North Carolina State Health Plan drops weight-loss coverage of Wegovy and Zepbound
Members of North Carolina's teacher and state employee health plan lost weight-loss coverage for drugs such as Wegovy and Zepbound, though the same medicines stayed covered for diabetes.
The board of trustees of the North Carolina State Health Plan voted in January 2024 to stop paying for GLP-1 medications prescribed for weight loss, a change that took effect in April 2024 [1]. The plan insures more than 750,000 teachers, state employees, retirees and their dependents [1].
Roughly 23,000 members were taking the drugs when the vote happened. After manufacturer rebates, the plan's net cost ran above $800 per member per month [1]. Staff projected the bill would pass $170 million for 2024 and top $1 billion over six years if the benefit stayed in place [1]. The board concluded that covering the drugs for weight loss was not financially sustainable and would have required premiums to rise by $48.50 per member per month [3]. Utilization had climbed 731 percent to reach the 23,000-member mark [3].
The cutoff removed weight-loss coverage for Wegovy and Saxenda, both made by Novo Nordisk, and for Eli Lilly's Zepbound [2]. Wegovy is semaglutide; Zepbound is tirzepatide. Members with a diabetes diagnosis kept their GLP-1 coverage, including Mounjaro, another tirzepatide product [1].
Negotiations had stalled before the vote. In January 2024 the plan lost a 40 percent discount on Wegovy and Saxenda after it paused new prescriptions for weight-loss use; CVS Caremark, its pharmacy benefit manager, said the move broke the terms behind the discount [2]. Staff had floated more than 10 options for slowing spending on drugs like Wegovy [2].
The decision also set off a public dispute. State Treasurer Dale Folwell, then the plan's overseer, told a September 2024 forum that the board "had to make the awful decision to stop covering Wegovy" and that the plan was insolvent [2]. House Speaker Tim Moore, in a letter to U.S. Sen. Ted Budd, accused Folwell of "scapegoating anti-obesity medicine coverage as the reason for the financial problems" [2]. Folwell answered that limited supply gave manufacturers the upper hand, writing that they "hold immense power and consistently wield that power to prevent any savings" [2].
Since then, North Carolina's two public programs have moved in different directions. Medicaid added coverage of FDA-approved obesity drugs in August 2024, including Wegovy, Zepbound and Saxenda, subject to prior authorization [1]. Medicaid then dropped obesity-only GLP-1 coverage on Oct. 1, 2025, pointing to a state funding shortfall, and reinstated it on Dec. 12, 2025 under an order from Gov. Josh Stein [1]. In June, Medicaid logged 34,524 beneficiaries with weight-loss GLP-1 claims worth $47,855,225, about $1,386 each, before federal matching money and manufacturer rebates [1]. The state says the rebates are substantial but does not publish the amounts [1].
Why it matters for patients
Whether a North Carolina resident can get these drugs covered now depends on which program they belong to. State Health Plan members have had no weight-loss benefit since April 2024, while Medicaid enrollees got one back in December 2025 [1]. The $800 figure describes what the plan paid per member after rebates, not what any patient owed [1]. What members spent out of pocket after the change has not been reported.
North Carolina is not alone in pulling back. As of March 2025, 11 states covered GLP-1s for weight loss through their employee health plans and nine through Medicaid, with five covering the drugs under both programs [3].
What happens next
State Treasurer Brad Briner, who took office in January 2025 and chairs the board, has pushed for a narrower benefit: about $100 million to cover an estimated 14,000 members with a body mass index of 38 or higher [1]. A 2025 Senate budget plan set aside $25 million for partial coverage, the House plan set aside nothing, and Briner said in May 2026 that he no longer expected lawmakers to supply the $100 million [1]. The budget Stein signed in July contains no provision specifically restoring weight-loss coverage through the plan [1].
The plan has tried another route. An October 2025 agreement with CVS Caremark lets it negotiate prices directly with GLP-1 manufacturers, though a spokesperson said those talks have not yet reached a price the plan considers affordable [1]. Under a law enacted in April, the state health department must deliver a Medicaid cost-savings plan by Oct. 1, with implementation barred before July 1, 2027; the law directs it to give managed care plans more flexibility to control weight-loss GLP-1 use and to require participation in nutrition, weight-loss and lifestyle programs [1].
Sources
Semaglutides.org provides information only, not medical advice. Talk to a licensed provider about your own care before making changes. Some telehealth links are affiliate links and are labeled where they appear.