North Carolina State Health Plan votes to drop GLP-1 weight-loss coverage

The board of trustees of the North Carolina State Health Plan voted in January 2024 to stop covering GLP-1 medications when prescribed for weight loss, ending a benefit that had been in place since 2015 ^[3]. The change took effect April 1, 2024 and cut off coverage of the semaglutide injection Wegovy and liraglutide (Saxenda), both made by Novo Nordisk, as well as the tirzepatide injection Zepbound, made by Eli Lilly ^[2][3]. The plan covers more than 750,000 teachers, state employees, retirees and their dependents ^[1].

The decision came down to cost. At the time of the vote, more than 23,000 plan members were taking GLP-1s for weight loss at a net cost of more than $800 per member per month after rebates ^[1]. Plan officials projected spending on the drugs would top $170 million in 2024 and exceed $1 billion over the following six years if coverage continued ^[1][2]. The board concluded that continuing the benefit would have required a premium increase of $48.50 per member per month ^[3]. Utilization had climbed 731% by 2024 ^[3].

The vote followed a failed round of negotiations. In 2023 the plan imposed a moratorium on new prescriptions for Wegovy when prescribed solely for weight loss, and in January 2024 it lost a 40% discount on Wegovy and Saxenda after its pharmacy benefit manager, CVS Caremark, said the plan had violated the terms and conditions for those discounts ^[2]. Plan staff had earlier proposed more than 10 ways to rein in spending on the drugs ^[2]. Then-State Treasurer Dale Folwell, who chaired the board, later said the board "had to make the awful decision to stop covering Wegovy" and that "because supply of GLP-1s is still limited, drug manufacturers hold immense power and consistently wield that power to prevent any savings" ^[2].

One note on dates: news coverage describes the vote as happening in January 2024, while a plan statement points to a January 25, 2024 board meeting as the date of the decision ^[2][3].

Why it matters for patients

Members using these drugs for weight loss had to find another way to pay starting April 1, 2024, or stop. The plan continued to cover GLP-1 medications for members diagnosed with diabetes ^[1], so the split turned on diagnosis rather than on the drug itself.

The move was not isolated. West Virginia's Public Employees Insurance Agency paused a 1,000-person GLP-1 obesity pilot in 2024, citing a $1.3 million monthly price tag including rebates ^[3]. Colorado announced in January 2025 that it would end weight-loss coverage under its state employee plan as of July 1, 2025, expecting to save $17 million a year ^[3]. As of March 2025, only 11 states covered GLP-1s for weight loss under their state employee health plan and nine covered them under Medicaid ^[3].

The North Carolina cut also did not fix the plan's finances. In July 2024, staff forecast the plan would be $816 million in the red by calendar year 2027 and "likely to be unable to pay bills in fall 2026" ^[2]. Without the GLP-1 exclusion, April 2024 staff calculations had projected a shortfall of more than $1.5 billion by 2027 ^[2].

What happens next

The plan has not restored the benefit. Under Treasurer Brad Briner, who took office in January 2025, the plan sought roughly $100 million to cover an estimated 14,000 higher-risk members using a body mass index threshold of 38 or above ^[1]. A 2025 Senate budget proposal included $25 million; the House proposal included none, and the final budget signed by Gov. Josh Stein in July contained no provision restoring the benefit ^[1]. An October 2025 agreement with CVS Caremark lets the plan negotiate directly with GLP-1 manufacturers, but those talks have not yet produced a price the plan considers affordable ^[1].

"Current prices remain unaffordable given the Plan's financial condition," Treasurer's Office spokesperson Loretta Boniti said ^[1]. Meanwhile, North Carolina Medicaid added coverage of FDA-approved obesity medications in August 2024, briefly dropped it on Oct. 1, 2025, and restored it effective Dec. 12, 2025 ^[1].