Weight loss drug coverage could return for some state workers under proposed NC budget

Millions of dollars in a new $32.6 billion state budget proposal could allow for the return of GLP-1 coverage for some state employees.

The state Senate proposed $25 million to be put toward providing coverage of GLP-1 medications for state employees with the state health plan. It would only apply to individuals with BMIs of 38 or higher.

North Carolina Treasurer Brad Briner said in a statement, “We are grateful to the Senate for their generous investment in the State Health Plan, fully funding the pension plan and helping with critical infrastructure needs of our department.”

Despite the money being just a quarter of the $100M originally requested, Briner stated it is a historic investment in the State Health Plan.

“In recent years, the state budget has averaged an increase of around 3.3% annually toward the State Health Plan cost. Based on the Department’s recommendation, this proposal would represent about 5% more than was contributed last fiscal year- which signifies a priority on state employee health as the Senate faced many difficult funding decisions,” he shared.

Dr. Sarah Ro, medical director of the UNC Physicians Network Weight Management Program, shared she is glad at least some of her employees will be able to afford the medications once again.

“Many of my patients who were on GLP-1s through North Carolina’s state health plan, suddenly got cut off from them,” Ro said. “Many of them have serious medical conditions associated with their obesity.”

Ro shared a lack of coverage has left patients in tough spots financially.

“Most of the dosages are now at $499. It’s our teachers, our firefighters, our janitors who work so hard, and they can’t afford $499 a month. That’s their rent, their food, so it really increases the health disparities,” the physician said.

Ro shared weight-loss drugs aren’t meant for every patient. She told WRAL she understands why the state would want to limit who it covers, but said a different BMI marker should be implemented.

“For somebody with a BMI less than 38 with significant health issues, I think there should be some leeway for the way physicians to appeal that decision so folks who need it based on the higher risk disease process could obtain it,” said Ro.

The physician stated she did agree the initial 27 BMI level used by the state for GLP-1 coverage was too low, stating resources are limited.

“I may not agree with 38, I think it should be 35,” Ro said. “Patients at highest risk should be able to obtain them.”

In a statement to WRAL News, State Health Plan Executive Director Thomas Friedman wrote, “With all of the challenge’s facing North Carolina right now, we’re appreciative that the Senate’s budget proposal included funding to offer GLP-1s to Plan members.”

The statement continued, “This funding will allow us the flexibility to start the necessary work and conversations with drug manufactures. While this amount won’t fund the ability to offer GLP-1s to all members, it will allow us the ability to develop a program that would offer GLP-1s to the members that need it the most, which has always been the goal.”

How many members the $25 million would provide coverage for is unclear.

The original $100 million request was estimated to be enough to provide coverage for roughly 14,000 employees. A state treasurer spokesperson said they are working to determine what coverage will mean with just the proposed $25 million.

Coverage for GLP-1s was originally pulled for state health plan members last year. The state at the time cited high costs from manufacturers.

The move to put coverage back on the table comes after manufacturers, including Novo Nordisk and Eli Lilly, slashed costs in recent months.