Delaware weighs cutting GLP-1 coverage on state plan
Delaware is grappling with soaring costs associated with popular weight-loss drugs like Ozempic and Wegovy, potentially impacting state employees, retirees, and their families. Coverage for these medications, which began in 2023 as part of the state health plan, has led to a dramatic increase in claims and is prompting administrators to consider significant changes to the programme.
Rising Costs and Potential Changes
The State Employee Benefits Committee (SEBC), responsible for managing Delaware’s state employee health insurance plans, met on Friday to discuss funding levels for these drugs moving forward. Several options are on the table, all of which involve shifting costs to consumers or reducing coverage. Currently, members pay $32 for a 30-day supply or $64 for a 90-day supply. Proposed co-pays could increase to $120 and $200, respectively.
A more drastic option being considered is the complete elimination of coverage for weight-loss use, which officials estimate could save the state $179 million over the next three years. Continuing current coverage levels is projected to cost nearly $211 million by 2029. The Group Health Insurance Plan covers state employees, retirees, and their eligible family members.
‘What’s Wrong with the Pharmaceutical Business’
Board members expressed frustration with the limited options presented. Jeff Taschner, executive director of the Delaware State Education Association, called increased co-pays “unconscionable,” noting the potential financial burden on lower-income employees, potentially adding $1,000 to $2,000 annually to their healthcare expenses.
Brian Maxwell, chair of the board and director of the Office of Management and Budget, voiced concerns about removing prior-authorization requirements, fearing the drugs would be “giving these things out like Tic Tacs.” Removing these requirements could lead to increased rebates from pharmaceutical companies, but also potentially allow access for individuals who are not clinically appropriate candidates for the medication.
Christina Tarabicos, a member of the public, argued against adjusting coverage, suggesting that eliminating coverage would only delay addressing underlying health complications and potentially increase costs in the long run. Delaware Health Secretary Christen Linke Young suggested focusing on increasing rebates received from drug companies, citing an expiring patent in Canada that could open the door for competition.
Delaware’s Broader Efforts to Lower Prices
Delaware’s situation mirrors a national trend, as states across the country re-evaluate coverage for GLP-1 drugs. The FDA approved Ozempic for weight loss in 2021, building on its existing use for treating type 2 diabetes. Delaware also recently filed a lawsuit against pharmaceutical manufacturers and pharmacy benefit managers, accusing them of conspiring to inflate drug prices, including those for GLP-1s and insulin.
Frequently Asked Questions
What drugs are at the center of this debate?
Drugs like Ozempic, Wegovy, Mounjaro and Zepbound are the focus of the discussion, as their popularity and cost have significantly impacted the state’s health plan.
What options is the SEBC considering?
The SEBC is considering options ranging from doing nothing to completely eliminating coverage for weight loss, as well as implementing significantly higher co-pays.
When will a decision be made?
SEBC members are scheduled to make a decision on new coverage levels at 9 a.m. On Monday, Feb. 23, at the Delaware Department of Human Resources in Dover. Virtual attendance information is available online.
As Delaware weighs its options, the future of access to these weight-loss medications for state employees remains uncertain. What impact will these potential changes have on the health and well-being of Delawareans?