North Carolina Spent $100M On Weight Loss Medications in 2023.

article case study Mar 12, 2024

In January, The State Health Plan of North Carolina Board of Trustees met to discuss a growing concern – they had spent $100 million on anti-obesity medications in 2023. And if the trend continued, those costs would reach $600 million annually within five years.

The State Health Plan of North Carolina is one of thousands of employers facing a big dilemma: cover the medication and see costs skyrocket, or eliminate coverage and not support members who could benefit from a life-changing medication.

The growing concern over coverage of these medications comes at a time when chronic disease like obesity and diabetes have reached alarming levels.

Per the FDA labeling instructions for drugs like Zepbound, over 50% of the commercial age population would qualify for the medication which at list price costs over $1,000 per month.

What Employers Are Doing About It

Despite the costs, the number of employers planning to cover weight loss medications is expected to double from 23% to over 43%

"This is a benefit more valuable to many of our employees than retirement benefits," noted Karen Young, VP of Total Rewards at Standard Imaging. "We want to support happy, healthy employees - and we feel these drugs will help them change their lives."

Indeed as more employers offer coverage, surveys have found that 54% of employees would consider switching jobs or staying in their current jobs if weight loss medications were covered. 

For employers who do cover it - 95% of benefits leaders who cover weight loss medications plan to continue coverage this years. 76% report higher employee satisfaction and overall employee wellbeing. 

How To Balance Cost and Access.

84% of employers who cover weight loss medications currently implement some kind of plan design that includes prior auth requirements, required participation in an adjunct wellness program - and other tools to mitigate cost exposure. 

In the case of the State Health Plan of North Carolina, they didn't have a plan when they started covering medications - which led to out of control costs and them having to abandon coverage altogether. 

There are a lot of factors that go into plan design and member support - some of which could impact rebates and other contracts with the PBM. 

It's important to discuss these with you broker or benefits consultant.

Smart Care Management

Since 2018, BioCoach has helped companies and consultants offer access to metabolic therapies in a smart way that both contains costs and supports members. 

Book a call to and let us help your organization evaluate weight loss medication coverage.

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