North Carolina Medicaid recorded more than $47 million in claims for GLP-1 medications used for weight loss in June alone, covering more than 34,500 beneficiaries. State Health Plan officials, meanwhile, say the same medications remain too expensive to cover for teachers and state employees.
The two state-administered health programs have taken different approaches to the increasingly popular weight-loss drugs since 2024, with Medicaid continuing to provide coverage while the State Health Plan seeks to restore a benefit it eliminated more than two years ago.
According to the North Carolina Department of Health and Human Services (NCDHHS), 34,524 Medicaid beneficiaries had GLP-1 claims for weight loss in June, totaling $47,855,225 — an average of about $1,386 per beneficiary for the month. Those beneficiaries represent roughly 1.1% of the more than 3.1 million North Carolinians covered by Medicaid.
But that nearly $48 million figure is not what North Carolina ultimately paid.
NCDHHS told Carolina Journal the amount represents total claims before federal Medicaid matching funds and drug manufacturer rebates are applied. The department said the rebates are significant, but their amounts are not publicly available.
That financing structure is one of the distinctions between Medicaid and the State Health Plan, which provides health coverage for more than 750,000 teachers, state employees, retirees, and their dependents.
For the State Health Plan, current prices remain a barrier to restoring weight-loss coverage.
“The State Health Plan continues to monitor the GLP-1 market and explore opportunities to secure more sustainable pricing,” Loretta Boniti, a spokesperson for the State Treasurer’s Office, told Carolina Journal. “However, current prices remain unaffordable given the Plan’s financial condition.”
The divergence dates back to 2024.
The State Health Plan Board of Trustees voted in January of that year to end coverage of GLP-1 medications when prescribed for weight loss. At the time, more than 23,000 plan members were using the medications at a net cost of more than $800 per member per month after rebates.
Plan officials projected spending on the drugs would exceed $170 million in 2024 and surpass $1 billion over the following six years if coverage continued.
Four months after the State Health Plan stopped paying for the medications, Medicaid moved in the opposite direction and expanded coverage.
NC Medicaid added coverage of FDA-approved obesity medications in August 2024. NCDHHS told Carolina Journal the decision was intended to support improved health outcomes, preventive care, and potential long-term cost savings.
The coverage includes drugs such as Wegovy, Zepbound, and Saxenda, subject to Medicaid’s clinical and prior-authorization requirements.
Medicaid’s coverage, however, has not been uninterrupted.
NCDHHS announced in September 2025 that it would discontinue coverage of GLP-1s solely for the treatment of obesity beginning Oct. 1, citing a shortage of state funding for the Medicaid program. Coverage continued when the medications were prescribed for other indications, including diabetes and certain cardiovascular conditions.
That cutoff was short-lived, ending in less than three months.
Under a directive from Gov. Josh Stein, NCDHHS restored Medicaid’s obesity coverage effective Dec. 12, 2025, returning to the criteria that had existed before the October cutoff.
NCDHHS told Carolina Journal the weight-loss benefit was restored alongside the reversal of broader Medicaid provider rate cuts imposed during the state’s Medicaid funding dispute.
The department said it continues to view the medications as potentially producing health and financial benefits over time.
State Treasurer Brad Briner, who took office in January 2025 and chairs the State Health Plan Board of Trustees, has supported bringing back some weight-loss GLP-1 coverage — but on narrower, less expensive terms than the benefit that ended in 2024.
Briner previously sought roughly $100 million to provide coverage to an estimated 14,000 State Health Plan members considered at greater health risk, using a body mass index of 38 or higher as a threshold.
A Senate budget proposal in 2025 included $25 million toward restoring limited coverage, while the House proposal included no funding. By May 2026, Briner said he did not expect lawmakers to provide the roughly $100 million he had sought.
The final state budget signed by Stein in July does not include a provision specifically restoring GLP-1 weight-loss coverage through the State Health Plan.
The plan has instead pursued another route to potentially restore the benefit.
An October 2025 agreement with the pharmacy benefit manager CVS Caremark gave the State Health Plan the ability to negotiate directly with GLP-1 manufacturers to secure lower prices and potentially restore weight-loss coverage.
Those efforts have not yet produced a price the State Health Plan considers affordable.
“The Plan hopes to restore some level of coverage for GLP-1 medications for weight loss in the future, but its immediate priority is addressing the funding deficit and improving its long-term financial stability,” Boniti said. “Before expanding benefits, the Plan must first place itself on a more sustainable financial path.”
The State Health Plan continues to cover GLP-1 medications for members diagnosed with diabetes.
Even as Medicaid continues to cover GLP-1s for weight loss, state lawmakers are directing NCDHHS to find ways to control their costs and use.
The Medicaid overrun funding package, enacted in April, requires the Division of Health Benefits to develop a broader Medicaid cost-savings and efficiency plan.
The law specifically directs the department to grant Medicaid managed care plans greater flexibility in controlling the use of GLP-1 medications for weight loss. It calls for mandatory participation in nutrition, weight-loss, and lifestyle-management programs as part of that effort.
NCDHHS must submit its 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.
“NCDHHS continues to review and evaluate long-term cost-savings and utilization controls for GLP-1 medications prescribed for weight loss covered by NC Medicaid, and we will continue working with lawmakers to ensure efforts protect and strengthen access to care for all North Carolinians,” the department told Carolina Journal.
The push for additional GLP-1 controls comes as lawmakers are already confronting broader growth in North Carolina’s Medicaid program and the rising costs that accompany it.
The state’s newly enacted budget authorizes nearly $41.6 billion in total Medicaid spending for the current fiscal year, including federal funding, state appropriations, provider assessments, and other receipts. That is up from $21.6 billion just four years ago, an increase of nearly 93%.
The state’s share has also grown. General Fund support for Medicaid increased from $4.71 billion four years ago to $7.46 billion this year, a roughly 58% increase. Medicaid now accounts for nearly 22% of the General Fund, compared with 16% a decade ago.