State health plan cuts coverage for weight-loss drugs, citing high costs

The state says it will no longer pay to help its employees pay for their weight-loss drugs.

The State Health Plan Board of Trustees voted Thursday to put a moratorium on new users of drugs like Ozempic and Wegovy. As of Jan. 1, it means new users of the weight-loss drugs will have to pay for them out of their own pocket.

North Carolina State Treasurer Dale Folwell says this decision allows “the staff, Novo Nordisk, and our pharmacy benefit manager come together and figure out how we can tighten up this process, meet the need of our members and cut the cost.”

These drugs were originally meant to help people with diabetes regulate their blood sugar. However, they’ve quickly grown in popularity for their strong results in weight loss. The state said it has spent too much money on them.

The drugs costs the health plan $168 million a year “with minimal savings on medical costs” to offset the spending, plan consultant The Segal Group said in an August memorandum on the issue.

“I think the insurance companies were a little softer, as far as the requirements for who was allowed to take those medications,” said Steve Adkins, the owner of Health Park Pharmacy.

Those costs went from $3 million per month two years ago to more than $14 million per month this year, plan consultants said earlier this year.

About 20,000 people use the drugs out of the state's 700,000 plan members. It's an increase in users of about 731% from three years ago.

This class of drugs, known as GLP-1, would still be covered for diabetics, according to State Health Plan Administrator Sam Watts. But drugs such as Saxenda and Wegovy wouldn’t be covered for people who simply use them for weight loss.

However, the board says there are other weight loss drugs available under different tiers in the plan.

“A cost of one drug has the potential of costing us $170 million next year,” Folwell said.

Wegovy costs $1,349 for a month’s supply. Although a 40% rebate cuts the price significantly, the drug is still much more expensive in the United States than it is in Denmark, where drugmaker Novo Nordisk is headquartered, Watts said.

Folwell told WRAL News taht in Europe, semaglutide drugs sell for about $300.

“All I want is to be able to buy this drug at their price,” Folwell said.

Dr. C. Nicole Swiner is a user of Ozempic.

"I lost almost 40 pounds in that first year," Swiner said.

Swiner’s testimony is not an outlier. She says semaglutide has helped her lead a healthier lifestyle. It mimics that "full" feeling and slows digestion.

"I had a weight-loss coach," Swiner said. "I had been on Weight Watchers."

Swiner said using Ozempic helped her finally see results.

Many people argue that weight is a crucial factor of overall health.

"As we age, the BMI and our weight becomes more and more important for long-term chronic health risks," Swiner said.