Incarcerated People Are Gaining Skills. Is Industry Ready to Hire?

BY Emily Nonko | February 17, 2022

Editor's note: This is an installment in a two-part series on hiring the formerly incarcerated. Read the companion story here, a look at how Corporate America is giving people with criminal records a second chance. 

Every week inside the Everglades Correctional Institution, a group of incarcerated men get together to pore over textbooks and compare notes about sedimentation tanks, ask questions about nitrification of microorganisms, and agonize over microbiology and algebraic equations.

Their goal: to make it through the prison’s peer-led Wastewater Operator Course, pass a taxing Florida Department of Environmental Protection state exam, and walk out of prison as certified Wastewater Treatment Plant Operators. For those who do, they’re presented with opportunities in the green-jobs industry with stability, high pay and benefits, all of which serve as important lifelines leaving prison.

“It’s a rare course in that not many prisons offer anything like this in Florida,” said incarcerated instructor Ryan Moser, who wrote about the course’s success last year. For people who get the opportunity, he added, “their dedication is beyond anything I could have expected. They want to learn. They study for hours and hours. I didn’t think I could get a group of guys together who would be so serious about something.”

People in prison rarely get the opportunity for holistic job training to help them transition out of prison into in-demand industries. But there are some programs across the U.S. that show what’s possible—programs that focus on both hard and soft skills, facilitate support networks and professional relationships, and provide pipelines to stable and well-paid professions.

Beyond the Wastewater Treatment Course in Florida, some examples include the Friends of San Quentin News, which oversees a successful newsroom out of California’s San Quentin State Prison and is spearheading expansion into new prisons; Defy Ventures, a national program supporting entrepreneurship; and The Last Mile, which provides in-prison technology training.

These programs are huge departures from what state prisons traditionally offer to incarcerated people. Typical prison jobs, which pay pennies on the hour, usually revolve around servicing the prison, including cooking, janitorial, maintenance, and secreterial work. Incarcerated people also produce products like clothes and license plates for outside companies.

States often fund vocational training classes, though they tend to be strictly focused on the trades. “They can teach you how to do masonry, be a bricklayer, carpentry, automotive repair, computer repair,” said Jesse Vasquez, who was editor-in-chief of the San Quentin News before his sentence was commuted and he was released from prison. He’s now executive director of Friends of San Quentin News, which facilitates fundraising and expansion of the paper.

Vocational training, however, has its limitations. “It doesn’t require teamwork, collaboration, technology, a speciality skill or communication,” observed Vasquez. “If you want high-performing individuals with high work ethic, good communication skills, and the ability to work as a team, you have to create a different system inside.”

San Quentin News is a full-fledged newsroom run by the incarcerated, with support from outside advisors. The work has prepared newsroom staff for jobs in nonprofit leadership, media, communication, and advocacy. “I was positioned for success because I was in an environment where they nurtured my learning, there were tools I could grasp hands on, and there were people to guide me through the process if I didn’t know something,” Vasquez said. “Those are three instrumental components for someone to function on a corporate level.”

Brushing Up on Social Skills

Moser, the Florida instructor, emphasizes the importance of soft skills, given that most prison job-training programs don’t focus on them. “The things that employers look for, a lot of times we don’t have them because we’ve gotten out of practice,” he said. He focuses an entire class of the Wastewater Operator Course on soft skills and resume building. “We try to prepare the guys beyond studying. You have to work well with others, show up for work on time, have a positive attitude.”

Two outside nonprofits are also working to bring diverse skills and job training into prison. Defy Ventures, which currently works in 16 prisons in eight states, supports so-called Entrepreneurs in Training (or EITs) with programs including an entrepreneurial bootcamp and business accelerator. “We’ve seen that entrepreneurship can be a really transformative context for people because it requires you to challenge self-limiting beliefs,” said Defy’s CEO Andrew Glazier. “Vocational programs can be great, but a lot of times they neglect the whole mindset question.”

