State Health Plan no longer covering new Ozempic and WeGovy prescriptions

RALEIGH, N.C. (QUEEN CITY NEWS) -- North Carolina's state health plan no longer covers new prescriptions for drugs like Ozempic and Wegovy.

The diabetes medications are often used for weight loss but the state treasurer says the price of the drug is putting the state health plan under siege.

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"The cost of this drug has the real potential of financially harming the state health plan," N.C. Treasurer Dale Folwell said. "We are not questioning whether it works. We're not questioning the efficacy of it; what we're questioning is what we're having to pay."

To put the price into perspective, Folwell says the state is paying more for Ozempic and WeGovy than any cancer-saving drugs the state also is purchasing.

Folwell says out of 700,000 people covered under the state health insurance care plan, 22,000 people are prescribed Ozempic or Wegovy, which amounts to an estimated $170 million cost to the state and taxpayers.

"We've been able to freeze family premium for seven years, freeze the individual premium, we've been able to negotiate a better Medicare Advantage product for all of our retirees," Folwell said. "But even in light of that, with the increased cost of this drug, we're looking at the potential of doubling the individual premiums."

The state will no longer cover new Ozempic prescriptions for now. Folwell is calling for price parity between Denmark and the United States.

"The people in the home country of this drug manufacturer, they pay about $250 for this drug, which can cost as much as $1,500 retail in this country," Folwell said.

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As the cost explodes, North Carolina joins states like Virginia and Connecticut cutting coverage as a short-term solution while the state takes a closer look at restricting the diabetes and weight-loss medicine.

"We're starting to get some data about the impact this has, as far the number of people got prescriptions in December. This is not just a mathematical increase, it's what we call an exponential increase," Folwell said. "And I think your viewers are going to be very interested when we get to the bottom of who's actually prescribing this drug and because it is so lucrative, we want to get to the bottom of who is actually writing these prescriptions."

The state Medical Board will discuss coverage of Ozempic, WeGovy and GLP-1s again Jan. 25.