GLP-1 medications like Ozempic and Wegovy cost Connecticut more than $80 million last year, raising concerns over whether Medicaid should continue covering them.
WSHU’s Ebong Udoma spoke with CT Mirror’s Katy Golvala to discuss her article, “People Call GLP-1s Life-Changing. CT Says It Can’t Afford Them,” as part of the collaborative podcast Long Story Short.
The Case of Sarah Makowicki
Makowicki’s story highlights the critical role of GLP-1 drugs in weight loss treatment. Years ago, she faced severe knee pain and needed a knee replacement. However, she didn’t qualify for surgery because her BMI exceeded 40—hers was around 70.
To qualify for surgery, she underwent bariatric sleeve surgery, which helped her lose significant weight. But when her progress stalled, her doctor prescribed a GLP-1 medication, Monjaro, which further supported her weight loss.
What Are GLP-1 Drugs?
GLP-1 medications, including Ozempic and Wegovy, have gained widespread attention for their ability to regulate hunger by mimicking a hormone that controls insulin and blood glucose levels. These drugs not only aid weight loss but have also shown potential benefits for conditions like alcohol addiction and Alzheimer’s disease.
The High Cost of GLP-1s
Despite their effectiveness, these drugs are expensive—costing around $1,000 per month for uninsured patients. In Connecticut, Medicaid spending on GLP-1s reached approximately $85 million in fiscal year 2024, accounting for more than one-third of the state’s Medicaid pharmaceutical budget. This raises concerns about resource allocation and trade-offs in healthcare spending.
Medicaid Coverage and Legal Loopholes
While Medicaid is generally required to cover FDA-approved drugs, there are exceptions—weight loss drugs being one of them. Although Ozempic is FDA-approved for diabetes, it is not formally approved for weight loss, meaning Medicaid is not obligated to cover it.
In 2023, Connecticut legislators passed a law allowing Medicaid to cover weight loss drugs. However, state officials interpreted the law as a broad mandate rather than a specific directive to cover GLP-1s. Instead, they sought approval to cover older, less effective weight loss drugs, frustrating advocates who argue that Medicaid should support medications with proven efficacy.
Budget Challenges and Political Debate
Connecticut’s Medicaid program currently faces a $290 million deficit. Governor Lamont’s proposed budget includes no additional funding for GLP-1 coverage. In fact, he is seeking to eliminate Medicaid coverage for these drugs entirely.
Meanwhile, lawmakers who supported the 2023 law are pushing for a new bill that would ensure Medicaid covers GLP-1s for individuals with a BMI of 35 or higher. The bill would also protect coverage for those who lose weight but require continued medication to prevent regaining it.
Uncertain Future Amid Federal Cuts
The ongoing debate is further complicated by potential federal Medicaid cuts, adding uncertainty to Connecticut’s healthcare budget. As policymakers navigate financial constraints and public health priorities, the fate of GLP-1 coverage remains uncertain.
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