NC Medicaid to cover weight-loss drugs like Wegovy, after access cut for state workers

People on Medicaid in North Carolina will soon be able to have obesity management medications covered.

The state’s Department of Health and Human Services (DHHS) announced that effective Aug. 1, NC Medicaid will add coverage of FDA-approved obesity management medications for beneficiaries 12 and older.

This coverage includes glucagon-like peptide 1 agonists (GLP-1s). The expanded access for low-income patients on the state and federal health insurance program comes as state government has cut back on access to the drugs for public employees and retirees.

GLP-1s exploded in popularity in recent years following the Food and Drug Administration approval of their use for people with obesity who do not have diabetes. These drugs, which work by making people stay fuller for longer, have been found to help people lose over 10% of their body weight.

The FDA has approved for weight loss GLP-1 drugs Wegovy and Saxenda, which are manufactured by Novo Nordisk, a Danish company. It’s also approved Zepbound, manufactured by Eli Lilly, a U.S. company.

“NC Medicaid is adding this coverage because of the substantial weight loss associated with these medications and the impact on comorbidities,” DHHS said in a news release.

“Prescription obesity management medications are now playing a role in addressing the obesity epidemic, as they may provide additional weight loss benefits compared to lifestyle modifications alone,” the release says. “Certain weight loss therapies, such as glucagon-like peptide 1 agonists (GLP-1s), can help reduce weight, lower blood sugar and lower rates of significant cardiovascular events, such as heart attack and stroke.”

Weight-loss drug costs

But these drugs come with a hefty price tag: A monthly supply of some of these drugs can cost more than $1,000 without insurance or rebates .

The State Health Plan, which covers hundreds of thousands of state employees, ended coverage of these drugs for weight loss in January, citing rising costs.

The plan spent a projected $102 million on the drugs in 2023, or 10% of its roughly $1 billion in net pharmacy spending last year, The News & Observer previously reported.

For the added Medicaid coverage, a public notice posted July 10 on DHHS’ website says that the change will cost the state more than $21 million in 2025 and over $15 million in 2026.

During a legislative committee meeting in early March, DHHS Secretary Kody Kinsley spoke on GLP-1 drugs and the potential of expanding NC Medicaid coverage of the drugs for weight loss.

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

“It’s frankly so frustrating to me that they are so incredibly expensive relative to what we see in other countries,” Kinsley said.

“I believe that they’re being held back from the people of North Carolina when they could be providing a great deal of value ... so my desire is for us to go after this and figure out a way to both get increased coverage, but to figure out a way that it’s got to be cheaper,” he said.