Studying in professor Porter's class at the Sullivan Correctional Facility in Fallsburg, NY (Photo by Jason Andrew)

The program realizes not all participants will become entrepreneurs, but the idea of the curriculum is to build confidence and connections, develop a holistic set of job skills, and even help participants to work through trauma. Bringing volunteers into the prison for programs also results in powerful relationship-building that can support the incarcerated participants when they come home. “There are these deeply human social interactions that are transformative by themselves, both for the Entrepreneurs in Training and for our volunteers, who have all of their beliefs challenged about the justice system and who's inside of it.”

Coding Skills, With a Holistic Approach

The Last Mile began in 2010 with a focus on entrepreneurship, but found “the pipeline to employment post-release was not scalable,” according to executive director Syd Heller. So the program shifted to teach coding skills. The Last Mile now operates at 15 facilities across six states with a curriculum covering web development fundamentals, MERN development and audio and video production. That’s alongside an innovative workforce-development program providing graduates of the coding program the chance to gain real-life work experience and have a portfolio of work before they enter the tech job market.

Like the other programs, The Last Mile focuses on holistic support, professional networking, and the teaching of initiative and self-agency. “We’ve really tried to re-humanize those who have been dehumanized by giving them ownership of things and giving them real opportunities,” said Heller. “We have a franchise approach where we centrally manage all our equipment– we don’t rely on Departments of Corrections–and because of that we’ve built this really cohesive environment our students can step into.”

The Last Mile programs prompt participants to create a re-entry plan to map out the support they have, the support they need, and their career aspirations. “After they’re released,” said Heller, “our support changes to provide equipment people may need, such as laptops.” The Last Mile also built a community within the web-development profession to help support participants after they come home and help them find jobs.

The Last Mile, Defy, and Friends of San Quentin News all work to support participants in re-entry, a daunting task in which formerly-incarcerated people have to build their life, adapt to new cultural norms, find a job, and begin supporting themselves. Defy has an alumni association that provides technology, resume, and interview workshops, individual action plans and a support network focused on stable employment.

At Friends of San Quentin News, “We’ve identified the roles the newsroom prepares people for. Now it’s a matter of who can we partner up with and how can we create a pipeline so we can get internships for people coming home,” Vasquez says. One missing component: “Having corporate representatives come into the prison to see the hands-on training people go through.”

Moser, too, believes there can be stronger partnerships from outside industry. “I can train somebody for months, they can pass the state exam and be ready for a new career, but the disconnect is we have no communication with the actual treatment plants and no ability to start a network from inside,” he said.

Improved job training in prison is meaningless “if we don’t follow it up with some kind of re-entry task force to help with job placement,” Moser said. “If the re-entry element isn’t there, we’re limiting the success rate of people who get out of prison.”

Emily Nonko is a Brooklyn, NY-based reporter who writes about real estate, architecture, urbanism and design. Her work has appeared in the Wall Street Journal, New York magazine, Curbed and other publications.  


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Are You Asking Too Much of Your Job Candidates? How to Get ‘Test Projects’ Right

