee Benefit Plans found that 76% of respondents provided GLP-1 drug coverage for diabetes, versus only 27% that provided coverage for weight loss. But 13% of plan sponsors indicated they were considering coverage for weight loss. Covering these drugs, however, is harder for smaller employers, many of whom rely on off-the-shelf plans offered by their insurance carriers. While there are plans that cover GLP-1 drugs, the cost can be prohibitive for many small businesses.

There’s strong demand from employees for coverage and smaller employers would like to be able to do it, but there are trade-offs, said Shawn Gremminger, president and chief executive of the National Alliance of Healthcare Purchaser Coalitions, a nonprofit purchaser-led organization. Companies have to consider the impact on wages or other benefits they might like to offer. “The company money has to come from somewhere,” he said.

In some cases, small employers, even if they want to cover weight-loss drugs, are simply priced out of the market and they may have to accept they can’t offer the coverage they would like to. 

“Given the price of these drugs, you have to do the cost-benefit analysis and for a lot of small companies — even some larger ones — they just can’t do it,” Gremminger said. “No matter how much they want to.”

Here are a few issues for small business employers and employees to understand in accessing expensive weight-loss drugs as part of job benefits.

Annual benefits deals are being brokered now. Open enrollment season for health insurance doesn’t occur until the fall, but employers should be having renewal discussions with their benefits broker or agent now, and that conversation should include weight-loss drugs. Small business employers should be telling a broker they would like to be able to provide weight-loss drugs for employees, and ask for help in finding the right carrier or the right plan, said Gary Kushner, chair and president of Kushner & Company, a benefits design and management company.

The market is changing quickly. Last year, an insurance carrier asked about covering weight-loss drugs may have said no, but it’s worth asking the carrier again because they may have been forced to make changes to their offerings for competitive reasons, said Kate Moher, president of national employee health and benefits for Marsh McLennan Agency, which advises employers on plan designs and benefits programs. “You should be asking the question every year,” she said. 

Insurance premiums may rise. To gain access to weight-loss drugs, many small businesses may have to switch insurance carriers, and probably pay more. “It most likely will be more expensive if one is not covering the drugs and the other is,” Kushner said.

Employers also have to decide how much of that can be reasonably passed to employees, without unduly burdening workers who may never need these drugs. “If 20% of your population takes it, everyone’s premium goes up by whatever percentage that is to cover the cost,” Gremminger said.

Small businesses should consider a ‘captive health’ plan. Generally speaking, any business with at least 50 employees might consider working with a captive health insurance plan like Roundstone, ParetoHealth, Stealth and Amwins, Moher said. These businesses allow groups of companies who couldn’t self-insure — the approach most large corporations take — to pool resources and design a group health plan together. 

This approach may allow a small business and its employees more flexibility, Moher said, but owners still have to weigh the costs and there are requirements to qualify. It’s also not something businesses can change every year like they could when working with a traditional insurance carrier. “It’s a long-term play; you can’t jump in and out,” Moher said. 

These plans are designed for the long-term because, as member-owners, the participants all agree to spread the risk, an approach that can keep costs down over time and decrease volatility. But if business owners are looking for a quick-fix or prefer to wait and see how the market develops over the next year, it’s probably not the right model.

A GLP-1 drug standalone coverage option could also work for some small businesses. Companies like Vida Health, Calibrate, Found Health and Vitality Group provide these offerings separate from an employer’s primary carrier, Gremminger said. Employers need to do the math to determine whether it could be more cost effective, and whether the option truly suits their employees’ needs based on the offerings.

Use an FSA to help cover weight-loss drug costs. If insurance coverage options aren’t an effective solution today, small employers may have a few other ways to help employees defray the cost of weight-loss drugs. They might consider, for instance, making contributions to employees’ flexible spending accounts or health savings accounts. They could also consider a health reimbursement arrangement, or HRA, which is an employer-funded plan that reimburses employees for qualified medical expenses. 

However, there are strict rules and requirements for each of these options. For example, with an FSA, the IRS limits an employer’s contribution based on how much the employee contributes, and this still isn’t likely to suffice to cover the cost of these drugs long-term. “Does it help? Sure. Does it solve the problem? No,” Kushner said.

It’s also not a move to make without first getting sign-off from legal counsel. “You need the guidance of your ERISA attorneys to make sure you meet all the criteria,” Moher said. “It’s a creative way of doing it, but you have to make sure you’re meeting all of your compliance requirements.”

Right now, the end result can be very discouraging for small businesses and their employees given the costs and limited options, but it’s also important to know that there are 20 or so drugs in the approval pipeline. Once they get approved, costs are likely to come down, Moher said. “This is something that may be a short-term thing until we get more GLP-1 drugs approved.”