Winter in the Connecticut Hills

Connecticut Flouts the Law and People with Obesity Suffer

Two years ago, Connecticut Governor Ned Lamont signed a bill into law to provide better access to obesity care under the state’s Medicaid program. This includes access to GLP-1 medicines. Now, it seems, the state is flouting the law. So people with obesity who rely on Medicaid are left out in the cold if they need a GLP-1 medicine.

Late last year, the Commissioner of the state’s Medicaid program issued a bulletin stating the program will no longer cover GLP-1 agonist medicines without a diagnosis of type-2 diabetes. When asked about this apparent violation of law, a spokesperson for the Connecticut Department of Social services was evasive, writing:

“Obesity is a complex and chronic medical condition that requires comprehensive, evidence-based management. We are dedicated to ensuring access to approved weight loss medications while maintaining thoughtful clinical oversight to safeguard Medicaid members’ long-term health and ensure coverage for those who meet the eligibility criteria.”

This is bureaucratic double-talk that translates to “no comment.”

One Step Forward, Two Steps Back

State Senator Matt Lesser worked hard to pass the law guaranteeing access to obesity medicines in Connecticut. He expressed frustration:

“It is discouraging when we work with DSS and the administration to pass a law and then they decide that the law doesn’t apply to them.

“What they have told me, and I believe them, is that when they first negotiated the law, they looked at the prices at the moment, and that the drug companies have since raised the price, and so that has changed the calculus.”

Essentially, DSS is playing with the health of its citizens as a negotiating tactic for price concessions.

Bias Lurking

There is no way to explain this except as a blatant disregard of the human dignity of people with obesity. Note that DSS is not taking meds from persons with diabetes in their ploy. But the implicit message is that people with obesity are not as worthy. Even though these medicines can be life saving.

Research tells us that these types of actions arise from ignorance. When benefit managers understand the biological factors underpinning obesity, they are less likely to cut off access to care.

Sadly, though we are making progress, we have much work to do before we can be sure that all health program managers understand obesity.

Click here and here for more on the problem in Connecticut.

Winter in the Connecticut Hills, painting by Childe Hassam / WikiArt

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


 

January 20, 2025

3 Responses to “Connecticut Flouts the Law and People with Obesity Suffer”

  1. January 20, 2025 at 7:00 am, Michael Jones said:

    Ted, perhaps you can highlight that Virginia has, in effect, done something similar. Since 2021 Virginia Medicaid has covered GLP-1s for obesity using FDA indicated criteria. As of September 2024 they raised the BMI criteria for initiation of therapy to 37 with 2 comorbidities or 40. This is bad enough, but they then require an ongoing loss of 5% (not just initial), however the medication is no longer covered if the person’s BMI drops below the initiation BMI criteria. So, the upshot, if it’s ineffective, they stop paying (reasonable), if it’s too effective they stop paying. I have a large number of people regaining a lot of excess adiposity. Frustrating!

    • January 20, 2025 at 10:17 am, Ted said:

      I think you did a fine job of highlighting this, Michael.

  2. January 21, 2025 at 11:45 am, Becca Saul said:

    Unfortunately, SC is doing much the same as VA and CT. Our state Medicaid program has covered these medications since November 2024 but categorically denies the medications when prescribed, and prior authorization folks are not even READING the requested patient notes when they ask for “additional information.”

    I have taken to listing every single criterion in a bold faced, bulleted table with exact diagnoses that the individual meets which makes them eligible for the medication under SC Medicaid’s OWN guidelines. They are also then automatically denied when dose changes occur, despite the fact that the authorizations are supposed to last 6 months for initial prescriptions and then 12 months for subsequent re authorizations. Patients are getting one month sometimes on their first prior authorizations if they can even get it approved, and then the 2nd month is being denied for lack of progress even with documented progress, documentation of multidisciplinary team management (including an RD for nutrition support) and intensive lifestyle interventions with me monthly as adjunct treatment in addition to medications.

    I’ve spent over 2 hours on the phone with Medicaid and once spoke to 4 different people just for one patient, just in the last 2 weeks. I am now making calls for prior authorization on every single one and requesting peer to peers, though this cuts into patient appointment time and or my productivity. Unfortunately, even the providers for peer to peer are being evasive about why medications are being denied despite a patient meeting criterion for prescribing. The fact that size biased withholding of medical treatment actively happens is vastly under reported. It borders on blatant discrimination in many cases. I find that saying this out loud makes the person on the other end of the phone feels more compelled to act in a manner consistent with their published guidelines. Wish it weren’t so difficult to get my patients access to care. Medicaid is getting tired of hearing from me, but I have no immediate plans to ignore this overt bias. Hopefully others are doing the same!