The recent explosion of buzzy (and expensive) weight-loss drugs like Ozempic has many employers worried about the potential price tags associated with covering the costs. As they should be: employer health care spend is currently rising at the steepest rate seen in years.
But while employers fret over the price of these drugs and scramble to reduce spend, there’s a much costlier epidemic they’re largely ignoring: autoimmune disease. This group of health conditions affect around 1 in 5 Americans – a figure that has almost doubled in the past 30 years, and continues to rapidly rise.
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Spending on prescription drugs for autoimmune diseases has increased by 459% over the past decade, even surpassing cancer drugs. Yet despite driving around 30% of employers’ entire prescription spend, autoimmune diseases have remained completely overlooked in employer health spend.
Why? There are 80-100 autoimmune diseases, and they tend to fall under different diagnostic categories based on the organ affected. For example, Crohn’s disease is classified as a gastrointestinal disease, psoriasis as a skin condition, multiple sclerosis as a neurological disease, and so on.
In fact, these are all autoimmune diseases. But until now, it’s been difficult for employers to recognize their enormous collective impact because the current categorization hides them in the weeds.
If we zoom out and look at these conditions more holistically (rather than by the body part they affect), it’s easier to identify parallels in their treatment and prevention. Most employers don’t realize that there are simple ways that they can make this shift, to better support their autoimmune employees and reduce overall healthcare costs.
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Just say no to (specialty) drugs as a first line of defense
Many autoimmune patients are prescribed biologics: a class of drugs that work by suppressing the immune system to prevent it from attacking itself. But by lowering immune defenses, these drugs can potentially reactivate prior infections, leave patients vulnerable to new infections, and even increase the risk of certain cancers.
Of the 21 biologic drugs approved by the FDA, almost 2 in 3 have received black box warnings – the most serious risk alert of the FDA. We also know biologics can become less effective over time.
More importantly, they fail to address the underlying root causes of autoimmune disease. A growing body of research has identified the role that environmental factors such as the Western diet, viruses, toxins, and stress play in triggering autoimmunity. 80% of chronic diseases boil down to lifestyle choices and 70-80% of the immune system is found in the gut. Yet, diet and lifestyle changes are not taken seriously as therapeutic solutions.
If these factors aren’t enough to encourage employers to reconsider prescription drugs as a first response, there’s also the hefty price tag. Humira, a brand name biologic, has a list price of up to $80,000 per year for a single patient (more than 7x the cost of Ozempic) – and most people are on these drugs for a lifetime. Employers, particularly those who are self-insured, are bearing the burden of this cost.
You can massively reduce health care costs by offering employees lower-risk options to try before escalating to a biologic. Diet and lifestyle programs can be hugely effective in helping autoimmune patients identify their triggers, and can even help keep flare-ups under control without the need for medication.
Of course, I’m not saying that prescriptions should be written off – they are essential treatments for many autoimmune diseases, such as type 1 diabetes. But providing alternative options early on exposes patients to treatment options they may find sufficient, or choose to combine with pharmaceuticals, as diet and lifestyle interventions have been shown to improve the efficacy of autoimmune medications.
Provide whole-person offerings that meet your employees where they’re at
As an autoimmune patient, I’ve experienced firsthand how siloed and fragmented the medical system is. It takes, on average, five doctors and 4.5 years to get a diagnosis.
If you have Hashimoto’s, you see an endocrinologist.
If you have rheumatoid arthritis, you see a rheumatologist.
If you have celiac disease, you see a gastroenterologist, and the list goes on.
However, these “ologist’s” rarely interact with each other, let alone recognize that seemingly disparate symptoms are actually interrelated. This reactive, symptoms-focused approach is a lot like patching up a ceiling leak without addressing its underlying source. What autoimmune patients truly need is care that considers their unique health needs and looks at them as whole people, not just a collection of symptoms.
This also echoes what rising generations in the workforce are demanding for the future of healthcare. Millennials and Gen-Z, like myself, view mental and emotional wellbeing, nutrition, movement, sleep, and stress as all being critical aspects of health. We want “whole-person”, long-term, and preventative healthcare, rather than just treating acute health issues as they arise. We’re also more likely to report physical health issues as a hurdle to effective work performance (even when compared to our older colleagues).
Considering that autoimmunity is rising most rapidly among young people, employers that offer whole-person care programs for these conditions are setting up their Gen-Z talent to thrive in the long-run.
So, how can you adapt to this paradigm shift? Look at your utilization reports to identify any red flags of insufficient healthcare (for example, patients ping-ponging between specialists, or repeat hospitalizations).
Check if your health plan offers any care programs for patients with autoimmune disease. If not, research the different options that are available, and look to provide access to patient education and disease management programs, in addition to covering necessary medications and medical treatments.
You can also put pressure on your pharmacy benefit manager (these are third parties who help negotiate drug costs for insurers) to offer less-expensive alternatives to high-cost medications.
The doctor isn’t in: underutilized providers should be prioritized
One of the biggest challenges around treating autoimmune disease is that there’s no one-size-fits-all approach. These are extremely complicated conditions that look different for each patient. Therefore, the most effective health solutions are tailored to the individual – but this level of personalization is nearly impossible in the current healthcare setting.
For starters, less than 20% of medical schools require a nutrition course – an essential element to lifestyle guidance in autoimmune disease. Furthermore, the average primary care exam is just 18 minutes long, not nearly enough time to manage the complexity of these conditions.
Most physicians just aren’t trained to be experts in diet and behavior change, but employers can fill this gap by covering access to specialists who are. This doesn’t have to cost more. In fact, registered dietitians and health coaches specialized in autoimmune disease can work with patients with a number of different health conditions, developing individualized plans that get to the root of the disease.
This approach improves their overall quality of life and also massively reduces their reliance on expensive interventions like drugs and ER visits. It also reduces the financial consequences of illness at work, such as absenteeism and presenteeism.
Historically, these types of providers have been overlooked and viewed as an unnecessary extra (or even a luxury). But in reality they should be at the heart of delivering care for these patients. We desperately need a multidisciplinary care team approach to reverse this epidemic—our healthcare system is breaking under the weight of its current model.
Revamping your healthcare plans to better respond to employees’ needs is no easy fix. But we need to move away from our reactive strategy of simply treating symptoms, and prescribing “a pill for every ill.” The sooner we treat the body holistically, the sooner we can effectively address the life-altering symptoms, underlying causes and unnecessary healthcare costs related to autoimmune disease.
Photo: champc, Getty Images
Ellen Rudolph is co-founder and CEO of WellTheory, the virtual care platform reversing the autoimmune epidemic. Launched in 2022, WellTheory was born out of Ellen's personal autoimmune journey and the gaps in traditional care encountered along the way. She is on a mission to empower the 50M+ Americans navigating autoimmune disease with education, community, and evidence-based, whole-person care. WellTheory has raised a total of $7.2M from Accel, Lux Capital, Box Group, Rock Health, and others.
