Four years ago, Sarah Makowicki was in constant pain. She desperately needed a knee replacement, but patients must have a body mass index of 40 or under to receive the procedure. At the time, Makowicki’s was nearly 70. To bring her weight down, Makowicki underwent bariatric sleeve surgery, whi ch involves removing a significant portion of the stomach, in December 2021. The results were dramatic — she lost 145 pounds over the next eight months. But then, before she reached the BMI she needed to qualify for a knee replacement, her weight loss stalled. After about a year of limited progress, Makowicki’s physician recommended she start on Mounjaro, a glucagon-like peptide-1 agonist, commonly known as a GLP-1. The results were unlike anything she’d tried before. “My mother put me in Weight Watchers when I was nine years old,” Makowicki, a 42-year-old resident of Deep River, said. “I’ve tried every diet and exercise and everything. There’s something in my body chemistry — it just doesn’t stick.” Sarah Makowicki at the state Capitol on March 19, 2025. Credit: Shahrzad Rasekh / CT Mirror Makowicki, who’s currently getting a Master’s in Social Work with a concentration in policy practice at the University of Connecticut, was able to get coverage of Mounjaro through her Medicaid insurance plan. By December 2023, she had lost enough weight to qualify for knee replacement surgery. She now lives pain free and credits the results, in no small part, to her weight loss medication.  GLP-1 drugs like Mounjaro, Ozempic and Wegovy, have surged in popularity because of their effectiveness. They work by mimicking the GLP-1 hormone in the body that controls insulin and blood glucose levels, and their effects on the brain can reduce hunger, helping people feel full for longer. But they come with a hefty price tag — without insurance, they can cost as much as $1,000 a month. The high costs of these drugs have led some insurers to roll back coverage. Advocates say cutting off access to save money is short-sighted, failing to see the long-term savings of avoiding obesity related illnesses, like diabetes and heart disease.  In fiscal year 2024, GLP-1s cost Connecticut’s Medicaid program $85 million, after factoring in rebates, which amounted to 35% of the entire Medicaid pharmaceutical budget for the year. As a result, the state is looking to eliminate Medicaid coverage of the drugs when prescribed only for obesity, which would leave Medicaid patients who are currently prescribed GLP-1s for weight loss in limbo.  Those who have other qualifying conditions like type 2 diabetes could retain coverage, but others will have to find alternative medications that some say aren’t as effective. Makowicki, along with other advocates, is fighting to preserve access. “I feel that it’s almost discriminatory,” Makowicki, who works as a legislative intern for state Rep. Jillian Gilchrest, D-West Hartford, said of the proposal. “We have a medical bias against people who are overweight. And now, it’s like ‘Oh, we’ve finally found this tool,’ and you’re saying, ‘Oh no, you can’t have it because we don’t want to spend the money.’” April Martin poses for a portrait in Welles Park in Glastonbury with her dog Bow James on March 14, 2025. Credit: Shahrzad Rasekh / CT Mirror CT Medicaid coverage In general, state Medicaid programs must cover all FDA-approved drugs. But in a handful of cases, including weight loss medications, states get to decide for themselves. Connecticut’s policy towards Medicaid coverage of GLP-1s has been murky, at best.  In 2023, the legislature passed a bill expanding Medicaid coverage to include drugs — like Wegovy — that had been approved by the U.S. Food and Drug Administration for weight loss, for people with a BMI of at least 35. Now Lamont is seeking to repeal that provision — estimating the move would save the state roughly $45.6 million over the next two fiscal years — though his proposal would continue coverage for people who use the drugs for other FDA-approved reasons, like type 2 diabetes.  The governor’s administration is cracking down in other ways, too. Under the 2023 law, the Department of Social Services was not required to cover other GLP-1s — like Ozempic and Mounjaro — that had not been FDA-approved for treating weight loss, even though they’re approved for other conditions, like type 2 diabetes, and are widely used for weight loss.  However, there were patients like Makowicki whose physicians prescribed them GLP-1s for weight loss who were able to obtain coverage through an apparent bureaucratic oversight by DSS. The agency has issued a notice to physicians that these patients will lose coverage on June 15.  “I started to panic,” April Martin, who takes Ozempic, said as she recalled the moment in February when her physician told her Medicaid would no longer cover the drug. “My first reaction was fear — fear for me and fear for other people who are going to be taken off their medication.” Like Makowicki, Martin, a 38-year-old Glastonbury resident, began using a GLP-1 after weight loss surgery. Martin and her physician have discussed starting her on alternative medication for weight loss while she’s still on the Ozempic, so they have a chance to see how her body reacts to it. She said she’s worried about what will happen to her weight once she has to stop the Ozempic. Makowicki hasn’t yet spoken with her physician about a plan, but she’s set to graduate from UConn in May and hopes to secure a job with insurance benefits that will cover GLP-1s. Even before these explicit moves by the Lamont administration to control the costs of GLP-1s, several advocates say the state never implemented Medicaid coverage for FDA-approved weight loss drugs, despite the law passed in 2023. Sheldon Toubman, an attorney with Disability Rights Connecticut, called this “a blatant violation.” “They acknowledged that their non-compliance had nothing to do with the law itself but rather with their desire not to spend money that the law signed by the governor expressly required, because they perceived it to be too much,” Toubman wrote in public testimony. The Lamont administration insists it is complying with state law, which does not mention covering GLP-1s specifically, only weight loss drugs in general. “The Department has taken steps to implement the 2023 law which says the state will cover medical services for weight loss, which includes prescription drugs and nutritional counseling, which we are doing. Then it will be up to the Centers for Medicare and Medicaid Services to approve the state plan amendment,” Christine Stuart, a spokesperson with DSS, said. DSS is currently in the process of submitting an amendment to federal regulators asking for permission to cover two non-GLP-1 weight loss drugs in particular — Orlistat and Phentermine. It will also begin covering certified dietician-nutritionist services on July 1.  Toubman took issue with the department’s explanation for several reasons. First, the state didn’t seek permission to cover weight loss drugs until this year, even though the law was passed in 2023, he said. Second, states often make Medicaid expansions and then file amendments retroactively.  Plus Orlistat and Phentermine, the drugs DSS is seeking federal approval for, while cheaper, are much less effective at treating obesity and have more severe side effects, Toubman said. Sen. Matt Lesser, D-Middletown, co-chair of the Human Services Committee and one of the legislators who worked on the 2023 weight loss bill, agreed. “The understanding when we passed the law was that they were going to find a way to cover specifically GLP-1 drugs,” Lesser said. “They have tried to come in compliance of the law by covering a couple of ancient non-GLP-1 weight loss drugs that are less effective and not commonly used.” Lamont’s own budget proposal, which “eliminates coverage” of GLP-1s for weight loss, seems to acknowledge that state law currently requires it. This year, lawmakers are considering proposals that would, for people with a BMI of 35 or over, clearly require that Medicaid cover FDA-approved GLP-1 drugs. The provisions would also require continued coverage if a patient’s BMI drops below 35, as long as a doctor certifies that stopping the drug would likely cause the patient’s BMI to revert above that threshold. An Ozempic injection pen on April Martin’s kitchen table on March 14, 2025. Credit: Shahrzad Rasekh / CT Mirror Cost concerns The Lamont administration’s laser focus on cost isn’t unfounded: The Medicaid program is under pressure at the state level, where it continues to face massive overruns, and at the federal level, where devastating cuts are looming. According to March estimates from Connecticut’s Office of Policy and Management, the state’s Medicaid program faces a deficit of $290 million this fiscal year. The cost of prescription drugs is the single largest component of those overruns, Lesser said. The state isn’t alone in its concern about the cost of covering GLP-1s. A 2024 analysis by the health policy organization KFF found that just 13 states cover GLP-1s for obesity treatment. Two-thirds of the states that don’t, including Connecticut, mentioned cost as a reason among other factors.  