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Health & Medicine

North Carolina to Cut Weight Loss Drugs from Its Health Plans

— November 10, 2023

The expense of carrying weight loss remedies is too much for NC.

Given the widespread nature of the obesity crisis in the United States, it should be no surprise that weight loss drugs are extremely popular as a way to pursue improved health. Unfortunately, these drugs can come at an extreme cost, and for some health plans, offering them can be too expensive for the plan to handle.

That seems to be the case with the North Carolina State Health Plan and the weight loss drugs it has been offering. The financial burden that comes with making these drugs available on health plans has become too much, and the staff is now recommending that they be taken off of available coverage.

This recommendation from health plan staff comes in light of the stunning numbers that are being experienced by the system related to weight loss drugs. Specifically, there are over 20,000 people on the state health plan who are taking drugs that come with brand names such as Saxenda and Wegovy. Given the price tag for these drugs – well over $1,000 per month – the total cost to the health plan is more than it can reasonably bear moving forward.

North Carolina to Cut Weight Loss Drugs from Its Health Plans
Photo by Moe Magners from Pexels

In fact, spending has gotten so high on weight loss drugs that Wegovy is now the single costliest drug on the books for the health plan. Given the expense, continuing with the status quo is not an option, and some type of change will have to be made.

Based on the research done by the health plan staff, there are a few options that the Board can consider moving forward. If nothing is done to change the coverage of these drugs, the premiums for everyone in the health plan are going to have to increase dramatically. This will essentially have the effect of all members bearing the burden of paying for the drugs that are needed by a portion of the population.

On the other end of the spectrum, the Board could choose to simply end the coverage of drugs in this category. Obviously, this would have the effect of saving the health plan a huge amount of money, but members would no longer have subsidized access to a drug that may be helpful in losing weight and improving their overall health. In between the possibilities of doing nothing and cutting the drugs out entirely, there are three other recommended paths that offer some adjustment to the current system to save on expenses while still making it viable for as many people as possible to gain access to these medications.

If weight loss drugs can deliver on their promises and help overweight people improve their health, they’ll certainly be a valuable tool for many. However, with costs that are often prohibitive, it’s hard to see how these drugs will be able to serve the widespread market as a whole. There will likely be many more battles over funding and pricing to reach a point where people who need these drugs are able to obtain them in a sustainable manner.


NC State Health Plan staff recommends cutting coverage of popular weight loss drugs

NC State Health Plan begins crackdown on spending for weight-loss drugs

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