Illinois expands weight loss drug coverage to state employees

Illinois is expanding coverage of weight-loss drugs to state employees, a move Gov. JB Pritzker's office estimates could cost up to $210 million annually, WBEZ reported April 30.

Starting July 1, the nine health plans available to the state's employees and their dependents will have to cover GLP-1s such as Wegovy, Mounjaro and Ozempic. 

The new policy stipulates that the state health program "shall provide coverage for all types of injectable medicines prescribed on-label or off-label to improve glucose or weight loss for use by adults diagnosed or previously diagnosed with prediabetes, gestational diabetes, or obesity." 

A spokesperson for the state department that administers the employee health insurance program told WBEZ that enrollees are eligible for GLP-1 coverage if “deemed medically appropriate by the physician" and if they participate in a lifestyle management program.

The new policy does not apply to Medicaid enrollees or state retirees with a Medicare Advantage plan.

State health plans have grappled with how to cover the expensive weight loss medications, which can cost upward of $10,000 annually. In January, North Carolina's employee health plan ended coverage for GLP-1s, citing high costs.

Centene, the largest managed Medicaid organization, told investors in April that few state Medicaid programs are adding GLP-1 coverage for weight loss.

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