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Drugs & Medical Devices

It’s Yet to be Seen Whether Wegovy Will Continue to be Covered

— October 27, 2023

Novo Nordisk’s miracle drug may come at a steep price without insurance coverage.

The obesity epidemic that continues to exist in the United States needs no introduction. A huge percentage of the population falls into the overweight or obese categories, and carrying those extra pounds leads to a long list of health complications. The personal toll on the people who are overweight is serious, of course, as is the financial toll and stress that this epidemic places on the healthcare system and covered services as a whole.

While diet and exercise continue to be the standard, tried-and-true approach to managing obesity, it’s also important to note the role that medications can play in helping people address this issue. One drug from Novo Nordisk has shown impressive results, but the cost of that medication has become burdensome on public systems that are supporting thousands of people who use it regularly.

The drug in question here is Wegovy, which is showing results where people lose roughly 15% of their body weight, on average. At first glance, that’s an incredible outcome, and one that is certainly worth exploring for as many people as possible. If simply taking a drug can help people lose around 15% of their body weight, many negative health outcomes will become far less likely as a result.

It's Yet to be Seen Whether Wegovy Will Continue to be Covered
Photo by Moe Magners from Pexels

At first, the cost to the North Carolina State Health Plan was fairly reasonable, when just a few thousand people were on the drug. As it started to show legitimate promise, however, more and more people became interested, and now well over 20,000 people are using it. As a result, costs for the state health plan have skyrocketed, and it’s now the biggest medication expense on the books for the health plan.

If the drug is providing good results for patients, it is appealing to continue to cover it and help those people lose weight. But what if the math just doesn’t add up for the state’s health plan? In other states, obesity medications are increasingly falling into the not-covered category, simply because of overwhelming demand and incredible costs that don’t fit into the budget. There is a good chance that a similar outcome will play out in North Carolina in the near future. The scale of the obesity crisis is such that millions of people need help losing weight, but when it comes to using a drug to get that job done, the costs can quickly spiral out of control, and it becomes hard to get everyone what they need.

It remains to be seen if the state healthcare system will continue to pay for Wegovy and similar drugs as part of covered health management services that might yield positive results but come at a steep price. Also, the lasting results of weight loss drugs remain hard to measure and not backed by solid science, so healthcare systems may be hesitant to pay for something that may only offer short-term results. To be sure, plenty of future studies, meetings, and debates will be on the horizon for this and similar issues.


Costly weight-loss drugs are draining the NC State Health Plan. Can coverage continue?

Wegovy: When Insurance Won’t Cover Your Meds

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