North Dakota becomes 1st state to cover weight loss medication with federally-backed health insurance – InForum

BISMARCK — North Dakota has become the first state in the U.S. with federally-backed health insurance that covers

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weight loss drugs

for individual plans.

Individual plans that are compliant with the Affordable Care Act and are purchased on Healthcare.gov or through a local agent in North Dakota include coverage for glucagon-like peptide-1 (GLP-1) and gastric inhibitory polypeptide drugs as of Wednesday, Jan. 1. That could include Ozempic and Tirzepatide.

The drugs can be used to prevent diabetes and to treat insulin resistance, metabolic syndrome or morbid obesity, according to a

news release from the state Insurance Department.

The change does not impact large employer plans, the North Dakota Insurance Department said.

North Dakota Insurance Commissioner Jon Godfread confirmed to The Forum that the state is the first to offer the option in the U.S. Other states are expected to follow North Dakota’s suit in adding weight loss drugs to ACA-backed plans, Godfread said.

“It’s all with the goal of trying to make North Dakota a healthier state and keeping our citizenry healthy,” Godfread said.

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The move is a change to the state’s essential health benefit benchmark plan, which hadn’t been updated since the ACA was implemented in 2015, Godfread said. The plan is a standard for which states can decide what essential benefits to offer residents.

North Dakota was “long overdue” for an update to its essential health benefit benchmark plan, Godfread said. The state’s new plan also added coverage for insulin and insulin supplies, hearing aids, periodontal disease, PET scans for prostate cancer and nutritional benefits that could help with weight loss.

The changes also set a limit for opioid prescriptions to seven days, according to a news release.

As of 2023, North Dakota rated 14th for adult obesity, with roughly 35% of residents 18 years old and above self-reporting that they had a body mass index of 30% or more, according to the

Centers for Disease Control and Prevention.

The national prevalence of obesity in adults is about 40%, the CDC said.

There has been an increase in obesity rates in North Dakota, Godfread said. That has led to concerns about cardiovascular diseases, diabetes, cancer and other long-term health conditions, he said.

The increase in obesity not only impacts a person’s health but the cost of the health care system, Godfread said. Annual medical costs for adults with obesity are

100% higher

than those who are not obese, according to the North Dakota Insurance Department.

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“Helping to get control of the root cause of some of those health issues not only will make the person healthier and hopefully live a better life but also help bring down the cost of the system,” Godfread said. “In the long-term, the goal is that a healthier population leads to a more cost-effective system, which is good for insurance and good for everybody.”

Insurance plans that cover weight loss medication are uncommon.

Health Affairs,

a peer-reviewed journal on health policy thought and research, reported in October that 18% of U.S. employers with at least 200 workers have plans for their employees that cover GLP-1 for weight loss. More than half said their plans don’t cover the drug, and 31% were unsure.

Blue Cross Blue Shield of North Dakota, the largest health insurance provider in the state, started offering coverage for weight loss medications on Wednesday, spokeswoman Melissa Richard said. The move for the company that provides insurance to roughly 450,000 North Dakotans is for individual and small group plans, she said.

Small group plans are for employers with 50 employees or less. Employers with more than 50 workers get to decide what benefits they offer to their employees, Richard noted.

That means residents who work for larger companies may not have plans that cover weight loss medication.

“BCBSND members who would like to check their plan’s drug coverage should call the member services number on the back of their member ID card,” Richard said.