This bulletin applies to NC Medicaid Direct and NC Medicaid Managed Care.
Effective Aug. 1, 2024, NC Medicaid will add coverage for U.S. Food & Drug (FDA) - approved obesity management medications for beneficiaries 12 years of age and older.
Covered medications will include drugs from manufacturers enrolled in the Medicaid Drug Rebate Program, which are covered for the FDA-approved indication of treating obesity. The additional coverage applies to both NC Medicaid Direct and NC Medicaid Managed Care beneficiaries who are covered under the Outpatient Pharmacy benefit.
Historically, medications for weight loss have been subject to exclusion from Medicaid coverage as cited in federal regulation and as outlined in Outpatient Pharmacy Clinical Coverage Policy No. 9, which is available on the Program Specific Clinical Coverage Policies page.
NC Medicaid is adding this coverage because of the substantial weight loss associated with these medications and the impact on comorbidities. Prescription obesity management medications are now playing a role in addressing the obesity epidemic, as they may provide additional weight loss benefits compared to lifestyle modifications alone. Certain weight loss therapies, such as glucagon-like peptide 1 agonists (GLP-1s), can help reduce weight, lower blood sugar and lower rates of significant cardiovascular events, such as heart attack and stroke.
This new coverage helps to mitigate gaps in care that are unaddressed by currently covered services and reach eligible beneficiaries who are most at risk of obesity-related health complications.
Medicaid beneficiaries should contact their health care provider for more information.