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Ozempic drives up health-care costs, whether you can get it or not

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CNBC Investigates: Ozempic underworld

About 165 million Americans rely on employer-sponsored health insurance and yet, workers may still not get the coverage they want — particularly when it comes to drugs like Wegovy and Novo Nordisk’s diabetes drug Ozempic.

One in three employees are looking for more resources to combat obesity, according to a recent report by consulting firm Gallagher. Glucagon-like peptide-1 treatments such as Wegovy and Ozempic, which mimic hormones produced in the gut to suppress a person’s appetite, are considered game changers on this front.

These blockbuster weight-loss drugs have skyrocketed in popularity in the U.S. but are still not universally covered — even though “Americans have higher rates of obesity and diabetes and more behavioral health conditions today than ever before,” according to Trilliant Health’s “2024 Trends Shaping the Health Economy” report.

Cost is a key issue.

Although research shows that obesity drugs may have significant health benefits beyond shedding unwanted pounds, organizations representing U.S. insurers have said concerns remain about the high price involved with covering those medications, which are nearly $1,350 per month for a single patient. 

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The price tag for GLP-1 medications, along with the large number of workers who could potentially benefit from using them, are a big driver of higher health-care costs, several studies show. Already, prescription drug costs jumped 8.6% last year, due in part to a surge in the use of GLP-1 drugs, according to a recent report by Mercer.

“Is that significant? Yes,” said Sunit Patel, Mercer’s U.S. chief health actuary.

Patients on these medications need to complete months, if not years, of continuous treatment.

“It becomes a lifelong drug,” said Gary Kushner, chair and president of Kushner & Company, a benefits design and management company. “That’s a pretty expensive commitment.”

Cost is a key factor in coverage

Currently, fewer than half — 42% — of companies cover the expensive weight-loss drugs to some extent. Another 27% are considering adding coverage in the year ahead, according to the survey by Mercer.

Still, “not everyone who wants it can get it,” Patel said.

On the flipside, 3% of employers have recently removed coverage for these drugs and 10% of companies that currently cover them are considering removing them for 2025.  

To improve access to weight-loss drugs, many businesses would have to pay even more — and health-care costs are already reaching a post-pandemic high, with employers and employees set to shell out significantly more for coverage in 2025, according to WTW, a consulting firm formerly known as Willis Towers Watson. U.S. employers project their healthcare costs will increase by 7.7% in 2025, compared to 6.9% in 2024 and 6.5% in 2023.

Among employers’ greatest concerns was how to cover increasingly sought-after weight loss drugs, a Kaiser Family Foundation survey also found.

“Employers face the challenge of integrating these potentially important treatments into their already costly benefit plans,” Gary Claxton, KFF’s vice president said in a press statement.

Syringes from weight loss drugs “Wegovy,” “Ozempic” and “Mounjaro.”

Picture Alliance | Getty Images

Access for weight-loss use is an issue

For now, some employers cover only GLP-1 drugs exclusively for the treatment of diabetes, while others cover certain GLP-1s for weight loss but only if they are approved by the Food and Drug Administration for that use — ruling out Ozempic, which is just FDA-approved for the treatment of Type 2 diabetes.

“Most employers cover Ozempic for diabetes, they don’t necessarily cover it as an anti-obesity medication,” said Seth Friedman, pharmacy and health plans practice leader at Gallagher.

That makes it even trickier for employees to navigate whether they can get access to the drug and if it will be covered by their insurance. “They see that it’s covered but they get rejected,” Friedman said.

A 2023 survey by the International Foundation of Employee Benefit Plans found that 76% of the companies polled provided GLP-1 drug coverage for diabetes, versus only 27% that provided coverage for weight loss — leaving many workers shut out.

“Obviously, there is demand for them, and it’s not for diabetes, it’s for weight loss,” said Kushner.

Capturing the Weight Loss Drug Craze

“Looking ahead to 2025, about half of large employers will cover the drugs for weight loss,” said Beth Umland, Mercer’s research director of health and benefits. However, “even when they do, there are guardrails around who can use it.”

Demand for these treatments is only expected to increase — but the added controls for coverage are also helping to keep costs in check.

Nearly all employers have some sort of “utilization management” restrictions in place, like a prior authorization requirement, according to Gallagher’s Friedman.

For some companies, that may mean workers must try other weight-loss methods first or meet with a dietician and enroll in a weight-loss management program. Others may require a threshold for body mass index, or BMI, of at least 30, depending on how the plan is set up, Friedman said.

This information is available during open enrollment, which typically runs through early December. 

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What it would cost to live like the ‘Home Alone’ family today

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Home Alone (1990)

20th Century Fox

The classic Christmas movie “Home Alone” tells the improbable tale of a family who leaves their 8-year-old son home when they leave for vacation.

Yet in the years since the 1990 film was released, viewers have focused on another question — how wealthy was the fictitious McCallister family featured in the movie?

