At the most recent State Health Plan Board of Trustees meeting held on January 25, 2024, the board voted to removed GLP-1 and GIP-GLP-1 agonist medications from State Health Plan coverage for the purpose of weight loss effective April 1, 2024. These medications will still be covered for members managing diabetes.
It is estimated that continuing to cover this class of medications for weight loss would result in a premium increase of $48.50 per subscriber per month, doubling the premium for all individual subscribers, even those not taking these medications.
The cost of these medications was projected to exceed $170 million in 2024, jumping to more than $1 billion over the next six years. This exceeds the amount the State Health Plan spends on cancer, rheumatoid arthritis, and chemotherapy medications.
Further, the State Health Plan faces a $4.2 billion budget gap over the next five years, and the recently enacted budget from the State Legislature funded the Plan by $240 million less than was requested over the next two years.
The State Health Plan simply can’t afford these medications at the manufacturer’s current price point. Maintaining the current benefit structure for these medications will significantly impair the State Health Plan’s strategic financial goals, reduce its solvency for current and future members, and halt the State Health Plan’s ability to lower member and family premiums.
Please note that the State Health Plan does cover other weight loss medications: Phentermine, Adipex-P, Orlistat, Qsymia, Benzphetamine, Diethylpropion, and Phendimetrazine and members are encouraged to discuss any change in medications with their provider.
State Health Plan members are encouraged to review all the information related to the recent board meetings on our website.
GLP-1 Request for Information
State Treasurer Dale R. Folwell, CPA, and the State Health Plan (Plan) issued a Request for Information (RFI) in April 2024, asking the public for help in lowering the cost of GLP-1 drugs for treating obesity. The RFI is the latest attempt by the Plan to find a way to provide these obesity medications for its members in a financially sustainable way. It is estimated that if the Plan’s Board of Trustees had continued to cover this class of medications for weight loss it would result in a premium increase of $48.50 per subscriber per month, doubling the premium for all individual subscribers, even those not taking these medications. Currently, the Plan faces a $4.2 billion budget gap over the next five years. The most recently enacted budget from the state legislature funded the Plan by $240 million less than was requested over the budget period.
Below are the RFI responses the Plan received. The Plan is actively reviewing the responses.
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RFI RESPONSES |
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INFORMATIONAL RESPONSES |
RESPONSES |