Russell Wooten from Hendersonville, North Karolina, spent most of his life fighting obesity, often carrying 260 pounds on the frame of 6 feet and 3 feet. He starved many times to lose weight and then recovered him, eating comfortable dishes. The cycle caused him to feel “depressed and desperate”.
In February 2023, Wooten began to take Wegova, one of the classes of drugs called GLP-1s. Long -prescribed patients with type 2 diabetes and cardiovascular diseases, these drugs balance blood sugar levels, but also limit hunger signals and can support people lose significant importance.
Wegova helped Wooten, a guardian at a local public school, to lose 40 pounds. But his joy was compact -lived: in April last year, the health plan of North Carolina’s state for teachers and other public employees stopped covering the medicine to lose weight. The catalog price for Wegova is at the top of USD 1300 per month – much more than Wooten can afford its salary 45,000 USD.
“It worked for me. I practiced. I felt better than for a long time, “said 54 -year -old Wooten,” it’s as if someone gave you Ferrari and then took him. “
The rapid popularity of slimming drugs quickly becomes a state budget problem. When deciding whether to cover medicines, decision-makers must choose between long-term benefits from limiting obesity among public employees and their families-what can reduce expenses for the treatment of chronic diseases-short-term costs.
Separately 13 state medicaid programs, including North Karolina, decided to cover GLP-1 for obesity. But Medicaid is jointly financed by the federal government and states, and drug manufacturers are obliged to offer significant discounts to these programs in exchange for insurance of their products. Insurance plans that include public employees largely must bear the costs themselves.
About a dozen states Last year, the provisions that would add the range of GLP-1 slimming drugs to state health plans, Medicaid or the rules offered on the market on inexpensive care were included. Most failed or did not advance. West Virginia, like North Karolina, covered drugs for state workers, but she stopped doing so. His movement, however, influenced much fewer people, because his initiative was a narrow pilot program.
Meanwhile, Illinois approved insurance for their public employees last year, and Connecticut officials claim that they will include drugs they began to do in 2023, despite the high price.
“North Karolina is wrong because when employees are healthy, they are more productive,” said Connecticut Sean Scanlon, Democrat.
Costs and benefits
Dr. Nicholas Pennings, chairman of family medicine at the University of Campbell, Buies Creek, North Karolina, saw how many patients in the employee state regain the weight they lost after the end of GLP-1. This is due to the fact that obesity is a chronic state that can be caused by genetics, emotional dependence and lack of hearty access to food.
In North Carolina, where 70% of the inhabitants are overweight or obesity, food such as grill pork and peach seam part of the local culture. Pennings said he had patients, including children of state employees who were doing well at GLP-1, but are now heading towards the development of diabetes.
The Health Plan of North Carolina, which covers almost 750,000 employees, retirees and their maintenance, began paying for GLP-1 for weight loss in 2015 to 2023. 23 215 beneficiaries were on drugs, compared to 2795 in 2021 . With various discounts and discounts, it was predicted that the health plan spent $ 170 million on medicines in 2024.
A total of $ 4.13 billion spends a total of $ 4.13 billion in total to provide protection for people working for state agencies, universities, universities and local school systems. Of this total, state dollars of taxpayers cover about 84% And employee contributions include the rest.
Scientists say that in the long run, the covering of slimming drugs can cause lower expenses for chronic obesity associated with diabetes, heart disease and some types of cancer. But Dale Folwell, a former Treasurer of the Republican State in North Carolina, who was balanced when the plan stopped covering medicine, said that this is an investment that the state could not afford.
“The whole problem for slimming drugs and their costs came to us as the highest fuel dragster at 300 miles per hour,” said Folwell. “This is not emotional, it is not political, it’s mathematical.”
State Health Plan Currently has a deficit worth 507 million dollars. Managers for pharmacy benefits, drug supply chain agents should apply their tender for negotiating lower drug prices, and the Folwell said that PBM Stanowy secured discounts on drugs for slimming. But they were not enough.
Brad Briner, who replaced the Folwell as a treasurer at the beginning of this month, said that the state was considering reducing costs, reducing insurance for patients with the greatest risk, but the current state agreement with his PBM would not allow it. He hopes that the next PBM agreement in the state will allow for greater flexibility, and the state will resume the cover of medicines for at least some patients next year.
In the meantime, Briner said that eliminating the range was the right decision.
“We need to balance the books before we add GLP-1,” Briner also said, also a Republican.
As in North Carolina, over 70% of West Virginia residents are overweight or obesity. State Public Insurance Agency for Employees, which supervises the State Health Plan, in March completed its diminutive pilot program, which covered about 1,100 recorded due to fears of costs and supply.
The agency told We -Mail that the program costs USD 1.3 million per month. If they had an extension of the range for all potential authorized members, about 70,000 people, the expected cost would be over $ 1 billion a year.
Dr. Laura Davisson, director of the medical management program at the University of West Virginia, one of the places of the program pilot Learn Learty Pilot, wrote to Stateline that her patients saw an average of 15% of weight loss, or “three times greater weight than programs only in programs lifestyle. “
“The challenge is that the benefits of obesity treatment, such as preventing long -term complications, may not become visible for several years,” wrote Davisson to Stateline.
Will remain a course
In Illinois, the democratic Governor JB Pritzker pressed the range of slimming drugs of public employees. The Pritzker administration estimates that it costs $ 210 million in the first year, but some economists say that the cost will probably be the same three times higher.
In Connecticut, the cost of covering slimming drugs for public employees increased rapidly from $ 7.7 million in 2020. Last year, $ 40 million is estimated. The Connecticut state health plan has about 270,000 beneficiaries.
Trying to control the costs, in 2023, he began to require patients to apply for GLP-1 prescription for weight loss Teradrowia program To support them introduce lifestyle changes instead of using medicine.
Scanlon, a state controller, said the program has reduced the apply of GLP-1, but registration is growing. He said that now the state was looking for another solution.
“Our northern star has always dealt with people who want to get the help they need and which they deserve,” he said.
He said Scanlon does not count, there is the price of GLP-1 drugs in the near future.
“The attempt to convince the creators of these drugs to be cheaper is as if I tried to convince my 2-year-old and 5-year-old, not to want to eat candy in a sweets store,” said Scanlon.
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