Dale Falwell said North Carolina is “under siege” by drug companies Novo Nordisk and Eli Lilly.
North Carolina’s state treasurer has said the state’s health crisis for about 700,000 teachers, state employees and retirees is due to soaring prices for popular weight-loss drugs (Novo Nordisk’s Wigovy and Saxenda and Eli Lilly’s Zepbound). He said the health system’s finances are under pressure. It was forced to stop offering drug insurance earlier this year.
Last year, North Carolina covered the cost of weight-loss drugs for about 25,000 state employees, costing them more than $100 million before rebates, according to the state Treasury Department. That’s about 10% of total spending on prescription drugs, more than they planned to spend on all health care costs. A combination of cancer treatments.
Weight loss drug use is projected to cost North Carolina an additional $600 million or more over the next five years. In response to the ballooning costs, the state health plan board of trustees voted in January to discontinue coverage of the state health plan.
That wasn’t what Falwell wanted.
Last fall, in a last-ditch effort to reduce the state’s spending on weight loss drugs, Falwell began working with the state’s pharmacy benefit manager, CVS Caremark, to negotiate drug prices with Novo Nordisk, followed by Eli Lilly. Ta. Negotiations are ongoing.
“In the last eight years that I’ve been a steward of public funds, I don’t recall ever attempting to engage directly with a drug manufacturer,” he said.
Novo Nordisk charges a list price of about $1,350 per month for Wegovy and Saxenda, while Lilly charges about $1,060 per month for Zepbound. North Carolina gets kickbacks from drug companies that lower prices by hundreds of dollars. Still, the state says the drug is too expensive to afford.
“The price of this drug is Manufacturing costs range from $10 to $70, which retail for well over $1,000,” Falwell said. “I don’t know what word in Webster’s Dictionary would best describe it other than gouged.”
Falwell also proposed raising the minimum body mass index (BMI) threshold for people with severe obesity to qualify for the drug in state health plans.food and drug administration approved the drug Patients with a BMI of 30 or higher are eligible, but this is characterized as obese rather than severely obese. He also wants to limit how long people can stay on drugs if they don’t work.
ongoing negotiations
Mr. Falwell comes to the negotiating table with one number in mind: $300. He says this is about the same price people pay in Denmark, where Novo and his Nordisk are based.
“When we are being rounded up on the price of this drug and the price in the home country where this company is headquartered, we have to take action,” he said.
In separate statements, Novo Nordisk and Eli Lilly said they are committed to working on potential solutions to provide coverage to patients in North Carolina.
But Novo Nordisk spokeswoman Nicole Ferreira said in a company statement that the state “rejected multiple viable options presented to us.”
“Denying patients insurance coverage for important and effective FDA-approved treatments is completely irresponsible,” she said.
If the state had continued to cover drugs under the current agreement, monthly premiums for all state employees participating in the plan would likely have doubled, Falwell said. People on this plan typically pay an average of $37 a month.
“We are committed to finding meaningful solutions to control costs,” said Ferreira.
“We remain committed to expanding access and are working with PBMs, health plans, “We continue to explore different approaches with employers.”
“We are cautiously optimistic that ongoing negotiations with CVS Caremark and pharmaceutical companies will result in affordable prices for these medications,” a state Department of Treasury spokesperson said in a statement. Ta.
North Carolina is not the only state plan to cover weight-loss drugs that has had to change.
Connecticut recently limited the provision of weight-loss drugs to state employees who agree to follow lifestyle, diet and exercise changes, which has led to cost savings, state Auditor Sean Scanlon said.
Asked about negotiations with drug companies, Scanlon said he is keeping a close eye on what’s happening in other states.
“But in my experience, the drug companies that are making this have a lock on it, and they’re making a ton of money, but there’s not a lot of incentive to do it,” he said. “So we’re not sitting around waiting for big pharma to be altruistic.”
Patients left behind
The ongoing negotiations offer little solace to North Carolina employees who lost drug insurance coverage in early April.
LeAnn Owens, a primary care provider in Hillsboro, North Carolina, treats patients enrolled in the state’s health plan. In recent weeks, she’s been receiving panicked calls from patients taking the drug, wondering what to do next.
“My patients had a lot of fear about coming off these medications, weight gain, and their relationship with food,” she says.
One of her patients, Skylar Hackney, a 26-year-old state employee who works in public schools, was prescribed Wigoby a year ago and has lost 50 pounds since then.
Skyler has prediabetes and says her condition could develop into diabetes and be able to take semaglutide again. Semaglutide is the active ingredient in both Wegoby and Nordisk’s diabetes drug Ozempic, and is often used off-label for weight loss purposes. North Carolina has not cut off access to diabetes drugs.
She took her last shot of Wegovy last Thursday. If she doesn’t earn more, she will be forced to quit.
“I really don’t want to do it again,” Hackney said. “When you put something new into your body, or even just take it off for a while, you get side effects that aren’t very good. But I reached my highest dose with his Wegovy and I feel like it’s plateaued. And it was great.”
