ND 1st state to cover Ozempic under the ACA

 North Dakota has become the first state to cover weight loss drugs under the ACA for diabetes and obesity.

As of Jan. 1, individual ACA plans and small-group plans from employers in the state include coverage for GLP-1s and gastric inhibitory polypeptide drugs, according to the North Dakota Insurance Department. 

CMS approved the changes to the state's essential health benefit benchmark plan in 2023, which also includes added coverage for insulin and insulin supplies, hearing aids, periodontal disease and PET scans for prostate cancer.

North Dakota Insurance Commissioner Jon Godfread told The Forum the state is the first to cover GLP-1s through the ACA, and others are expected to follow. 

Blue Cross Blue Shield of North Dakota also began offering coverage for weight loss medications for individual and small group plans on Jan. 1, a company spokesperson told the outlet.

The financial strain caused by expensive GLP-1 drugs has been evident in insurers' financial reports throughout the last few years, with some large group plans and self-funded employers dropping coverage.

According to a Mercer survey of more than 2,000 employers in 2024, 44% with 500 or more employees offer GLP-1 coverage for obesity. Among employers with 20,000 or more employees, 64% offer coverage.

The Biden administration has also proposed expanding Medicare and Medicaid coverage for weight loss drugs, with some state Medicaid programs already providing coverage.

https://www.beckerspayer.com/payer/the-first-state-to-cover-ozempic-under-the-aca.html