North Carolina budget leaves state employees without GLP-1 weight-loss coverage

North Carolina's final state budget, signed by Gov. Josh Stein in July 2026, does not restore State Health Plan coverage of GLP-1 medications for weight loss, and plan officials say current prices remain too high to bring the benefit back ^[1]. The confirmation came as the state's Medicaid program reported $47,855,225 in weight-loss GLP-1 claims in June alone, covering 34,524 beneficiaries ^[1].

Two programs, two paths

The State Health Plan covers more than 750,000 teachers, state employees, retirees and their dependents ^[1]. Its board of trustees voted in January 2024 to stop paying for GLP-1 medications prescribed for weight loss. At the time, more than 23,000 members were using the drugs at a net cost of more than $800 per member per month after rebates, and officials projected spending would exceed $170 million in 2024 and pass $1 billion over six years if coverage continued ^[1].

Medicaid moved the other way four months later, adding FDA-approved obesity medications in August 2024 ^[1]. That benefit covers drugs including Wegovy (semaglutide), Zepbound (tirzepatide) and Saxenda, subject to Medicaid's clinical and prior-authorization requirements ^[1]. Medicaid then announced it would stop covering GLP-1s for obesity alone starting Oct. 1, 2025, citing a shortage of state funding, before restoring the benefit effective Dec. 12, 2025 under a directive from Stein ^[1].

The June Medicaid total works out to about $1,386 per beneficiary for the month, and those 34,524 people were roughly 1.1% of the more than 3.1 million North Carolinians covered by Medicaid ^[1]. It is not the net amount the state paid: the Department of Health and Human Services said the figure is before federal matching funds and manufacturer rebates, and that rebate amounts are significant but not publicly available ^[1].

Loretta Boniti, a spokesperson for the State Treasurer's Office, told Carolina Journal the plan "continues to monitor the GLP-1 market and explore opportunities to secure more sustainable pricing," but that "current prices remain unaffordable given the Plan's financial condition" ^[1]. The plan still covers GLP-1 medications for members diagnosed with diabetes ^[1].

An October 2025 agreement with pharmacy benefit manager CVS Caremark gave the plan the ability to negotiate directly with GLP-1 manufacturers, but those efforts have not yet produced a price the plan considers affordable ^[1]. State Treasurer Brad Briner, who took office in January 2025 and chairs the plan's board, had sought roughly $100 million to cover an estimated 14,000 members with a body mass index of 38 or higher. A 2025 Senate budget proposal included $25 million for limited coverage, the House proposal included none, and by May 2026 Briner said he did not expect lawmakers to provide the $100 million ^[1].

Why it matters for patients

For teachers, state employees and retirees in North Carolina, the practical effect is that a GLP-1 prescription written for weight loss is not a covered benefit, while the same class of drug remains covered for diabetes ^[1]. That leaves the full retail cost to members who want the drugs for obesity, unless their prescriber documents another covered diagnosis.

Medicaid enrollees in the state are in a different position. Obesity coverage is in place now, but it has already been cut once and restored once in the past year, and it carries prior-authorization requirements ^[1].

Cost figures for the two programs are not directly comparable. Medicaid's $47.9 million June figure is a claims total before federal matching funds and confidential manufacturer rebates, so the state's net spending is not publicly known, while the State Health Plan's 2024 figure of more than $800 per member per month was described as a net cost after rebates ^[1].

Lawmakers are also directing changes to how Medicaid manages the drugs. A Medicaid funding package enacted in April requires the Division of Health Benefits to give managed care plans more flexibility to control use of GLP-1 medications for weight loss and calls for mandatory participation in nutrition, weight-loss and lifestyle-management programs ^[1]. The department said it "continues to review and evaluate long-term cost-savings and utilization controls" for the drugs ^[1].

The backdrop is broader Medicaid growth. The new budget authorizes nearly $41.6 billion in total Medicaid spending this fiscal year, up from $21.6 billion four years ago, a rise of almost 93%. General Fund support grew from $4.71 billion to $7.46 billion over the same period, and Medicaid now accounts for nearly 22% of the General Fund, compared with 16% a decade ago ^[1].

What happens next

NCDHHS must submit its Medicaid cost-savings and efficiency plan to the Joint Legislative Oversight Committee on Medicaid and the General Assembly's Fiscal Research Division by Oct. 1. The law says implementation cannot begin before July 1, 2027 ^[1].

The State Health Plan has not announced a date for a decision on restoring weight-loss coverage, and no manufacturer price that the plan considers affordable has been disclosed ^[1].