Who gets weight loss drugs covered by insurance? States try to reel in costs.
North Carolina stopped covering weight loss drugs such as Ozempic for state employees without diabetes. But it extended coverage for Medicaid recipients.
After losing and regaining the same 20-plus pounds more times than she could count, Anita Blanchard concluded that diets don’t work.
So when the University of North Carolina-Charlotte professor learned that Ozempic — developed to treat Type 2 diabetes — helped people lose weight and keep it off, Blanchard was determined to try it.
The state employee’s health insurance initially covered the prescription with Blanchard kicking in a $25 copayment. Over the next seven months, she said, she lost 45 pounds and lowered her blood pressure and cholesterol. The most significant benefits, though, were psychological.
“It stopped the food noise in my head, relieved my anxiety, and I was no longer drinking like a fish,” said Blanchard, now 60. “I’d have a glass of wine, and then that’s it.”
But North Carolina suffered from sticker shock as Blanchard shed pounds and thousands of others on the state insurance program — which covers more than 76,000 employees across 178 agencies, plus their dependents — tried to do the same. Ozempic and other glucagon-like peptide-1 (GPL-1) agonist medications accounted for 10% of the state employee health plan’s annual prescription drug spending, according to a North Carolina State Health Plan fact sheet. The state treasurer projected the class of drugs would cost the state more than $170 million this year, with costs jumping to more than $1 billion over the next six years.
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