The family orders 10 pizzas on the eve of their trip, lives in a house that can sleep 15 people (including extended family) and all fly to Paris for the Christmas holiday.

“They’re well off and in a good place financially,” Cody Garrett, a certified financial planner, owner and financial planner at Measure Twice Financial in Houston, said of the first impression of the McCallisters’ circumstances.

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But the family may not be quite as wealthy as they seem, Garrett said.

To better understand the details of the McCallister family’s financial circumstances, Garrett recently did a deep dive analysis of the family’s finances from “Home Alone” and “Home Alone 2: Lost in New York,” which debuted in late 1992, and hosted a webinar with around 25 financial planners to discuss financial planning opportunities that arise in the movies.

Both movies were shot long before social media made it popular to flaunt personal wealth online. Nevertheless, the lifestyle the McCallister family shows to the world may not necessarily be an indication of their wealth, Garrett said.

“There’s a lot of things that are showing that they spent a lot of money, or at least financed a lavish lifestyle to the public,” Garrett said. “But inside their own home, they’re actually maybe a little scared about money.”

What the McCallister lifestyle would be worth now

The Home Alone Experience created by Disney+, opens in London, offering an immersive experience inspired by the Christmas movie, with set recreations of the McCallister family’s home.

David Parry Media Assignments | PA Wire | AP

What looked lavish more than 30 years ago when the first two movies were shot is now even more luxurious today, thanks in large part to the effects of inflation.

The actual five-bedroom, six-bathroom Winnetka, Illinois, home where the movie was filmed was listed for $5.25 million in the spring. Today, it is still under contract, and a final sale price won’t be known until the deal is finalized, according to Zillow spokesperson Matt Kreamer.

To buy the house at $5.25 million today would cost approximately $34,000 per month, with principal, interest and property taxes, according to Kreamer. That’s with 20% down and a 7% mortgage rate.

To comfortably afford the home, you would need $100,000 per month in income, assuming you’re adhering to an affordability threshold of not spending more than one-third of your income on housing costs, Kreamer said.

“It’s a pretty spectacular house, and certainly one of the more famous movie homes that people can instantly recognize,” Kreamer said.

In 1990 when the first movie debuted, the home would have likely been worth a little less than $1 million, Kreamer estimates, which is still high for that time.

Yet the home may not necessarily point to a high net worth for the McCallister movie family.

“I would not be surprised if they don’t have much equity in their house,” Garrett said, given the couple’s stage of life and circumstances.

In the films, the McCallisters are also driving what at the time were relatively new cars — a 1986 Buick Electra Estate Wagon and a 1990 Buick LaSabre — each of which would be valued at $40,000 in today’s dollars, according to Garrett’s estimates.

While the family is eager to show their wealth — including mother Kate paying in cash for the $122.50 pizza bill while also offering a generous tip — they’re frugal when it comes to the things people don’t see, Garrett said.

How the family talks about money can sometimes point to a scarcity mindset, he said. For example, Kate mentions she doesn’t want to waste the family’s milk before they leave on vacation.

The family’s lifestyle isn’t paid for all on their own. Peter’s brother Rob actually foots the cost of the Paris trip for the family. That airfare would cost around $55,650 today, GoBankingRates recently estimated.

What financial planning lessons are hidden in the movie

Many major details about Kate and Peter McCallister’s finances are not disclosed, including what they do for a living.

Nevertheless, the financial planners who evaluated the family’s circumstances saw some holes that could be addressed with planning.

On the top of their wish list: proper insurance coverage.

Because Kate and Peter McCallister have five children, having enough life and disability insurance should they pass away or become unable to work should be a top priority to ensure their dependents are provided for, according to Garrett.

The movie — which includes many slips and falls at the family’s home as 8-year-old Kevin tries to ward off a pair of robbers — also signals a need for an umbrella insurance policy, in case the McCallisters are found liable for injuries or damages that occur.

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Kate and Peter — who forget or lose their son Kevin in both of the first two “Home Alone” movies — would also be wise to make proper estate planning arrangements in the event they can no longer provide or care for their children. That includes having wills, powers of attorney, advance directives, beneficiary designations, trusts and proper account titling, all kept up to date.

The couple should name physical and financial guardians who can care for the children. They may also establish a pre-need guardian for the children who can step in if the parents are unable to care for them even for a short period of time, said Aubrey Williams, financial planner at Open Path Financial in Santa Barbara, California.

“If the parents are not there to take care of the kids, there’s the possibility that kids, even if briefly, will become a ward at the state because there’s no one to care for them,” Williams said.

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The busiest return season of the year is about to begin

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Consumers are 'showing up and spending' following a strong November, says Tanger Outlets CEO

After a strong start to the holiday season, consumer spending is on track to reach record levels this year. But many of those purchases will soon be returned.

December’s peak shopping days are closely followed by the busiest month for sending items back, which experts dub “Returnuary.”

This year, returns are expected to amount to 17% of all merchandise sales, totaling $890 billion in returned goods, according to a recent report by the National Retail Federation — up from a return rate of about 15% of total U.S. retail sales, or $743 billion in returned goods, in 2023.

