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How North Carolina Is Reducing the Cost of Weight-Loss Drugs


North Carolina Treasurer Dale Folwell has voiced concerns over the high costs of popular weight loss drugs like Wegovy, Saxenda, and Zepbound, produced by Novo Nordisk and Eli Lilly. The financial strain on the state’s health insurance plan, which covers more than 750,000 teachers, state employees, and retirees, led to the cessation of coverage for these drugs earlier this year.

Last year, North Carolina’s health plan covered weight loss drugs for nearly 25,000 state employees, costing over $100 million, which accounted for about 10% of the state’s total prescription drug spending. This expense exceeded the total amount spent on all cancer treatments combined. Projections indicated that continuing to cover these drugs would cost North Carolina over $600 million in the next five years, prompting the health plan board of trustees to halt coverage.

Efforts to Reduce Costs


In an effort to reduce spending, Folwell, alongside the state’s pharmacy benefit manager CVS Caremark, initiated drug pricing negotiations with Novo Nordisk and Eli Lilly. This marked the first instance in Folwell’s eight-year tenure as state treasurer where direct negotiations with drug manufacturers were attempted. Despite these efforts, the negotiations have yet to yield significant cost reductions.

Novo Nordisk charges a monthly list price of around $1,350 for Wegovy and Saxenda, while Eli Lilly charges about $1,060 for Zepbound. Even with rebates that reduce these prices by a few hundred dollars, the state still finds the drugs unaffordable.

Folwell proposed raising the minimum body mass index (BMI) threshold for drug eligibility, reserving them for people with severe obesity. He also suggested limiting the duration of drug use if they prove ineffective. Folwell’s target price for the drugs is around $300, similar to what is charged in Denmark, where Novo Nordisk is based.

In response, Novo Nordisk and Eli Lilly have expressed a commitment to finding solutions to provide coverage for North Carolina patients. However, Novo Nordisk claimed that the state rejected multiple workable options. The state treasurer’s office stated that if coverage had continued under the current deal, monthly premiums for all state employees would likely have doubled.

North Carolina is not alone in facing these challenges. Connecticut recently limited weight loss drug coverage to state employees who also agreed to follow lifestyle, diet, and exercise changes, which helped lower costs. Connecticut’s state comptroller, Sean Scanlon, emphasized that drugmakers have little incentive to reduce prices given their profitability, hence states cannot wait for altruistic actions from large drug companies.

Impact on Patients

The cessation of coverage has left many North Carolina state employees in a difficult position. Primary care provider Leanne Owens has received numerous calls from panicked patients unsure of what to do without their medications. One of her patients, Skylar Hackney, a 26-year-old state employee, lost 50 pounds while on Wegovy but now faces uncertainty as her prescription runs out. Hackney, who had prediabetes, might have to wait for her condition to develop into diabetes to access semaglutide again under the state’s health plan.

The high cost of weight loss drugs is a significant burden on North Carolina’s health insurance plan, leading to difficult decisions and ongoing negotiations with drug manufacturers. While the state seeks affordable solutions, patients are left navigating the challenges of managing their health without coverage for these effective, yet expensive, medications.

What do you think of how North Carolina is reducing the cost of weight-loss drugs? Leave your thoughts in the comments below. 

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