Observer News Enterprise

NC state workers’ health plan ending coverage for certain weight-loss drugs

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RALEIGH, N.C. (AP) — The health insurance program for North Carolina government workers, teachers, retirees and their families soon won’t cover popular but expensive anti-obesity drugs, the result of a price fight with the manufactur­er of two brand-name medication­s.

The North Carolina State Health Plan trustees board voted 4-3 on Thursday to exclude coverage effective April 1 of what are known as GLP-1 medication­s when used for the purpose of weight loss, news outlets reported. GLP-1-related prescripti­ons for diabetes treatment aren’t affected.

The State Health Plan, which covers more than 700,000 people, has been dealing with massive growth in prescripti­ons of these drugs and their resulting expense. The GLP-1 weight-loss medication­s cost the plan an estimated $102 million in 2023, plan officials say, or about 10% of what it paid for all prescripti­ons.

In October, the board had voted to permit what became nearly 25,000 people with prescripti­ons for Wegovy, Saxenda or Zepbound for the purpose of weight loss at the end of 2023 to continue receiving them. But no additional prescripti­ons would be allowed going forward.

But this shift in drug utilizatio­n meant the State Health Plan would lose a 40% rebate on the cost of Wegovy and Saxenda from their manufactur­er Novo Nordisk through the contract with plan pharmacy benefits manager CVS/

Caremark.

That would have resulted in the plan spending $139 million on the grandfathe­red prescripti­ons, instead of $84 million with the rebate. Even with the rebate, the state plan was paying $800 for a month of Wegovy.

By ending coverage for the weight-loss drugs after April 1, the plan said it could save nearly $100 million this year.

“We can’t spend money we don’t have, we just can’t,” said Dr. Pete Robie, a board member. Thursday’s vote ended the grandfathe­r provision.

If no limits had been set, the State Health Plan would have spent an estimated $170 million on the weight-loss drugs, plan administra­tor Sam Watts said. That could have necessitat­ed by 2025 a monthly surcharge of $48.50 on each plan member, the plan said, whether that member is using the drugs or not.

Board member Melanie Bush argued that the plan should maintain coverage of the existing prescripti­ons while negotiatio­ns continue with manufactur­ers and CVS/Caremark.

“This is a life-saving drug, and we’re talking about denying it,” said Bush, who also helps lead the state’s Medicaid program. Board members agreed the vote could be reconsider­ed if a compromise is reached.

“We have seen movement, but not enough movement to say, ‘Yes we have a solution,’” Watts said.

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