State Health Plan board votes to restrict weight-loss drug coverage beginning in 2024

Oct 27, 2023

After a long and contentious meeting on Thursday, the State Health Plan Board of Trustees stopped short of ending coverage entirely for weight-loss drugs like Wegovy and Saxenda but took steps to restrict their use.

Effective Jan. 1, 2024, these drugs and other similar ones, when used for weight loss, will be excluded from State Health Plan coverage for any member who has not obtained the medication before Jan. 1, 2024. This decision does not impact members taking these medications to manage diabetes.

The board also directed the State Health Plan staff to investigate ways to mitigate costs other than ending coverage altogether.

SEANC stood up for members at the meeting, pointing out that the board should find ways to combat the enormous cost of the drugs with the same commitment as when they voted to fight hospital costs through the Clear Pricing Project. Wegovy is partially made in North Carolina by Novo Nordisk, which has received substantial incentive packages from the state.

The drugs cost around $1,300 a month per patient, and more than 23,000 Plan members are currently prescribed them. They are up to four times cheaper in European countries. The Plan estimates that it would need to raise premiums by $50 for all members to continue covering the drugs.

SEANC Lobbyist Flint Benson spoke in favor of continued coverage of the drugs and instead urged the board and staff to fight against the astronomical prices.

“These drugs have provided hope and a better life for many members,” he said. “They should not be penalized by ‘Big Pharma.’”