By Lindsey Banks
At Carolina Family Healthcare in Charlotte, family physician Dimitrios Hondros has seen firsthand the life-changing benefits of weight loss drugs like Ozempic and Wegovy.
Patients not only lose weight but also often see improvements in blood pressure, cholesterol and blood sugar — factors that reduce their risk for heart disease and diabetes.
Yet Hondros estimates that 30 percent to 40 percent of his patients who could benefit from these medications aren’t taking them. They simply can’t afford the high price tag, and health insurance coverage is limited.
The medications, called GLP-1s, can cost roughly $12,000 a year out-of-pocket. While most health insurance plans cover them for diabetes, coverage for obesity alone is far less common.
But with prices starting to fall and policies under review, insurance experts say that could soon change.
Originally developed for diabetes, GLP-1s soon became recognized for their ability to help patients lose 15 percent or more of their body weight through weekly injections. They have also shown broader benefits like better heart health, reduced symptoms of sleep apnea and enhanced liver and kidney function.
Hondros said that means healthcare costs for patients using GLP-1s down the road could be lower for insurance companies.
“Just 3 percent to 5 percent weight loss helps drive down the total cost of healthcare, because you’re improving other chronic disease outcomes,” said Hondros, who served as president of the North Carolina Academy of Family Physicians in 2022 and has been fighting for broader access to GLP-1s on the state level for many years.
The drugs can also help prevent devastating health outcomes, Hondros said. One of his patients, who couldn’t afford the medication, ended up in a wheelchair because of severe arthritis tied to her weight, he said.
Another died of a massive heart attack — an event that might have been prevented with access to weight loss medication, he said.
Who covers GLP-1s for weight loss?
North Carolina is one of just 13 states whose Medicaid program covers GLP-1s for weight loss, meaning the drugs are available to the state’s lowest-income residents.
Meanwhile, 750,000 state employees, including teachers, lost access in 2024 when the state health plan dropped coverage due to rising demand and cost. Dale Folwell, the state treasurer at the time, said the state was on track to spend $170M a year to cover 23,000 members taking the drugs.
For many patients, the deciding factor is employer-sponsored insurance. About 75 percent of working adults in the U.S. receive their insurance through their employer, according to a 2023 study from KFF, a nonprofit that focuses on health policy issues in the U.S.
In Charlotte, it’s unclear how many employers offer GLP-1 coverage.
Of more than a dozen large companies contacted by The Ledger, only one, Ally Financial, responded. The company said it has long covered GLP-1s for both weight loss and diabetes, but recently added new requirements, including documentation from a medical provider and enrollment in a virtual health program called Omada.
Nationally, roughly 18 percent of U.S. employers with 200 or more workers covered GLP-1s for weight loss in 2024, according to the KFF survey. Over half of those plans require participation in lifestyle programs or other criteria, such as consultations with dietitians or mental health professionals, the survey found.
Cover it or cut it?
Charlotte-area employers are grappling with how to handle coverage for GLP-1 medications for weight loss, trying to balance the drugs’ high price tag with their potential benefits, said Jim Holmes, CEO of Sentinel, an insurance advisory firm that recently opened an office in Charlotte.
He said the company fields employer questions about GLP-1s daily.
“It’s a really great medical advancement that just hasn’t caught up from a cost-benefit perspective,” Holmes said.
Many employers are limited by how insurers bundle drug coverage, said Vinay Patel, a pharmacist and founder of MakoRX, an N.C.-based healthcare agency that offers healthcare services and resources to employers and individuals. In many cases, employers are stuck with “all-or-nothing” plans: either cover the drugs without restrictions or not at all, Patel said.
Signs of a shift
But the landscape may be shifting. As evidence mounts for the drugs’ broader health benefits, more insurers are weighing expanded coverage, Holmes said.
In addition, prices have come down over the past year, said Rob Krieg, Sentinel’s managing director of employee benefits. Eli Lilly (Mounjaro/Zepbound) and Novo Nordisk (Ozempic/Wegovy) both now offer programs that cap monthly costs at around $500, Patel said.
And cheaper compounded versions of the drug, which some patients pay for out of pocket, may soon disappear. The U.S. Food and Drug Administration had allowed those alternatives while there was a shortage of brand-name medications, but the agency recently deemed that the shortage is over. As a result, patients who had relied on compounded versions may ramp up pressure on their employers to cover the brand-name medications.
Last month, the board that oversees the State Health Plan said it would like to reinstate coverage for the weight loss drugs for state employees in 2026 and asked the legislature for funding. The proposed N.C. Senate budget included $25M for the drugs, but the money was not in the House version.
The $25M would not cover GLP-1 medication for all members, a spokesman said, but it would allow the plan to develop specific criteria to cover it for those who need it most. A vote on the final state budget is expected in June.
“There’s a whole ecosystem that needs to be built,” said Patel of MakoRX. “But for now, employees and employers need to start talking. Ask your human resources team what options are available.”
Lindsey Banks is a staff writer for The Charlotte Ledger: lindsey@cltledger.com
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