Current dispatches from the job market describe an exhausting scene. On one side are overloaded recruiters, shuffling thousands of applications for a single role with limited resources and little time. On the other side are weary applicants feeling defeated and devalued by impersonal, drawn-out interview cycles and unresponsive employers.One particular point of tension is the candidate test project. To evaluate applicants’ skills and narrow the talent pool, employers are now frequently asking job candidates to complete test projects or evaluations in the form of strategy proposals, presentations, blog posts, research projects, and video-editing tests, to name a few. But job seekers are getting burned out, sinking hours into unpaid projects with seemingly little relevance to the role, only to be ignored or rejected by an automated email.It's rough out there, especially for well-paid office workers seeking a new job. “Welcome to the white-collar recession,” declared Business Insider. Reports Wall Street Journal columnist Callum Borchers: “I hear from a lot of white-collar workers on the job hunt who say it’s much harder to get hired than the unemployment numbers make it sound.” Said Bloomberg: “Take-home assignments during the interview process are on the rise, irking candidates.”While employers may have the advantage at the moment, they should avoid overplaying their hand, since their reputations are at stake. Job seekers who spoke to From Day One describe growing cynical and suspicious of companies that request burdensome projects, and especially of those that don’t compensate candidates for their time. Yet it may be the delivery and design of these projects, not their intention, that is souring relations between candidates and companies.How Test Projects Go WrongBeth Miller (not her real name)* has built a 20-year career as a writing instructor and communications practitioner in higher education and nonprofits, and for the last year, following a layoff, she has been on the job hunt.After submitting an application for a job in a university’s development office, Miller received an automated email inviting her to complete a performance task: an asynchronous video interview that was expected to take 30 minutes. Uncomfortable on camera yet eager to do it well, Miller sunk four hours into the project.A week later, at about 9 p.m. on the Thursday before Memorial Day weekend, Miller received an email with another request: a full grant proposal to be completed over the holiday, due Monday, she told From Day One. When Miller replied with questions, her emails quickly bounced back with out-of-office messages.“The most difficult thing is that the emails were not coming from a person,” she said. They were addressed to ‘dear applicant,’ and signed, ‘the hiring team,’” she said. Unable to get a new due date for the assignment, Miller gave up her weekend to the project.Miller’s story is like that of many job seekers right now. Unwieldy evaluations are popping up across industries and job types, and in a labor market where the competition is often among the applicants, rather than the employers, candidates are getting burnt out by the requests, sometimes completing several projects before they even speak to a recruiter.“These are, by no means, simple and easy,” said Liane Paonessa, who was applying for director-level roles in corporate PR earlier this year. “They’re complex, detailed, and basically provide the company with a free strategic plan and content from every candidate.”Further, they seem to be redundant. Some employers require a portfolio of prior work samples in addition to test projects. “In most cases, I [got] no feedback whatsoever on the projects, other than a ‘Thank you for your excellent work,’ before ghosting me and later sending me the standard form rejection email,” said Paonessa.Many job applicants who spoke to From Day One believe that employers use unpaid test projects to get free work from desperate applicants. Job seekers describe being asked to draft 12-month strategy plans, make hour-long presentations, pitch detailed article ideas, write website content, produce fresh code, and even provide names of other people who might be good additions to the company.As exhausted applicants churn through these often unacknowledged projects, it reinforces their cynical beliefs about employers’ attitudes towards job seekers. “It’s so dehumanizing to constantly be putting yourself at the feet of an organization and trying to tell them why you’re worth hiring,” Miller said.How Test Projects Go RightJob seekers don’t object to test projects in principle–workers know they have to demonstrate their skills to land a role, and many are glad to show off what they can do–but they do want a better experience: one with boundaries, respect, and communication.When recounting good experiences with test projects, job seekers describe assignments with clear, limited scopes that teach them something about the role responsibilities, an ability to get feedback on their work, and some kind of compensation.Last spring, Tori Zhou, a content-marketing professional in New York City, was in the running for a content-writing role at a tech company when she was asked to complete an assessment that changed the way she thinks of test projects. Not only were the instructions crystal-clear, the project came with a disclaimer, assuring applicants their work wouldn’t be used beyond the hiring process. “I thought it was so considerate that they said that,” Zhou explained. “I also believed it because of the structure of the test.”The assignment included copy-editing a few pieces of content and writing a new introductory paragraph for an existing blog post. But don’t worry, we’re not going to update it, the request read. And even though she didn’t get the job, the company offered constructive feedback on her work.