State Health Plan coverage of GLP-1 drugs for weight loss ends Monday

Mar 28, 2024

The State Health Plan will end coverage of GLP-1 drug for weight loss drugs on April 1. The Plan's Board of Trustees, by a 4-3 vote in January, decided to take this step because of the outrageous cost of these drugs.

The plan stated in January that around 25,000 plan 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.

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

In this week's episode of the SEANC View Podcast, SEANC interviews Dr. Daniel Knecht from CVS Caremark on the issues concerning GLP-1 drugs and their high costs. CVS Caremark is the Pharmacy Benefits Manager (PBM) for the Plan. PBMs engaged in price negotiations with drug manufacturers in hopes of driving down costs.

Novo Nordisk makes the GLP-1 drugs Ozempic and Wegovy right here in plants in Clayton and Durham and is the primary manufacturer of GLP-1 drugs. Up until recently, Novo Nordisk held a "legal monopoly" on them since they held most of the patents to make them. This allowed the company to charge exorbitant prices for them.

Although some other companies are now making similar drugs, Novo Nordisk continues to be the leader, and prices have yet to come down. SEANC has been in contact with congressional leaders from North Carolina and beyond to call attention to the issue. Sen. Bernie Sanders, who chairs the U.S. Senate Health, Education, Labor, and Pensions Committee, on Wednesday called on Novo Nordisk to lower its price for Ozempic after a Yale study found that it cost less than $5 to make a month's dose of it.

The drug costs just $59 a month in Germany and $155 a month in Canada.

Though time has almost run out for a deal to be made to continue coverage by the State Health Plan, negotiations will likely continue. The Board will revisit the issue should the price of the drugs decrease considerably.

Listen on Apple Podcasts, Spotify, Amazon Music, YouTube, or Podbean.