North Carolina Withdraws Coverage Of Weight Loss Medication

In a move that’s caused some controversy North Carolina state employees will no longer have access to anti obesity medications like Wegovy and Zepbound as part of their healthcare policies. The decision comes as the state grapples with soaring healthcare costs.

The Board of Trustees voted to cut coverage for GLP-1 receptor agonists Wegovy, Saxenda, and Zepbound when prescribed for weight loss for individuals on the State Health Plan.

The plan covers over 740,000 state employees, teachers, retirees, and their family members and the change we be implemented on April 1, 2024. However, GLP-1 receptor agonists will still be covered for individuals with type 2 diabetes.

Why Was The Decision Made

The decision was down to an unexpected raise in costs, GLP-1 receptor agonists accounted for 10% of all prescription costs last year, coming to $102m of the state’s health plan. And this was also considering that only a small number of the plans coverage actually required said anti obesity prescriptions.

The Popularity and Cost of GLP-1 Receptor Agonists

These medications work by mimicking the GLP-1 hormone which is released in the stomach after eating food in theory making the patients less hungry.

In clinical trials, patients using Wegovy (semaglutide) lost up to 20% of their body weight in 68 weeks, while Zepbound (tripeptide) helped patients shed up to 18% of their body weight after 72 weeks of treatment.

However critics of the medications to note that weight may return within a year after discontinuing these medications.

The effectiveness of GLP-1 receptor agonists comes at a very high price point. Without insurance coverage, these medications can cost about $1,000 per month. Meaning many of the current users will not be able to afford the medication.

Lack of Coverage for Weight Loss Medication

North Carolina is not the only entity that does not provide coverage for weight loss drugs. Medicare, despite the growing rates of obesity and its associated costs, also does not offer coverage for these medications.

The argument is of course that it saves money in the long run, with obesity complications causing much larger costs. Obesity affects approximately 40% of American adults and contributes to a staggering $147 billion per year in healthcare costs.

Effectiveness and Risks of GLP-1 Receptor Agonists

One of the key risks associated with GLP-1 receptor agonists is gastrointestinal effects. Studies have linked these medications to stomach paralysis and pancreatitis. Additionally, there have been reports of rare but severe psychiatric events associated with their use.

The Impact of the Decision

North Carolina's decision to drop coverage for obesity drugs leaves many individuals unable to continue using medications that have proven effective for weight loss. The withdrawal of rebates by Novo Nordisk, the manufacturer of Wegovy, further exacerbates the financial burden for existing patients.

Seeking Alternative Solutions

Healthcare providers and policymakers must explore other interventions, including lifestyle modifications, behavioral therapy, and surgical options. These approaches may offer viable alternatives for those unable to access or afford weight loss medications.

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