The State Health Plan Board of Trustees voted yesterday to remove coverage of expensive weight loss drugs like Wegovy and Saxenda. Beginning April 1, nearly 25,000 state employees with existing prescriptions for these types of medications for weight loss will have to pay out of pocket, or stop taking the medicine.
People like Meghan Ray, who told the board that she's been diagnosed with a pseudotumor. That's a condition affecting the brain that doctors tell her could make her go blind if she doesn't maintain a certain body mass index.
"Even though I have a healthy diet and lifestyle, the Wegovy has made the biggest difference in maintaining my weight," she said during a public comment period near the beginning of the board of trustees meeting.
After the meeting, Ray said there's no way she can afford the $1,349 monthly list price, and will have to look at other medical options.
"No, I can't afford it. So we're going to look at surgery then," she said. "They're going to have to pay for surgery if that's going to be the case. My doctors will make that decision. It cannot take my vision. Simple as that. I'm not going to let it."
The State Health Plan had covered the medications with members paying just a $24.99 monthly co-pay. But that means the plan pays the rest, and financial projections show it could cost the plan $170 million dollars this year alone.
Phillip Blando represents CVS Caremark, the pharmacy benefits manager that North Carolina contracts with to buy medicine. He said Wegovy manufacturer Novo Nordisk should lower prices.
"The manufacturers need to stop dragging their feet and come to the table and work with us, and work with the state and get a deal in place that gives access to these drugs at an affordable price," he said.
The board agrees and says it wants to draw a line in the sand to stop paying so much. Members argued that yesterday's action puts them in a better negotiating position.
In response, Novo Nordisk called the board's decision "irresponsible" and that it would "continue to engage" with state health plan officials over cost concerns. "We urge Treasurer Dale R. Folwel and the NCSHP to reconsider this decision and put patients first, according to a company statement.
However, the board's vote was not unanimous. Board member Melanie Bush voted to maintain coverage. She says she agrees with the board members that say the high prices Novo Nordisk charges are unconscionable.
"But I also don't want that to mean that we're the ones that suffer," she said. "It is a positive for public health. It is scarily expensive right now, and absurd … but I don't feel like the state employees are the ones that need to pay that price (of losing coverage)."
Board members say they hope they can avert a coverage loss, if Novo Nordisk negotiates a lower price before coverage drops on April first. These medicines will still be covered for certain patients with type-2 diabetes.
