{"id":2526,"date":"2024-01-26T19:46:06","date_gmt":"2024-01-26T19:46:06","guid":{"rendered":"https:\/\/news2shorts.com\/index.php\/2024\/01\/26\/north-carolina-state-workers-health-plan-ending-coverage-for-certain-weight-loss-drugs\/"},"modified":"2024-01-26T19:46:06","modified_gmt":"2024-01-26T19:46:06","slug":"north-carolina-state-workers-health-plan-ending-coverage-for-certain-weight-loss-drugs","status":"publish","type":"post","link":"https:\/\/news2shorts.com\/index.php\/2024\/01\/26\/north-carolina-state-workers-health-plan-ending-coverage-for-certain-weight-loss-drugs\/","title":{"rendered":"North Carolina state workers’ health plan ending coverage for certain weight-loss drugs"},"content":{"rendered":"

RALEIGH, N.C. (AP) \u2014 The health insurance program for North Carolina government workers, teachers, retirees and their families soon won\u2019t cover popular but expensive anti-obesity drugs<\/a>, the result of a price fight with the manufacturer of two brand-name medications.<\/p>\n

The North Carolina State Health Plan trustees board voted 4-3 on Thursday to exclude coverage effective April 1 of what are known as GLP-1 medications when used for the purpose of weight loss, news outlets reported. GLP-1-related prescriptions for diabetes treatment aren\u2019t affected.<\/p>\n

OZEMPIC, OTHER WEIGHT-LOSS DRUGS MAY STRENGTHEN NEW YEAR’S RESOLUTIONS, EXPERTS SAY: HEALTH GOAL ‘BOOST’<\/strong><\/a><\/p>\n

The State Health Plan, which covers more than 700,000 people, has been dealing with massive growth in prescriptions of these drugs and their resulting expense. The GLP-1 weight-loss medications cost the plan an estimated $102 million in 2023, plan officials say, or about 10% of what it paid for all prescriptions.<\/p>\n

In October, the board had voted to permit what became nearly 25,000 people with prescriptions for Wegovy<\/a>, Saxenda or Zepbound for the purpose of weight loss at the end of 2023 to continue receiving them. But no additional prescriptions would be allowed going forward.<\/p>\n

But this shift in drug utilization meant the State Health Plan would lose a 40% rebate on the cost of Wegovy<\/a> and Saxenda from their manufacturer Novo Nordisk through the contract with plan pharmacy benefits manager CVS\/Caremark.<\/p>\n

That would have resulted in the plan spending $139 million on the grandfathered prescriptions, instead of $84 million with the rebate. Even with the rebate, the state plan was paying $800 for a month of Wegovy.<\/p>\n

By ending coverage for the weight-loss drugs after April 1, the plan said it could save nearly $100 million this year.<\/p>\n

“We can\u2019t spend money we don\u2019t have, we just can\u2019t,” said Dr. Pete Robie, a board member. Thursday\u2019s vote ended the grandfather provision.<\/p>\n

If no limits had been set, the State Health Plan would have spent an estimated $170 million on the weight-loss drugs, plan administrator Sam Watts said. That could have necessitated by 2025 a monthly surcharge of $48.50 on each plan member, the plan said, whether that member is using the drugs or not.<\/p>\n

Board member Melanie Bush argued that the plan should maintain coverage of the existing prescriptions while negotiations continue with manufacturers and CVS\/Caremark.<\/p>\n

“This is a life-saving drug, and we\u2019re talking about denying it,” said Bush, who also helps lead the state’s Medicaid program. Board members agreed the vote could be reconsidered if a compromise is reached.<\/p>\n

“We have seen movement, but not enough movement to say, \u2018Yes we have a solution,\u2019” Watts said.<\/p>\n","protected":false},"excerpt":{"rendered":"

RALEIGH, N.C. (AP) \u2014 The health insurance program for North Carolina government workers, teachers, retirees and their families soon won\u2019t cover popular but expensive anti-obesity drugs, the result of a price fight with the manufacturer of two brand-name medications. The North Carolina State Health Plan trustees board voted 4-3 on Thursday to exclude coverage effective … Read more<\/a><\/p>\n","protected":false},"author":0,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[1],"tags":[],"class_list":["post-2526","post","type-post","status-publish","format-standard","hentry","category-blog"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/news2shorts.com\/index.php\/wp-json\/wp\/v2\/posts\/2526","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/news2shorts.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/news2shorts.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/news2shorts.com\/index.php\/wp-json\/wp\/v2\/comments?post=2526"}],"version-history":[{"count":0,"href":"https:\/\/news2shorts.com\/index.php\/wp-json\/wp\/v2\/posts\/2526\/revisions"}],"wp:attachment":[{"href":"https:\/\/news2shorts.com\/index.php\/wp-json\/wp\/v2\/media?parent=2526"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/news2shorts.com\/index.php\/wp-json\/wp\/v2\/categories?post=2526"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/news2shorts.com\/index.php\/wp-json\/wp\/v2\/tags?post=2526"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}