North Carolina state employees will no longer have coverage for obesity drugs like Wegovy and Zepbound as the state grapples with soaring costs.
The Board of Trustees voted Thursday to cut coverage for GLP-1 receptor agonists Wegovy, Saxenda, and Zepbound when prescribed for weight loss for individuals on the State Health Plan. The plan covers over 740,000 state employees, teachers, retirees, and their family members.
The decision will take effect on April 1, 2024. However, the State Health Plan will continue covering GLP-1 receptor agonists for type 2 diabetes.
GLP-1 receptor agonists have soared in popularity in recent years and cost the State Health Plan $102 million in 2023, accounting for 10% of all prescription costs.
The trustees who voted to drop coverage cited an unexpected increase in costs and said only a small number of all plan beneficiaries need coverage for obesity drugs.
In October, the board voted to cut coverage for new patients but continue covering those already taking the medications. Novo Nordisk, the manufacturer of Wegovy, responded by withdrawing rebates, a move estimated to increase the amount spent on prescriptions for existing patients by $54 million.
As the medications cost about $1,000 a month without insurance, paying out of pocket to continue using them for weight loss may not be an option for many.
Medicare does not offer coverage for weight loss drugs either, despite growing rates of obesity, the condition that affects about 40% of American adults and costs the United States healthcare system about $147 billion per year.
Effective but carries some risks
GLP-1 receptor agonists were initially approved for type 2 diabetes but have increasingly been used for weight loss, often off-label.
The medications work by mimicking the GLP-1 hormone, which is released in the stomach after eating food. They reduce the appetite and slow down food movement in the gut to make patients feel full for longer.
GLP-1 receptor agonists are highly effective. In the clinical trials, patients on Wegovy (semaglutide) lost up to 20% of their body weight in 68 weeks. Meanwhile, Zepbound (tripeptide), approved by the U.S. Food and Drug Administration in December, helps patients shed up to 18% of their body weight after 72 weeks of treatment.
However, research suggests that weight may return within a year after discontinuing the medication.
Moreover, emerging evidence associates GLP -1 receptor agonists with severe gastrointestinal effects, including stomach paralysis and pancreatitis. Scientists have recently warned that the medications may cause rare but severe psychiatric events.
North Carolina’s decision to drop coverage for obesity drugs may leave patients unable to continue effective but expensive medications.
- NC Health State Plan. State health plan board of trustees meeting - 1/25/2024.
- NC Health State Plan. GLP-1 medications for weight loss.
- CDC. Adult obesity facts.