“This is such a positive memory for me. I feel like it’s the best test I’ve ever done,” Zhou said. “I still look at their job careers page, even today, because I’m like, ‘Wow, that just left such a positive impression on me. I would just happily apply with them again.’”Candidates also want to learn something from the evaluation process. Olivia Ramirez, a job seeker who interviewed for a role at a financial services company, said test assignments have helped her decide whether she wants to pursue the role. When the hiring manager assigned a lengthy and technical writing project, “it definitely made me question whether I was the right fit for the company,” she said. “I wasn’t having the most enjoyable time writing about this topic. It’s a good way to understand what the actual day-to-day grittiness of the work is like.” And even though the assignment was a tough one, Ramirez said she liked having the chance to show the work she’s capable of doing.Zhou once completed a test project that was much more technical than she imagined the job to be. “That helped me think about, ‘OK, is this job really right for me?’” she said.How to Improve Interview Test ProjectsFrank Hauben is the global VP of product management at technical-interview platform CoderPad. He believes that sound candidate assessments have three characteristics.First, evaluations should be time-bound. “By time-bound, I don’t mean 40 hours,” he said. “On the order of 30 minutes to two hours is what we find to be a reasonable sweet spot.” Not only do boundaries limit the scope and complexity of the assignment, it helps make the interview process more equitable. As a parent of two young girls, Hauben said there’s no way he has 40 hours to spend on a project, and couldn’t compete with someone who does.Time boundaries are different from time estimates, and both matter. Employers should assume that applicants will exceed the time estimates attached to these assignments. When applicants need the job, they’ll sink their teeth in. One company told Tori Zhou not to spend more than two hours on the project. A self-described perfectionist, Zhou invested four, and estimates she has spent seven hours on another assessment. Ramirez describes spending upwards of 12 hours on a single take-home project.Next, instructions should be clear, said Hauben, and applicants should be given the opportunity to ask questions and receive responses about the evaluation.And finally, evaluations should give candidates the clearest possible picture of what the job is, said Hauben. But they don’t need to represent the entirety of the job. “What would you be walking somebody through on their first day or week? You want to give somebody something that is obviously realistic and relevant, not something out of a textbook or the most complex problem.”Consider, for example, asking candidates to come up with a solution to a problem you’ve already solved. “You know what the answer is, or what one answer could be,” Hauben said. And when you acknowledge that the problem has already been resolved, applicants don’t have to wonder if their work will be used after they’re ejected from the interview process.Compensating Applicants for Their TimeEvery job seeker who spoke to From Day One said that they want to be compensated for the time they spend on test projects. When they’re sinking multiple hours or days on an assignment, one that could ostensibly be exploited by the employer, they said, payment only feels fair. Many employers don't agree, which has created its own social-media debate. Applicants seldom have the luxury of turning down a test project when they really need the job, Miller said. “When you’re seeking employment, you’re really not at liberty to pass anything off. I know that companies take your work and use it. I know that they do that. To not be compensated for it is just validation that your concerns were right.”Miller, who’s still in the running for the job in college development, said that the hiring team asked about her experience with the test project, but as long as she’s a candidate, she feels that she can’t be completely candid.Ramirez, who was once compensated for a tough test assignment, said she thinks twice about companies that require unpaid test projects as part of the interview process because, ultimately, the candidate experience reflects the employee experience.“It would make me think about what their culture is like and what they’ve been implementing to be at the forefront of companies today, in terms of equity in the organization and advocating for their employees and potential employees,” she said. “If it’s paid, then I think that’s a great signal that the company is considering best practices and trying to stand up with the best of the best in the space.”Emily McCrary-Ruiz-Esparza is a freelance journalist and From Day One contributing editor who writes about work, the job market, and women’s experiences in the workplace. Her work has appeared in the Economist, the BBC, The Washington Post, Quartz, Fast Company, and Digiday’s Worklife.(Featured photo by Amenic181/iStock by Getty Images)*Editor’s note: Because she is still interviewing with the organization described here, Beth Miller asked that she not be identified by her real name.

