NC State Health Plan staff recommends cutting coverage of popular weight loss drugs
North Carolina State Health Plan staff recommended ending coverage of weight loss drugs Friday in order to rein in spending on a class of drugs called GLP-1s, which has put the plan’s finances “under siege.”
The recommendation comes ahead of next week’s NCSHP Board of Trustees meeting, where leaders are expected to vote on the future coverage of anti-obesity drugs like Wegovy and Saxenda.
More than 20,000 state health plan members currently take these medications for weight loss, which bear a $1,350 monthly list price.
State Treasurer Dale Folwell, who oversees the State Health Plan, said spending on these drugs has spiraled out of control. The plan spent more on Wegovy than any other medication this year, the plan’s pharmacy benefit manager told the board of trustees in August.
In documents uploaded Thursday night, the NCSHP staff laid out five options for coverage moving forward.
Those options are:
Maintaining the current coverage of weight loss drugs, which they wrote would require the plan to increase premiums substantially for all members.
Moving all the weight loss drugs to a lower tier. This would cause members to pay more out-of-pocket and would only slightly reduce the plan’s spending on these drugs, according to the plan’s projections.
Creating an entirely new tier for GLP-1s. This would increase out-of-pocket costs for members and reduce the number of people using weight loss drugs. This moderately reduces costs to NCSHP.
Ending coverage of GLP-1s for weight loss, with an exception process. This would dramatically reduce the number of people taking the medications, which substantially reduces costs for the plan. They wrote that allowing for exceptions “increases litigation risk.”
Ending coverage of GLP-1s for weight loss drugs with no path for exceptions.
NCSHP staff recommended the last option, which they acknowledged would negatively impact more than 20,000 members but also represents the “best cost-saving scenario” that puts the plan back on a more financially sustainable path.
State health plan leaders will vote on these options at the next Board of Trustees meeting on Oct. 26, when there will be time for public comment.
The health plan also recently tamped down off-label use of diabetes medicines like Ozempic, which have the same active ingredient as the weight loss drugs.
Teddy Rosenbluth covers science and health care for The News & Observer in a position funded by Duke Health and the Burroughs Wellcome Fund. The N&O maintains full editorial control of the work.
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