Connecticut officials are facing criticism for not covering certain weight loss drugs under the state’s Medicaid program, despite a law enacted last year that mandates such coverage.
In 2023, the state legislature expanded Medicaid to include obesity treatment services, which encompass bariatric surgery, nutritional counseling, and FDA-approved medications like Wegovy for weight loss. However, Senator Matt Lesser, a Democrat from Middletown and a key supporter of the legislation, reported that the Connecticut Department of Social Services (DSS) has been withholding coverage for these weight loss drugs due to concerns about costs.
“It is discouraging when we work with DSS and the administration to pass a law and then they decide that the law doesn’t apply to them,” Lesser remarked.
In response to inquiries, Christine Stuart, a spokesperson for DSS, did not specify whether the agency is currently covering FDA-approved weight loss medications for Medicaid recipients. She emphasized that obesity is a complex medical condition requiring comprehensive management and stated that DSS aims to ensure access to approved medications while maintaining clinical oversight.
Connecticut law guarantees coverage for weight loss drugs and nutritional counseling for Medicaid enrollees with a body mass index (BMI) of at least 35. The law also covers bariatric surgery for individuals with severe obesity, defined as a BMI of 35 or more with additional health conditions or a BMI of 40 or above. The legislation requires coverage only for FDA-approved weight loss medications like Wegovy. In contrast, Ozempic is approved solely for treating Type 2 diabetes and is not mandated for weight loss coverage.
Some healthcare providers have been prescribing Ozempic to Medicaid patients for weight loss, but this practice will soon change. Earlier this month, DSS informed medical providers and pharmacies that Ozempic can now only be prescribed to patients diagnosed with Type 2 diabetes. Starting January 15, DSS will stop covering Ozempic prescriptions used for other purposes.
As a result, Medicaid enrollees who rely on GLP-1 agonists for weight loss will have limited options. Lesser stated that DSS officials confirmed they are not currently covering FDA-approved weight loss drugs or nutritional counseling. He noted that there was less clarity regarding coverage for bariatric surgeries and mentioned that the agency does not cover Wegovy for non-weight loss purposes, such as treating cardiovascular disease, which could violate federal law.
GLP-1 agonists like Ozempic and Wegovy mimic the GLP-1 hormone in the body, which regulates insulin and blood glucose levels while also reducing hunger. These medications have gained popularity due to their effectiveness despite their high costs—up to $1,000 per month without insurance. A study from Yale School of Medicine indicated that these medications could prevent over 40,000 deaths annually in the U.S., highlighting their potential public health impact.
The Biden administration recently proposed expanding access to these drugs under Medicare and Medicaid programs. Currently, Connecticut is among fewer than 20 states that cover GLP-1 medications specifically for weight loss through its Medicaid program. A survey by KFF Health News found that many states not covering these drugs cite cost as a significant concern.
Connecticut’s Medicaid program is projected to face a $260 million shortfall this fiscal year. According to Lesser, DSS indicated that rising drug prices influenced the decision not to cover weight loss medications. “They told me that when they first negotiated the law, they looked at prices at that time, but drug companies have since raised their prices,” he explained.
Sheldon Toubman, an attorney with Disability Rights Connecticut, recently urged DSS Commissioner Andrea Barton Reeves to adhere to state and federal mandates regarding drug coverage. “Your agency knowingly disregarded the law for a year and a half,” Toubman wrote in his letter.
Lesser emphasized the need for creative strategies to strengthen negotiations with drug manufacturers while asserting that high costs do not justify ignoring legal obligations. “The cost of this coverage is quite high but that doesn’t mean flouting the law is ever acceptable,” he stated.