Emily McCrary-Ruiz-Esparza | June 17, 2024

ADHD in the Workplace: What You Should Know–and What Can Help

Pete came to our weekly psychotherapy session frustrated with work. He had just returned to his office, post pandemic, and found the new, open plan noisy and overwhelming. Pete, which is not his real name, has attention-deficit/hyperactivity disorder (ADHD) and is easily distractible and sensitive to noise. He had trouble concentrating, was irritated by the constant chatter of colleagues, and, as a result, was feeling less productive.“Could you talk to your manager about getting some accommodations?” I asked.“No way!” he said. “That would be a career killer.”Pete’s wariness is not uncommon. A few of my psychotherapy patients with ADHD have confided in their managers, but most feel it’s unwise to do so. They fear they will be stigmatized and sidelined.Edward Hallowell, M.D., agrees with their concern. The founder of the Hallowell ADHD Centers and one of the leading authorities on the disorder, explained to From Day One: “We’re not there yet. Most corporate professionals think of ADHD as some kind of mental illness.”Given that ADHD is not well-understood in the workplace, how can employees speak up about their needs in a way that feels safe? And how can managers and HR leaders better understand how to respond to those needs–whether employees want to name their ADHD, or not? A well-accommodated employee is, after all, a happier and more productive one. “It’s in everyone’s best interest to remove obstacles to someone’s performance,” said Hallowell. Here’s what experts recommend:Know What It IsADHD is a neuro-developmental disorder characterized by symptoms of restlessness, impulsivity and difficulty sustaining attention to boring tasks. It tends to run in families and is often inherited from a parent. There are three types: inattentive (dreamy and distractible), hyperactive-impulsive (restless and talkative), and a combination of the two. Most adults with ADHD have the inattentive type. Though it was long considered to be a childhood disorder affecting mostly boys, research has shown that it persists into adulthood—about 30% to 70% of children with ADHD continue to have symptoms later in life.Ned Hallowell, M.D., a pre-eminent expert on ADHD (Photo courtesy of the Hallowell ADHD Centers)An undiagnosed adult may think of themselves as spacey, messy, or undisciplined—and they often suffer from low self-esteem. A recent study found that only 10% to 25% of adults with ADHD receive an accurate diagnosis and adequate treatment. “They are often inaccurately diagnosed with anxiety or depression, which are really just the fallout of untreated ADHD,” said Ari Tuckman, a psychologist in West Chester, Penn., who specializes in the treatment of ADHD. As Hallowell puts it: “It’s like driving on square wheels.” In dealing with tasks, you will make progress, but it may take longer.And That the Diagnosis Is On the RiseWhile children are still the most likely group to be identified with the disorder, the number of adult diagnoses has been rising for decades. The pandemic accelerated the trend: the overall incidence in adults (30 to 49 years old) nearly doubled from 2020 to 2022, fueled mainly by an increase in diagnoses among women, according to Epic Research, a medical-record software company. While it’s not clear exactly why women are being diagnosed more often, experts theorize that it may be due to increasing smartphone and technology use, which can amplify distractibility and stress, as well as a greater awareness that ADHD can be also be a women’s issue. As more adults are diagnosed, they—like Pete—often face workplaces that are not ADHD-literate.How It Affects Work Performance–But Not Always in a Bad WayPeople with the disorder may have difficulty with organization, time management and procrastination—all of which can make it hard to meet deadlines and work within teams. They find tedious tasks, such as scheduling and filling out expense reports, unusually challenging and have a different sense of time than others. “People with ADHD have more difficulty seeing time and feeling the future,” notes Tuckman,More than half (56%) of adults with ADHD said they believe the disorder “strongly impacts their ability to succeed at work,” according to a 2008 survey by McNeil Pediatrics. A more recent survey by Akili, a therapeutic-technology company, interviewed 500 adults with ADHD and found that employees with ADHD felt the disorder had a negative impact on their career.     