Even though returns happen throughout the year, they are much more prevalent during the holiday season, the NRF also found. As shopping reaches a peak, retailers expect their return rate for the holidays to be 17% higher, on average, than usual.

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“Ideally, I hope there is a world in which you can reduce the percent of returns,” said Amena Ali, CEO of returns solution company Optoro, but “the problem is not going to abate any time soon.”

How returns became an $890 billion problem

With the explosion of online shopping during and since the pandemic, customers got increasingly comfortable with their buying and returning habits and more shoppers began ordering products they never intended to keep.

Nearly two-thirds of consumers now buy multiple sizes or colors, some of which they then send back, a practice known as “bracketing,” according to Happy Returns.

Even more — 69% — of shoppers admit to “wardrobing,” or buying an item for a specific event and returning it afterward, a separate report by Optoro found. That’s a 39% increase from 2023.

Largely because of these types of behaviors, 46% of consumers said they are returning goods multiple times a month — a 29% jump from last year, according to Optoro.

All of that back-and-forth comes at a hefty price.

“With behaviors like bracketing and rising return rates putting strain on traditional systems, retailers need to rethink reverse logistics,” David Sobie, Happy Returns’ co-founder and CEO, said in a statement.

What happens to returned goods

Processing a return costs retailers an average of 30% of an item’s original price, Optoro found. But returns aren’t just a problem for retailers’ bottom line.

Often returns do not end up back on the shelf, and that also causes issues for retailers struggling to enhance sustainability, according to Spencer Kieboom, founder and CEO of Pollen Returns, a return management company. 

Sending products back to be repackaged, restocked and resold — sometimes overseas — generates even more carbon emissions, assuming they can be put back in circulation.

In some cases, returned goods are sent straight to landfills, and only 54% of all packaging was recycled in 2018, the most recent data available, according to the U.S. Environmental Protection Agency.

Returns in 2023 created 8.4 billion pounds of landfill waste, according to Optoro.

That presents a major challenge for retailers, not only in terms of the lost revenue, but also in terms of the environmental impact of managing those returns, said Rachel Delacour, co-founder and CEO of Sweep, a sustainability data management firm. “At the end of the day, being sustainable is a business strategy.”

To that end, companies are doing what they can to keep returns in check.

In 2023, 81% of U.S. retailers rolled out stricter return policies, including shortening the return window and charging a return or restocking fee, according to another report from Happy Returns.

While restocking fees and shipping charges may help curb the amount of inventory that is sent back, retailers also said that improving the returns experience was a key goal for 2025.

Now 33% of retailers, including Amazon and Target, are allowing their customers to simply “keep it,” offering a refund without taking the product back.

Retail's return secret: What a 'keep it' policy means

For shoppers, return policies are key

Increasingly, return policies and expectations are an important predictor of consumer behavior, according to Happy Returns’ Sobie, particularly for Generation Z and millennials.

“Return policies are no longer just a post-purchase consideration — they’re shaping how younger generations shop from the start,” Sobie said.

Three-quarters, or 76%, of shoppers consider free returns a key factor in deciding where to spend their money, and 67% say a negative return experience would discourage them from shopping with a retailer again, the NRF found.

A survey of 1,500 adults by GoDaddy found that 77% of shoppers check the return policy before making a purchase.

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1 million taxpayers to receive up to $1,400 in ‘special payments’

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Ryanjlane | E+ | Getty Images

The IRS plans to issue automatic “special payments” of up to $1,400 to 1 million taxpayers starting later this month, the agency announced on Friday.

The payments will go to individuals who did not claim the 2021 Recovery Rebate Credit on their tax returns for that year and who are eligible for the money.

The Recovery Rebate Credit is a refundable tax credit provided to individuals who did not receive one or more economic impact payments — more popularly known as stimulus checks — that were sent by the federal government in the wake of the Covid-19 pandemic.

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The maximum payment will be $1,400 per individual and will vary based on circumstances, according to the IRS. The agency will make an estimated total of about $2.4 billion in payments.

“Looking at our internal data, we realized that one million taxpayers overlooked claiming this complex credit when they were actually eligible,” IRS Commissioner Danny Werfel said in a statement. “To minimize headaches and get this money to eligible taxpayers, we’re making these payments automatic, meaning these people will not be required to go through the extensive process of filing an amended return to receive it.” 

No action needed for eligible taxpayers

The new payments are slated to be sent out automatically in December. In most cases, the money should arrive by late January, according to the IRS.

Eligible taxpayers can expect to receive the money either by direct deposit or a paper check in the mail. They will also receive a separate letter notifying them about the payment.

Direct deposit payments will go to taxpayers who have current bank account information on file with the IRS.

If eligible individuals have closed their bank accounts since their 2023 tax returns, payments will be reissued by the IRS through paper checks to the mailing addresses on record. Those taxpayers do not need to take action, according to the agency.

How to tell if you qualify

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