RALEIGH, N.C. (WNCN) — Around 24,000 people covered under the State Health Plan were already taking certain prescription drugs that fight obesity when the announcement came that their insurance would no longer pay for them. Now less than a week away from that going into effect, doctors worry about the impact on their patients.
“So treating obesity is an important long-term health goal for most people to either help regress chronic disease that they already have or prevent getting chronic diseases including cardiovascular disease which is still the leading cause of death for both men and women in the United States,” said Dr. Andrea Coviello, UNC Weight Management Program medical director.
Medical issues brought on by obesity like cardiovascular disease, diabetes and cancer can cost insurance companies hundreds of thousands of dollars per patient. But after spending $138 million on weight loss medication last year, the NC treasurer’s office said the state can’t afford specific drugs like Wegovy.
According to the state treasurer, the list prices of Wegovy and Saxenda are $1,349.02 per member per month. After rebates, the cost of the weight-loss medications is more than $800 per member per month while Novo Nordisk sells the exact same product in the Netherlands for $296 per month.
Dr. Covielo said she is paying close attention to the April 1 deadline.
“I have patients on the state health plan who, if they lose coverage and they gain weight, that condition will get worse and so I am very concerned that those people with particularly severe conditions that respond to weight loss continue coverage. The data that’s out there suggests that these medications are in a range that they are cost effective for treating or preventing chronic diseases,” said Dr. Covielo.
Further, she said there are two basic problems facing the U.S. healthcare system in terms of cost related to obesity. One, she said, is the increasing prevalence of the obesity epidemic.
More from FOX8
North Carolina News
“About 42% of U.S. adults are now obese, so that is a lot of patients or people that are eligible for this type of medication according to general guidelines from professional societies. But if you layer the sheer number of people who are eligible for the cost of these medications then you have an economic issue, a very practical issue about how much can the health care system afford to pay for these types of medications to get those health benefits. I think that’s the current conundrum, you know, facing the U.S. healthcare system. Not just in North Carolina, but across the country for coverage for these types of medications,” Dr. Covielo added.
The state said they are still negotiating with Novo Nordisk and CVS Caremark and are hopeful there will be a resolution.
Dr. Covielo said, “I know negotiations are going down to the wire and I’m hoping that they achieve some sort of step-wise progression back to coverage for most of their most of their 700,000-plus clients. I am hopeful to a certain extent that they start with the most needy patients the patients who are going to benefit the most in the next six to twelve months from continuing this therapy but on the other end of the spectrum, I’m very hopeful that they that they sort of continue with their prior recognition that prevention is key.”