GLP-1s are a huge driver of spend for the state’s Medicaid program, making up 35% of the $242 million net pharmaceutical spending. And the state’s demand for GLP-1s is exploding. Between 2019 and 2023, the number of prescriptions for GLP-1s, including Mounjaro and Ozempic, grew by over 500%. But Martin and others say cutting off coverage to save costs is short-sighted because the treatments save money in the long-term by reducing the cost of treating expensive obesity-related conditions, like cardiovascular disease and type 2 diabetes. “Obesity can be such a costly problem for humans and possibly the insurers,” Martin said. “We’re looking at diabetes, strokes, heart attacks, fatty liver disease.” In the same KFF poll, among the states that do cover the drugs, the most popular reason given for doing so was “positive health outcomes and longer-term savings,” followed by “enrollee access and health equity.” Both Martin and Makowicki continue to experience these types of positive health outcomes a few years into using GLP-1s. But, Martin said, sustaining those results requires sticking with lifestyle changes — like adjustments to diet and exercise — that she began even before her weight loss surgery. “You get what you put into it,” she said, adding that she stays active by lifting weights multiple times a week and going on daily walks with her bichon frisé, Bow — short for Rainbow. April Martin runs in Welles Park with her dog Bow James on March 14, 2025. Credit: Shahrzad Rasekh / CT Mirror A middle ground Comptroller Sean Scanlon, who manages the state employee health plan, said he believes it’s important to maintain coverage of GLP-1s while exploring ways to control costs.  “At a time when people are making this binary choice to either keep covering [GLP-1s] in a vacuum or turn the costs off, what we’re doing is unique,” Scanlon said.  The state employee plan covers GLP-1s for weight loss in cases where employees, retirees and dependents have a BMI of 30 or higher. Participants can also qualify if they have a BMI of 27 or higher along with an obesity-related condition, like cardiovascular or liver disease. But beginning in 2023, the plan required anyone seeking a GLP-1 for weight loss to enroll in a program called Flyte, which connects them with a care team of trained obesity specialists that also provide services like regular telehealth check-ins to track weight loss goals, devices to measure weight and blood pressure, as well as meal, recipe and exercise planning. Within the first year, Flyte kept costs flat, compared to projections that the plan was set to double its spending on GLP-1s, Scanlon said. Those savings were achieved, he added, by finding alternatives for some people who were seeking GLP-1 prescriptions for weight loss. “Not everybody who thinks they need one of these drugs actually needs them. There are other drugs and tools that people can use to get better and to be healthier,” Scanlon said. The results have been gaining attention at the state and federal level, Scanlon said. Sen. Bernie Sanders’s office reached out to ask about the program, and the federal Office of Policy Management asked if Scanlon’s team would give them a presentation on how it works. Scanlon said he’s also presented to a handful of the largest employers in the state. Now that popularity of the drugs has exploded, Scanlon’s office needs to find new ways to control costs. Soon the plan will require a $25 monthly copay for the Flyte program — effectively a copay for anyone who is on a GLP-1 for weight loss. The comptroller’s office is also going to review patients who currently receive GLP-1s for diabetes to ensure they actually have a diabetes diagnosis, and remove anyone who does not. “Our current prior authorization looks for a prior diabetic [prescription] to approve a GLP-1 for diabetes. And we believe that members who do not have diabetes are being prescribed another generic diabetic medication and then moving onto a GLP-1,” Scanlon said.  Scanlon said he thinks it’s important to maintain coverage of GLP-1 drugs because of their demonstrated impact. Over the last 18 months, state employee health plan participants using GLP-1s have cut their weight by an average of 19%. Results like these convinced him of the importance of maintaining coverage for his members, and he said he believes in the long-term savings that these drugs deliver to Connecticut residents.  “I have a responsibility as the executive of this plan to try to maintain access to vital health care that people need to stay healthy,” Scanlon said. “I also believe fundamentally that we’re saving the taxpayers money. I will not have this job, likely, when that money savings becomes evident because [the proof] is a guy who’s a 30-year-old state employee right now who doesn’t have a heart attack at age 55.” Makowicki said she also feels a responsibility to advocate for expanded access to these drugs now that she finds herself working at the legislature. Her experience taking a GLP-1 gives her an overwhelming sense of pride, she said — in being part of a movement that recognizes obesity as a disease in need of treatment, and not a lack of willpower, but also pride in herself for the progress she’s made. “I’ve come so far and now I have the power to be able to influence legislation to help others. I never thought I would be able to have that power,” Makowicki said. ...read more read less