Connecticut’s comptroller explains his thinking about GLP-1s for state employees

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It seems these days like everyone is talking about Ozempic and Wegovy. These drugs, known formally as GLP-1 medications, are getting a lot of buzz thanks to strong clinical results in reducing obesity.

The catch? The annual costs per patient can range from $4,000 to $14,000. That can add up — especially when you’re the comptroller of a state whose insurance covers more than 265,000 people.

This spring, a few months into my term as Connecticut state comptroller, my team sat me down to talk about these costs. As comptroller, my office runs the state employee health plan, which has historically covered these drugs because their on-label use is treating diabetes. In 2022, though, one-third of the approximately 6,000 plan members using GLP-1s had no previous diabetes diagnosis, meaning the drugs were likely being prescribed off-label to treat obesity.

As a result, we’ve seen a 50% growth in the cost of GLP-1s every year since 2020. In 2023 alone, we expect to spend more than $30 million on this drug class.

But instead of sitting back and watching our costs rise or following the trend of large employers dropping coverage for GLP-1s due to their price tags, we decided to take a different approach.

Under a new policy that took effect July 1, we will continue covering these important GLP-1 drugs, but we now require our plan members to take another important step in order to use them.

We’ve partnered with Intellihealth, a Connecticut-based company, to continue providing access to GLP-1s while also requiring that state health plan members who are seeking to treat obesity with these drugs enroll in a clinical lifestyle management program, Flyte.

The program, which is free for plan participants, provides access to enhanced care and support from experts in obesity medicine with guardrails for appropriate treatment and responsible prescribing. Even without GLP-1s, a 2020, Patient-Centered Outcomes Research Institute-funded study found that combining Flyte’s online program with traditional intervention resulted in better patient outcomes. Aspects of the program include meeting with a registered dietician for nutrition counseling or meeting with a clinician to construct a plan to identify and address a patient’s personal barriers to weight loss.

Since our launch, more than 1,000 state plan members — this includes current employees, retirees, and their dependents — have applied for the program, without any advertising on our part. We’ve heard from one participant who encountered a yearlong wait at her local clinic; Flyte’s online platform was a convenient one-stop shop to begin her weight-loss journey. Patients have also relayed emotional benefits and relief from finally meeting with clinicians trained to treat obesity — they are finally seeing their condition being approached as a disease rather than deficient willpower.

Our partnership with Intellihealth is currently in its pilot stage. Come May 2024, we’re going to sit down, evaluate the current outcomes, and continue to chart our path for the future. What will we be looking for? Directional improvements in clinical measures for those participating: reductions in BMI, blood pressure, and hyperglycemia; enrollee satisfaction; whether program is attracting members most in need. Additionally, as more members enroll in the program, we are watching closely to ensure there are not capacity concerns and that wait times are practical.

At the same time, we are gathering feedback on the rollout of the program from plan participants for future adjustments and augmentation. One avenue we are exploring with Flyte in the coming months is a second-phase rollout that allows members to see local obesity specialists for GLP-1s while engaging with the app.

Additionally, we are working to resolve concerns regarding duplicate lab requests, as Flyte does not have access to patients’ prior results, and, although patients can submit results received in the last 12 months, they can be difficult to acquire. To resolve this, we are working with Flyte to determine whether they can access such information for their enrolled patients through the state’s Health Information Exchange, Connie. Finally, as Flyte only sees patients 18 and older, we are working with the state’s children’s hospitals to develop appropriate pediatric treatment.

But these are fixable issues. The bottom line is, GLP-1s have shown great success in the treatment of obesity. As I run the largest employer-sponsored health plan in the state, I believe it is a moral imperative to give people access to drugs that will improve their well-being.

As a bonus: There’s a fiscal imperative here, too. Treating obesity likely means fewer complications related to the disease down the road, like cardiovascular or respiratory conditions, which, in turn, saves the state money in the long run while also improving health outcomes for plan participants.

Addressing the challenges associated with obesity requires a holistic, compassionate approach to care, and the state of Connecticut is committed to providing our health plan members with access to experts who understand the complexity of this condition and its treatment.

Sean Scanlon is the state of Connecticut’s comptroller.