North Carolina treasurer says the state budget will not restore GLP-1 coverage for state employees

North Carolina State Treasurer Brad Briner said he does not expect the state's new budget to include funding to restore State Health Plan coverage of GLP-1 drugs for weight loss, leaving hundreds of thousands of state employees, teachers, retirees and their families without the benefit for now ^[1].

Briner, who chairs the State Health Plan, had requested about $100 million to bring back coverage. "I'd hoped it would get there this year," he said. "I don't think that's likely" ^[1]. State leaders have indicated they do not plan to fund the request this budget cycle, according to Briner ^[1].

The plan, which covers more than 700,000 people, dropped weight-loss coverage of GLP-1 drugs after costs surged. Spending on drugs such as Wegovy rose from about $3 million a month around 2021-2022 to more than $14 million a month by 2023, when the medications made up roughly 10% of the plan's $1 billion annual prescription drug budget ^[1]. The plan still covers GLP-1 drugs when prescribed for diabetes ^[1].

Budget proposals last year showed a split between the two legislative chambers. A 2025 Senate budget proposal included $25 million to restore GLP-1 weight-loss coverage, while the House's proposal included no funding for it ^[1]. House Speaker Destin Hall and Senate Leader Phil Berger did not respond to requests for comment ^[1].

Separately, the plan has been negotiating directly with drug manufacturers to lower prices for 2026. Briner said that if those talks succeed, the plan could restore coverage without needing lawmakers to appropriate new money ^[1].

Why it matters for patients

For state employees, teachers and retirees who rely on the State Health Plan, this means GLP-1 drugs prescribed specifically for weight loss will likely remain out of reach through the plan for at least another budget cycle, even as diabetes coverage continues ^[1]. Valerie Mendenhall, whose husband is a retired state employee, said she has used GLP-1 medications for years and cannot afford to pay out of pocket. "I can't pay for this," she said. "My health is at risk. My grandchildren will suffer because I won't be able to be myself" ^[1]. She said her doctor warned that weight gain could worsen her joint pain and mobility ^[1].

Dr. Sarah Ro, director of the University of North Carolina Medical Group's weight management program, said expanding access could reduce long-term health care costs for the state while benefiting patients, though that potential savings has not translated into funding this year ^[1].

Separately from the State Health Plan, Medicaid in North Carolina covers GLP-1 drugs for conditions like diabetes and certain heart-related conditions, but not for weight loss ^[1]. A Medicaid bill signed by Gov. Josh Stein last month directs the state's health department to develop a plan giving Medicaid managed care plans more flexibility in covering GLP-1 drugs for conditions beyond diabetes and heart disease, but it does not require weight-loss coverage ^[1]. Whether Medicaid could eventually be expanded to cover weight-loss use remains unclear, and no final policy decisions have been made ^[1].

What happens next

Budget negotiations in Raleigh are continuing after lawmakers failed to pass a budget for the fiscal year that began July 1, 2025, though they recently reached agreement on tax rates and state employee raises ^[1]. The State Health Plan's manufacturer negotiations for 2026 pricing are ongoing, and Briner said success there could allow coverage to resume without legislative action ^[1]. The North Carolina Department of Health and Human Services did not respond to a request for comment on the Medicaid flexibility plan required under the new law ^[1].