Medicaid to cover weight-loss medications, state health plan members still without aid

Paying upwards of $1,000 for weight-loss medications has kept the drugs out of the hands of many North Carolinians without insurance, until now.

NCDHHS announced Medicaid is expanding coverage to include U.S. Food and Drug Administration [FDA] obesity management medications starting Aug. 1.

Dr. Sarah Ro and nearly 30 other obesity medicine physicians have been calling for the coverage since July 2023.

“I think it’s a step in the right direction,” said Ro. “Medicaid beneficiaries represent the most vulnerable population in North Carolina with the highest rate of obesity, but they’ve been excluded from the latest advancement in obesity treatment, until now.”

Ro, medical director of the UNC Physicians Network Weight Management Program, said wider access to weight-loss medications will lead to better outcomes for patients.

“We expect improvements in their chronic diseases, their overall health and their quality of life,” she said. “We see this on a daily basis, our patients just suffering enormously from the complications of severe obesity.”

While some celebrate the increased coverage, Jessia Rieger was left with mixed emotions.

The Johnston County mother learned of the expanded Medicaid coverage by watching WRAL News Monday morning.

“I sat up in bed and was like, ‘What in the world?!” Rieger shared.

Rieger works as the director of program performance and operations for the North Carolina Community College System. She said she has lost more than 100 pounds since starting Wegovy in 2022, but the state health plan stopped offering coverage for the medication this year.

It was estimated roughly 20,000 people out of the 700,000 on the state health plan sought coverage for weight-loss medication.

“Instead of taking it every seven days I’m taking it every 12-14 days to try and max out the prescription because even with the coupon from Novo Nordisk it’s still $1,069 for me,” Rieger said. “What that means for my family is no vacations this year, no extra purchases.”

Rieger continued, “This is the happiest, healthiest I’ve ever been. Having to make the cost of this work just for that benefit is a struggle. I’ve never been at a better space than where I am now, but it’s coming at a cost to any kind of savings, any home improvements, anything extra.”

Rieger questioned how something like Medicaid was able to provide coverage for more individuals when her state health plan could not.

WRAL News took her question to State Treasurer Dale Folwell. He shared the high cost by manufacturers is keeping the coverage from returning.

“I was talking with Senator Bernie Sanders about three months ago who estimates covering this drug nationally for Medicare and Medicaid could cost up to $3 trillion,” Folwell said

In North Carolina, Folwell estimates state health plan coverage of weight-loss medications would cost roughly $175 million annually.

“Now, we have people in Denmark, the home country of Novo Nordisk who are only paying about $200 for this drug and they’re complaining their drug costs are too high,” Folwell said. “If they’re complaining about $200 and the drug companies are trying to charge the state health plan nearly $1,200 for this drug, the question still remains: ‘Why does it cost so much and ultimately, who has to pay for it?'”

WRAL News asked Folwell if he had a message to Rieger and others like her.

He responded, “Any mom, any dad who teachers or protects and serves, what they need to know is we are doing everything financially humanly possible. We put out an RFI to get ideas from anyone, anywhere, about how to actually solve the problem. We think about this every day on her behalf.”

Folwell told WRAL if manufacturers like Novo Nordisk and Eli Lilly would reduce costs to around $200 per vial, then he would fight for state health plan coverage to return.