Communications Director, Connecticut Hospital Association
110 Barnes Road, Wallingford, CT
rall@chime.org, 203-265-7611
CT Insider – Tuesday, January 14, 2025
By Dan Haar
Like blockbuster drugs of years past, Ozempic and its cousins that deliver diabetes control and weight loss have become more than just pharmaceuticals. They are, as state Comptroller Sean Scanlon calls them, “a cultural phenomenon.”
The trend matters greatly to Scanlon in his role managing the health plan for state employees, retirees and their dependents. He figures Connecticut taxpayers will pony up $60 million in the year ending June 30 for this wildly popular GLP-1 class of drugs, which control blood sugar for Type 2 diabetes patients.
And oh by the way, these drugs also keep your appetite under control — whether you’re morbidly obese or overweight by 25 pounds or just looking for a beach bod as summer approaches.
Wow, sixty million bucks for just one class of drugs. That’s one-eighth of the entire pharmaceutical spend for the 250,000 people on the Connecticut plan, which is expected to hit $483 million this fiscal year.
That $60 million price tag is up from $38 million in the last fiscal year, $29 million in the year before that and $16 million three years ago. And that’s on top of tens of millions of dollars state taxpayers spend on Ozempic and its drug cousins for Medicaid patients.
Obviously that’s not a rate of growth we can afford for many more years. “That’s been our goal, to cut that unsustainable increase,” Scanlon told me Monday.
Scanlon’s answer, starting in mid-2023, has been to tie approval of the drugs when prescribed for weight loss to a counseling and wellness program run by a New Canaan-based start-up company, FlyteHealth. After 18 months, it’s showing dramatic results. And it weeds out people unwilling to make changes in their lifestyles.
“If they don’t want to do that then we don’t want to prescribe them the drug,” Scanlon told me Monday.
Mandate or none, it’s not easy to navigate around a tsunami of demand. This is a drug that can save lives, and taxpayer dollars, in the long run. But it also can be, and is, misused and overused at huge public expense.
“We’re riding a cultural phenomenon wave but we’re not just riding it with abandon. We’re trying to figure out a way to ride it sustainably,” Scanlon declared. “I don’t know what the ceiling is going to be.”
States need to manage it, not ban it
UBS, the global bank, forecast worldwide sales of $126 billion by 2029, up from just under $50 billion in 2024. Of course the United States, obesity capital of the world, leads the way.
Some states, seeing these costs, have simply nixed GLP-1’s off their approved list except for certified diabetes patients. Sorry, those states say to members of their health plans. No weight loss, period. You want that, pay for it yourself.
Because these drugs are in high demand and still under patent, U.S. customers pay top dollar. Treatment costs up to $15,000 a year, according to drugwatch.com.
If it sounds logical for states to ban the drug for weight loss, it isn’t — for several reasons. We know obesity is linked to heart disease and all manner of other chronic illness. The federal government approved Wegovy, basically Ozempic in a different dose, for chronic weight loss.
And anyway, doctors can and do prescribe drugs for “off-label” uses. That’s hard for a state to control. GSP-1 drugs passed Humira, the autoimmune disease treatment, as the state plan’s costliest.
Bottom line: If administered correctly by government payers, Ozempic and its cousins can save a lot of human suffering and a lot of taxpayer money. Studies show GLP-1 drugs can lead to fewer heart attacks and other health calamities but doctors including state Sen. Saud Anwar, D-South Windsor, urge common sense.
“If a person loses weight, a number of their health indices will improve,” Anwar, a pulmonologist, told me Monday at the Capitol. But he added, “Long-term, sustainable changes can only come if you make lifestyle changes.”
Anwar worries about large numbers of people relying on miracle drugs as short-cuts to fix any and all medical issues. “That’s not a healthy way for society to evolve,” he said.
‘Let’s get creative’
When Scanlon took office in early 2023 amid a spike in demand for Ozempic, his new colleagues told him about the problem and said many states are cutting the drugs off for weight loss. That idea seemed shortsighted. “Let’s get creative and try to find a way to control it,” Scanlon said he and his colleagues decided.
Results include an average 16 percent weight loss and 16 percent reduction in body-mass index, a measure of potential obesity, Scanlon said. And it appeared the program was slowing the increase in use, but that’s not clear.
Separately, the Connecticut Department of Social Services is preparing to roll out a policy on GSP-1 drugs for obesity in medicaid members, spokeswoman Christine Stuart said.
“Obesity is a complex and chronic medical condition that requires comprehensive, evidence-based management,” Stuart said in a written statement. “We are dedicated to ensuring access to approved weight-loss medications while maintaining thoughtful clinical oversight to safeguard Medicaid members’ long-term health.”
It’s been a slow process despite a state law requiring it. Two years ago the legislature adopted, and Gov. Ned Lamont signed, a bill requiring Connecticut Medicaid to cover bariatric surgery, nutritional counseling for obese people and medications approved by the Food and Drug Administration for weight loss, including Wegovy.
A co-author, Rep. Jaime Foster, D-Ellington, who holds a Ph.D in nutritional science, said Monday that DSS should move quickly in covering dietary counseling — a key to making these drugs work well for weight control — as Scanlon’s office has done for the state plan with the FlyteHealth program.
Daunting numbers for drug costs
Sen. Matt Lesser, D-Middletown, author of several sections of that 2023 bill, said the ability to negotiate prices with the drug companies is crucial, but states can’t limit access or the Ozempic and Wegovy manufacturer, Novo Nordisk, refuses to offer discounts.
“We’re required to do this by the Feds and we can’t afford it,” Lesser said.
Complicating matters on the state side, DSS issued a bulletin last month saying it won’t cover Ozempic other than for Type 2 diabetes, Lesser said.
As for the state plan, most of the usage remains outside of the FlyteHealth program, perhaps because docs are prescribing Ozempic for weight loss. Still, the FlyteHealth enrollment grew by 2,000 people in the last three months of 2024 to more than 10,000, Scanlon’s office reported.
In short, the numbers are daunting.
Consider, the state’s $483 million overall cost for pharmaceuticals this fiscal year for the 260,000 employees and retirees, their dependents and many municipal groups that have joined the state plan, is up from $420 million last year and $366 million in fiscal 2023. That’s a 32 jump over two years, not as sharp as the 100 percent cost bump for the GSP-1 drugs over the same two years, but a hefty hike nonetheless.
“We need new cures, we need Ozempic. This ultimately should save us money,” Lesser told me Monday. “But drug costs keep ballooning and we have to get a handle on it.”