And yet, people with ADHD often display qualities that work in their favor, notes Hallowell, who himself has ADHD. He sees the condition as a trait, not a disorder, that has positive benefits like creativity, humor, and spontaneity. “There’s more to it than most people realize,” he said. “ADHD is terrible term. We have an abundance of attention. Our challenge is where to put our focus.” People with ADHD can spend hours on topics that interest them and see details that others might miss, a trait sometimes called hyperfocus. Many successful people have talked openly about their ADHD, including Michael Phelps, Simone Biles, James Carville, astronaut Scott Kelly and JetBlue founder David Neeleman.How to Get DiagnosedIf you persistently miss deadlines, are chronically late, and feel like staying organized is a big effort, first ask a trusted friend or colleague if they find you more scattered than others. Then, make an appointment to see a psychologist or psychiatrist who specializes in treating the condition. There is no one standardized test—instead a professional will take a thorough history and may ask family members and friends to complete questionnaires about your behavior. You may be asked questions like, How often do you misplace items, feel bored and restless, or lose track of what needs to be done? If you meet the criteria, your doctor may talk to you about medication, therapy or coaching and, if needed, provide a diagnosis so you can receive accommodations at school or at work.Understand What HelpsMost people diagnosed with ADHD rely on medication to control their symptoms. Typical medications include stimulants such as Ritalin and Adderall, which increase the levels of the neurotransmitters dopamine and norepinephrine in the brain. There are also non-stimulant drugs such as Strattera. Stimulant medications that treat ADHD are the “most effective of medications in psychiatry,” said Tuckman, and help tame distractibility and impulsivity. About two thirds of people with ADHD diagnoses are prescribed stimulant medications, and that percentage has remained fairly consistent since 2013, according to Epic Research. Some people can help manage their symptoms by exercising regularly, getting proper sleep, and implementing strict organization and reminder systems. Or they hire very competent assistants.Once you are diagnosed and have figured out the best treatment, it’s like “getting fitted for the right eyeglasses,” said Dr. Hallowell. “Things come into sharper focus.”How to Make the Workplace More ADHD-FriendlySmall modifications can go a long way to helping people with ADHD perform better on the job. Tuckman suggests considering adjustments in the three domains described below. As an employee, you can make tweaks on your own or ask your manager for help. As for managers, if you have a worker who is struggling with organization and meeting deadlines, you could take the lead at putting these practices into place.Make distractions softer. Quiet spaces, headphones, and working on off-hours (say, early or late), can help mitigate the clatter of a bustling office. Often working from home is a good solution.Make important information stand out from the chatter. Putting assignments in writing, recording meetings, and highlighting deadlines can help workers whose focus is not great to stay on task.Bring the future closer to the present. Those who struggle with adhering to deadlines will benefit when big projects are broken into smaller chunks, and check-ins are on the calendar with frequent reminders of when tasks are due.So, Should You Tell Your Boss?If you have ADHD, you may be covered under the Americans with Disability Act (ADA). However, you might not want to play that card unless you absolutely must, says Belynda Gauthier, a retired HR director and past president of Children and Adults with ADHD (CHADD). “The first time I did a presentation on ADHD in the workplace, I launched into detail about how the employee should approach his supervisor or manager and suggested that he might want to go directly to HR first. An audience participant interrupted to tell me that her HR office actually is the problem for her. Oops! I took this to heart, did some serious thinking, and revamped my presentation. I no longer recommend revealing one’s diagnosis until and unless it’s necessary.” Indeed, 92% of surveyed adults with ADHD believe that their colleagues hold misconceptions, the most common of which is “people with ADHD just need to try harder.” A better strategy might be to simply approach your manager with a positive attitude and a few solutions. “Be sure to tell them what you are good at,” advised Hallowell.Gauthier suggests something like: “I am really enjoying processing these widgets, and I think I’m doing a good job. I believe I could do an even better job if I could move to that cubicle that’s farther from the copy machine. So many co-workers use it all day and everyone stops to say hello.” Avoid the use of the word “but” to qualify your suggestions and don’t be whiney, she says.      Accommodations can help, but sometimes the best solution is finding the right job in the right environment with the right supports. “When I finally figured out I had it, it was a relief,” David Neeleman said in a recent interview with Forbes. “I was just really careful to surround myself with people that could complement my ADHD. I have people around me that help implement a lot of the ideas I have.” When you can turn your intense focus on something that truly fascinates you, ADHD can be a bonus rather a deficit.Lesley Alderman, LCSW, is a psychotherapist and journalist based in Brooklyn, NY. In her therapy practice, she works with individuals and couples. She writes about mental health topics for the Washington Post and has been an editor at Money and Real Simple magazines and a health columnist for the New York Times.(Featured photo by Valentin Russanov/iStock by Getty Images) 

