NC Medicaid will cover weight-loss drugs like Wegovy after restricting access for state employees

People with Medicaid insurance in North Carolina will soon have their costs covered for medications to treat obesity.

The state Department of Health and Human Services (DHHS) announced that effective August 1, NC Medicaid will add coverage for FDA-approved drugs to treat obesity for beneficiaries ages 12 and older.

This coverage includes glucagon-like peptide-1 (GLP-1) agonists. Expanded access for low-income patients under the state and federal health insurance program occurs while the state government has restricted access to these drugs for public employees and retirees.

The popularity of GLP-1 has exploded in recent years after the Food and Drug Administration approved its use for people with obesity who do not have diabetes. These drugs, which work by keeping people fuller for longer, have helped people lose over 10% of their body weight.

The FDA has approved the GLP-1 weight-loss drugs Wegovy and Saxenda, made by the Danish company Novo Nordisk, as well as Zepbound, made by the US company Eli Lilly.

“NC Medicaid is adding this coverage because these medications are associated with significant weight loss and impact comorbidities,” DHHS said in a press release.

“Prescription drugs to treat obesity now have a role to play in combating the obesity epidemic because they may provide additional weight loss benefits compared to lifestyle changes alone,” the press release states. “Certain weight loss therapies, such as glucagon-like peptide-1 (GLP-1) agonists, may help reduce weight, lower blood sugar, and reduce the rate of serious cardiovascular events such as heart attack and stroke.”

Cost of weight loss medication

However, these drugs come at a price: a month's supply of some of these medications can cost more than $1,000 without insurance or reimbursement.

The State Health Plan, which insures hundreds of thousands of state employees, stopped covering these weight-loss drugs in January, citing rising costs.

As The News & Observer previously reported, the plan is expected to spend $102 million on the drugs in 2023, or 10% of pharmacy net spending of about $1 billion last year.

A July 10 public notice on the DHHS website states that the additional Medicaid coverage will cost the state more than $21 million in 2025 and more than $15 million in 2026.

During a House committee meeting in early March, DHHS Secretary Kody Kinsley spoke about GLP-1 drugs and the possibility of expanding NC Medicaid coverage of these weight loss drugs.

Kinsley also told lawmakers that GLP-1 drugs are already covered by Medicaid, but only for people with diabetes.

“Honestly, I find it so frustrating that they are so incredibly expensive compared to what we see in other countries,” Kinsley said.

“I believe they are being withheld from the people of North Carolina, even though they could provide great value … so my wish is that we address this and find a way to both provide better coverage and a way to do it more cheaply,” he said.