Connecticut Requires Lifestyle Changes Prior to Weight Loss Medication Coverage

Connecticut Requires Lifestyle Modifications before Covering Weight Loss Medication – In order to combat the rising cost of weight loss drugs Connecticut’s State Employee Health Plan requires that participants complete a lifestyle management plan before they are covered for injectable weight loss medication like Ozempic.

Due to the high cost of these weight loss drugs such as Ozempic and Wegovy (and recently FDA approved Zepbound), health insurance providers have been burdened financially. Connecticut, for example, faced the challenge of managing $30 million in weight loss drugs that were expected to be prescribed for the members.

The state decided to implement a new policy for weight loss drugs on July 1, which will cover approximately 265,000 of its employees. The policy requires that all plan members who want to get a prescription for weight-loss medications first enroll in Flyte – a medical weight-loss program – before their state’s health insurance will cover the drugs such as Ozempic or Wegovy.

Individuals must be at least 18 years old, have a Body Mass Index (BMI), or a BMI, of 30 or more, or a higher BMI, and a weight related health condition, such as diabetes or cardiovascular disease. A Flyte doctor will work with an individual to create a weight-management care plan. They may prescribe weight loss medications or other options.

Ozempic, or any other weight loss medication prescribed by Flyte physicians will be covered under the state’s health plan for employees.

Connecticut’s new weight loss drug policy could serve as a model for other employers

The innovative weight loss drug policy that Connecticut’s State Employee Health Plan has implemented could set a standard for other states, and insurance providers who are struggling with the rising cost of these medications.

A number of health insurance companies have already decided to stop covering these drugs due to their exorbitant cost. Ascension Healthcare, for example, has discontinued coverage of Ozempic, as well as similar medications, in its employee plan. The University of Texas at Austin also terminated coverage of weight loss drugs in September.

North Carolina’s health plan will follow suit and end coverage of weight loss drugs for new members on January 1, 2024.

The American Medical Association (AMA), however, issued a press release on November 14, advocating that health insurance cover evidence-based treatments for obesity, including FDA approved weight loss medications. The organization emphasizes obesity as a chronic illness and a major concern for health in the United States.

Bobby Mukkamala M.D., AMA Trustee, stated that “The AMA is going to urge health insurance companies to cover FDA-approved weight loss medications, including GLP-1 medication, as a way to demonstrate a commitment to our patients’ health and wellbeing.”