Lesley Alderman, LCSW | May 15, 2024

Workers Want Weight-Loss Drugs, But How Can Employers Pay the Bills?

When consumers see splashy TV commercials for weight-loss drugs, they often find the the pitch irresistible. But for HR and benefits executives, they may trigger an uneasy feeling. That's because the revolutionary weight-loss drugs like Wegovy bring with them both magic and mystery–the magic is how well they can work; the mystery is how to pay for them.GLP-1, or glucagon-like peptide-1, drugs have historically been used to treat diabetes. But the development of stronger drugs like Novo Nordisk’s Ozempic in recent years, and now the approval of Wegovy and Eli Lilly’s Zepbound specifically for weight management, has led to a sharp increase in demand. That’s particularly true as more research emerges showing the drugs may also reduce the risk of cardiovascular disease, stroke, and potentially bring other long-term health benefits. Yet the medications can cost as much as $1,000 to $1,500 per month–a price that few Americans can afford unless they have generous health-insurance coverage.And unlike expensive drugs for rare conditions, the potential number of patients for GLP-1s is vast. More than 40% of Americans have obesity, according to the Centers for Disease Control and Prevention, and that is expected to reach 50% by 2030.Many doctors are thrilled about the potential for GLP-1s to change how obesity is treated, but that puts employers–where nearly half of Americans get their health insurance–in a tricky position. Here’s what employers need to know as they consider coverage for these drugs in the quickly changing landscape:High Costs, Low CoverageWhile employer health plans widely cover GLP-1s for the purpose of treating diabetes, coverage for weight-loss purposes is much more spotty right now. A survey last fall by the International Foundation of Employee Benefit Plans found that 27% of 205 employers covered GLP-1s for weight loss and another 13% did not yet cover them but were considering adding coverage. Meanwhile, Willis Towers Watson (WTW), a global insurance benefits-consulting company that serves many large employers, found about 38% of employers it surveyed cover the weight-loss drugs. Those that do cover them are seeing significant cost increases. The retail price for Wegovy comes out to $15,000 to $16,000 per year, and after rebates and discounts from manufacturers, health plans still pay about $9,000 per year, says Cody Midlam, a director at WTW’s pharmacy practice. The cost per member per month for GLP-1s has doubled each of the last three years, according to WTW’s analysis, amounting to an extra $11 per member per month last year, or about 9% of all pharmacy costs.Companies are aware of the research showing the drugs’ effectiveness at tackling obesity. Yet while doctors say that helping people lose weight could lead to less cardiovascular disease, fewer mental health issues, and savings from avoiding knee replacements or other surgeries related to obesity, long-term data on clinical outcomes remains limited. With high employee turnover in many industries, it’s tough for these employers to factor in potential future savings in healthcare costs over the life of the employee.“Those outcomes take a very long time to manifest,” says Midlam. “It’s not something that’s easily measurable on a short timescale when plan decisions are being made.” Andrew Witty, CEO of UnitedHealth Group, the largest U.S. insurer, said his corporate clients see the benefits, but first have to deal with the short-term costs. “We’re very positive about the potential for another tool in the toolbox to help folks manage their weight. We recognize that has potential benefits,” Witty said in the third-quarter earnings call last year. “But we’re struggling.”Employers Meet the DemandDespite the high costs and headlines about some insurance plans scrapping GLP-1 coverage, plenty of employers see the upside to covering the new obesity medications. Ninety-nine percent of companies already covering GLP-1s said they planned to continue doing so next year, according to a fall survey from Accolade, a healthcare navigation and advocacy company. Employers reported that after they added GLP-1 coverage, they saw higher employee satisfaction, increased engagement in other well-being programs, and improvements in other or comorbid health conditions. Midlam of WTW says his firm’s corporate clients want to “avoid member disruption” wherever possible.Doctors agree that should be a priority. Dan Azagury, M.D., medical director for the Stanford Lifestyle and Weight Management Center, says GLP-1s have been a “game changer” for many of his patients. “If you stop it overnight, whether it’s insurance, or financial, or shortages, the rebound is ferocious,” he said. “So it’s really very frustrating that they encounter that situation.” Some companies have expressed concerns about the idea of paying for a drug that employees essentially have to take forever to maintain its benefits. But while side effects, including vomiting and gastrointestinal issues, can be unpleasant for some people, doctors like Azagury say they know how to help patients