Get updates delivered to you daily. Free and customizable.
The New York Times
The State That Chose to Cover Obesity Drugs for Its Poor, but Not Its Own Employees
By Margot Sanger-Katz,
10 hours ago
Dale Folwell, right, North Carolina treasurer, speaks during a state health plan board of trustees meeting in Raleigh, N.C., on Jan. 25, 2024. (Eamon Queeney/The New York Times)
RALEIGH, N.C. — This month, North Carolina did something enthusiastically that most states have been reluctant to try: It started covering new obesity medicines like Wegovy for its poorest residents as part of its Medicaid program.
For Kody Kinsley, the state’s health and human services secretary, the choice was easy. Those poor residents are disproportionately affected by obesity and its related diseases. “From a baseline justice perspective,” he said, “why are we even talking about it?”
The reason many people are talking about it is the price tag. Expensive drugs are nothing new in the U.S. health system, but these are an unprecedented type of blockbuster because so many people could benefit: More than a third of American adults meet the clinical definition of obesity. The combination of high prices and high demand is forcing every insurer, public and private, to make tough decisions.
Just this spring, the North Carolina state employees’ health plan dropped coverage of the same class of drugs, citing unsustainable costs, ending coverage for nearly 25,000 people who were taking them.
That means the civil-service administrators who will be helping the state’s poorest residents get access to Wegovy and its siblings have lost their own employer coverage for the very same drugs.
The costs of the drugs, known as GLP-1 agonists, can add up quickly. Novo Nordisk’s Wegovy and Eli Lilly’s Zepbound — the two GLP-1 drugs that have been approved specifically for weight loss — each come with a sticker price over $1,200 a month and need to be taken long-term for sustained effect. (Ozempic has the same active ingredient as Wegovy but has been approved for diabetes.)
Medicare, which provides prescription drug coverage for Americans older than 65, is banned by law from paying for drugs just for weight loss. But state Medicaid programs like North Carolina’s can choose to cover the drugs for poor residents — or not. Most states don’t.
North Carolina officials estimate that Medicaid’s total bill for Wegovy in its first year will be $16 million.
Kody Kinsley, North Carolina's secretary of health, speaks during an announcement surrounding the expansion of Medicaid coverage for new obesity drugs, in Raleigh, N.C., on July 12, 2024. (Cornell Watson/The New York Times) Angela Smith, North Carolina's director of pharmacy, at the Department of Health and Human Services in Raleigh, N.C., on Aug. 23, 2024. (Cornell Watson/The New York Times)
Get updates delivered to you daily. Free and customizable.
It’s essential to note our commitment to transparency:
Our Terms of Use acknowledge that our services may not always be error-free, and our Community Standards emphasize our discretion in enforcing policies. As a platform hosting over 100,000 pieces of content published daily, we cannot pre-vet content, but we strive to foster a dynamic environment for free expression and robust discourse through safety guardrails of human and AI moderation.
Comments / 0