RALEIGH, N.C. (AP) — North Carolina's health insurance program for government employees, teachers, retirees and their families is losing out on a popular but expensive insurance program after a price war with two brand-name manufacturers. It will soon no longer cover obesity drugs. medicine.
The North Carolina Board of Health Planning Boards voted 4-3 Thursday to exempt so-called GLP-1 drugs used for weight loss starting April 1, news outlets reported. His GLP-1-related prescriptions for diabetes treatment are not affected.
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State health plans, which cover more than 700,000 people, have been dealing with significant increases in the amount of prescriptions for these drugs and their associated costs. GLP-1 weight loss drugs will cost the plan an estimated $102 million in 2023, about 10% of what it pays for all prescriptions, plan officials said.
The board voted in October to allow approximately 25,000 people with prescriptions for Wigoby, Saxenda and Zepbound to continue receiving the drugs for weight loss as of the end of 2023. However, no additional prescriptions will be allowed in the future.
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However, due to this change in drug utilization, the state health plan will lose a 40% rebate on the cost of Wegoby and Saxenda from the manufacturer, Novo Nordisk, through its contract with the plan pharmacy benefits administrator, CVS/Caremark. It turns out.
In that case, the plan would spend $139 million on obsolete prescriptions instead of $84 million with rebates. Even with the rebate, the state plan was paying him $800 a month for Wegovy.
The plan says it would save nearly $100 million this year by ending insurance coverage for weight loss drugs after April 1.
“We can't spend money we don't have. We can't do that,” board member Dr. Pete Roby said. Thursday's vote repealed the grandfather clause.
If the limit had not been set, the state health plan would have spent an estimated $170 million on weight loss drugs, said plan administrator Sam Watts. As a result, by 2025, each plan member could be required to pay an additional $48.50 per month, regardless of whether the member uses drugs, the plan says.
Board member Melanie Bush argued that the plan should maintain existing prescription coverage while negotiations with manufacturers and CVS/Caremark continue.
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“This is a life-saving drug, and we're talking about denying it,” said Bush, who also leads the state's Medicaid program. Board members agreed that the vote could be revisited if a compromise is reached.
“We've seen movement, but not enough movement to say, 'Yes, there is a solution,'” Watts said.
