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Connecticut Mandates Lifestyle Modifications Before Covering Weight Loss Medications – To combat the rising costs of weight loss drugs, Connecticut’s
Connecticut Mandates Lifestyle Modifications Before Covering Weight Loss Medications – To combat the rising costs of weight loss drugs, Connecticut’s state employee health plan requires participants to embark on a lifestyle management program before covering injectable weight loss medications like Ozempic.
The growing popularity of weight loss drugs, such as Ozempic, Wegovy, and the recently FDA-approved Zepbound, has posed a financial burden on health insurance providers due to their high costs. In Connecticut, for instance, the state’s employee health plan administrators were faced with the challenge of managing the $30 million they were projected to spend on weight loss drug prescriptions for their members this year.
Rather than eliminating coverage altogether, the state implemented a new weight loss drug coverage policy on July 1 for its approximately 265,000 employees. This policy mandates that any plan member seeking a prescription for weight loss medications must first enroll in Flyte, a medical weight loss program, before the state’s insurance will cover drugs like Ozempic and Wegovy.
To qualify, individuals must be 18 years of age or older, have a body mass index (BMI) of 30 or higher, or a BMI of 27 or higher and a weight-related health condition such as diabetes or heart disease. Upon entering the program, a Flyte physician will collaborate with the individual to develop a weight management care plan and determine whether to prescribe weight loss drugs or other treatment options.
The state’s employee health plan will cover Ozempic or another weight loss medication if prescribed by a Flyte physician.
How Connecticut’s New Weight Loss Drug Policy Could Serve as a Model for Other Employers
The novel weight loss drug policy implemented by Connecticut’s state employee health plan has the potential to establish a benchmark for other states and health insurance providers grappling with the rising costs associated with these medications.
Several health insurers have already opted to discontinue coverage due to the exorbitant expense of these drugs. For instance, Ascension Healthcare has eliminated coverage for Ozempic and similar medications in its employee plans, and the University of Texas at Austin similarly terminated weight loss drug coverage in September.
Moreover, North Carolina’s state health plan is poised to follow suit, ending weight loss drug coverage for new members starting January 1, 2024.
However, the American Medical Association (AMA) issued a statement on November 14 advocating for health insurance coverage of evidence-based obesity treatments, including FDA-approved weight loss medications. The organization highlights obesity as a chronic disease and a major health concern in the United States.
“The AMA will urge health insurers to provide coverage of available FDA-approved weight-loss medications, including GLP-1 medications, to exemplify a commitment to the health and well-being of our patients,” stated AMA Trustee Bobby Mukkamala, M.D.
