Connecticut's state employee health plan requires members to enroll in a lifestyle management program before covering injectable weight loss medications like Ozempic.
The steady popularity of weight loss drugs, such as Ozempic, Wegovy, and recently FDA-approved Zepbound, has created financial challenges for health insurers due to the drugs' high costs. In Connecticut, for example, individuals in charge of the state's employee health plan were grappling with how to handle the $30 million they would have to pay for members' weight loss drug prescriptions this year.
However, instead of denying coverage altogether, on July 1, the state implemented a new weight loss drug coverage policy for its estimated 265,000 employees.
The policy requires any plan member who wants to pursue a prescription for weight loss medications to enroll in Flyte, a medical weight loss program, before the state's insurance will cover drugs like Ozempic and Wegovy.
To be eligible, the member must be 18 years or older, have a BMI of 30 or higher, or a BMI of 27 and a weight-related health condition such as diabetes or heart disease. After entering the program, a Flyte physician will work with the individual to develop a weight management care plan and decide whether to prescribe weight loss drugs or other treatments.
The state's employee health plan will cover Ozempic or another weight loss medication if a Flyte doctor prescribes it.
How other employers could benefit from Connecticut's weight loss drug policy
According to Politico, the new policy could set a precedent for other states and health insurance providers currently dealing with similar weight loss drug coverage costs.
Some health insurers have already dropped coverage due to the high costs of these medications. For example, Ascension Healthcare no longer offers coverage for Ozempic or similar drugs in their employee plans, and the University of Texas in Austin also ended weight loss drug coverage in September.
In addition, North Carolina's state health plan will soon follow suit by ending weight loss drug coverage for new members beginning January 1, 2024.
However, on November 14, the American Medical Association (AMA) released a statement calling for health insurance coverage for evidence-based treatment of obesity, including FDA-approved weight loss medications. The organization says obesity is a disease and a primary health concern in the United States.
AMA Trustee Bobby Mukkamala, M.D., said, "The AMA will urge health insurers to provide coverage of available FDA-approved weight-loss medications, including GLP-1 medications, to demonstrate a commitment to the health and well-being of our patients."