SHP Trustees vote to end GLP-1 drug coverage on April 1

Jan 26, 2024

By a 4-3 vote, the State Health Plan Board of Trustees voted on Thursday to end coverage of GLP-1 drugs for the treatment of weight loss on April 1, including for those patients currently grandfathered in.

The Plan will continue to cover the drugs in treatment of diabetes.

The vote came after a long debate over the drugs’ cost and impact on the State Health Plan. Around 25,000 members currently take the drugs – five times as many as this time last year. Continued coverage of the drugs would result in a $48.50 increase in premiums for all plan members.

SEANC Executive Director Ardis Watkins pointed out that GLP-1 drugs are up to four times cheaper in Europe than they are here, even though Novo Nordisk makes their drugs in nearby Clayton and Durham and received incentives to locate them here. Watch her entire testimony here.

“We keep putting every problem that is not caused by the employees back on the employees," Watkins said. "Why are the price tags what they are on these prescriptions? It is absolutely unacceptable that we are getting hit on both ends.”

The board voted in October to deny coverage for new prescriptions on Jan. 1, 2024, but continued to cover the drug for those already on them. The Plan’s pharmacy benefits manager (PBM), CVS Caremark, took away the rebate the Plan receives on each prescription, around $500, in response.

"It comes down to almost extortion to say, if you won't do this, we won't give you the rebate for your existing prescriptions," said Trustee and former SEANC President Wayne Fish during the meeting. "That's like getting held up at gunpoint in a back alleyway."

SEANC has worked with The Wall Street Journal and The New York Times on national coverage of the issue. Board members said they will revisit coverage of the drugs if Novo Nordisk and CVS/Caremark are willing to cut the price.