manage them, and that they are seeing more patients have a positive response to GLP-1s than to previous generations of weight loss medications. Holistic Care, Not Just PrescriptionsEven when employers decide they want to help their employees lose weight, there are still lots of details to consider. As companies approach designing their insurance plans for 2025 and beyond, they are trying to figure out how many employees are likely to use GLP-1 drugs if coverage is offered, whether there should be limits on who can get the drugs, and what kind of requirements they should use to prove the drugs are medically necessary. Most companies that cover GLP-1s use some cost-control strategies, according to the International Foundation of Employee Benefit Plans survey. Many use prior authorization, step therapy during which patients must try lower-cost drugs first, or specific eligibility requirements.Typically, eligibility requirements have been tied to the standards on the FDA labels for these medications. But some employers are considering restrictions such as only covering the drugs for people with obesity but not those who are overweight, says Tracy Spencer, a pharmacy practice leader for benefits consultant Aon. If they add those limits, she warns that employers should be aware that could change or jeopardize the rebates they get from the drug manufacturers, so they need to predict whether the savings they get from limiting the drugs’ use will offset the loss of the rebates.Benefits consultants like Aon and WTW are also seeing employers shift the way they look at GLP-1 drugs to view them as one piece in a broader strategy to address cardio-metabolic issues.That might mean employers choose to cover the drugs for targeted indications, such as covering Wegovy not for weight loss on its own, but for people with increased risk of cardiovascular disease, which Medicare recently announced it would do. It can also mean pairing GLP-1 coverage with required lifestyle modifications or participation in a virtual weight-loss or coaching program. Employers often have access to virtual health programs through their pharmacy benefit managers, and many have tried these to target diabetes in recent years. The biopharmaceutical company Moderna, which offers coverage of GLP-1s for diabetes and weight management, is one company that has tried this strategy. “In 2023 we saw a spike related to weight-loss management: We looked at claims data, and after mental health, obesity and weight management were the second drivers,” Jeffrey Stohlberg, Moderna’s director of corporate benefits, said at a From Day One conference earlier this year. So the company started using the virtual weight-loss management program Wondr Health, where an employee can work with a physician specializing in weight loss. “It’s not a path to GLP-1s, but [the physicians] can provide medication for that person,” Stohlberg said. Labcorp also announced in February that it would provide U.S. employees on GLP-1s with virtual care and medication management through WeightWatchers for Business. Other companies such as Omada Health and telehealth providers like Teladoc and Ro have launched similar offerings over the last year. Medical providers agree that a holistic approach is needed, but Angela Fitch, M.D., president of the Obesity Medicine Association and co-founder and chief medical officer of the obesity-focused primary care startup knownwell, worries that requiring a standard weight-management program for every person is another barrier and potentially a waste of money if the program doesn’t have solid evidence behind it.“You can offer lifestyle [strategies] in addition to medication,” she said, “but it should be driven by that shared decision making discussion with the clinician.” If insurers want to make sure patients are getting holistic care, she would rather have them require patients to get their prescriptions from a qualified physician who does a true evaluation so that solutions can be personalized. In her role with the Obesity Medicine Association, Fitch often advises employers on their health plan designs, so she understands that costs are a major concern for companies. But in her primary-care practice and others like it, she says her staff are “burning out” as they spend hours each day trying to navigate all the new and often strict and confusing insurance requirements for these medications. “We have got to deal with costs,” Fitch said. “But it should be transparent and flexible.” She worries that overly rigid restrictions are “adding to the bias and stigma of obesity” by signaling to patients that their weight is their responsibility to treat on their own. Her major advice is to view obesity with the nuance that people view other chronic conditions. “You do not need a GLP-1 management solution. You need a comprehensive obesity-care solution.”Abigail Abrams is a health writer and editor. Currently she is the senior manager of content operations for Atria. Previously, she was a staff writer on health and politics for TIME magazine. Her freelance work has appeared in the Washington Post, the Guardian, and other publications.

Abigail Abrams | April 15, 2024