Delaware Weighs Cutting GLP-1 Coverage or Raising Copays as Costs Skyrocket
Delaware's state employee health plan may raise GLP-1 copays from $32 to $120 per month or eliminate weight-loss drug coverage entirely, as costs are projected to reach $211 million by 2029. A decision is expected February 23, 2027.
Delaware's State Employee Benefits Committee (SEBC) is considering major changes to GLP-1 weight-loss drug coverage for state employees, retirees, and their eligible family members, including significantly higher copays or complete elimination of coverage. The state began covering commercial weight-loss drugs like Ozempic and Wegovy in 2023, but claims have skyrocketed and the drugs are now among the largest pharmaceutical expenditures for the state's Group Health Insurance Plan.
According to a presentation at the SEBC meeting, members currently pay $32 for a 30-day supply or $64 for a 90-day supply. Under proposed new copays, those numbers would jump to $120 and $200, respectively — roughly four to five times the current rate. Another option would be to completely eliminate coverage of the drugs for weight loss, which officials estimate would save the state $179 million over the next three years. If the state continues its current coverage, the SEBC estimates it would cost nearly $211 million by 2029.
A 30-day supply of Ozempic costs about $1,000 without manufacturer rebates. Board members expressed frustration with the available options. One board member described the proposed higher copays as "unconscionable," noting it would result in $1,000 to $2,000 more annually for employees earning $25,000 per year.
Another option presented would remove prior-authorization requirements in exchange for higher drug rebates from pharmaceutical companies, potentially lowering net costs to the state. However, the board chair cautioned this could lead to the drugs being prescribed without adequate clinical oversight. Delaware Health Secretary Christen Linke Young suggested the state should work to negotiate supplemental rebates, noting that a patent for a key ingredient in Ozempic and Wegovy is set to expire this year in Canada, which could open the door for competitors.
The SEBC is set to make a decision on new coverage levels at a meeting on February 23, 2027.