Connecticut Medicaid does not cover Wegovy for weight loss. Under HUSKY Health, Wegovy is reimbursable only for two narrow medical uses: reducing the risk of major adverse cardiovascular events in adults with established heart disease, and treating a serious liver condition called metabolic-associated steatohepatitis (MASH). Both require prior authorization, both have strict clinical criteria, and neither is available when the drug is prescribed solely to help a patient lose weight.
The Two Conditions Medicaid Will Pay For
Wegovy is covered under HUSKY Health Programs A, C, and D for adults 18 and older when a prescriber documents one of two qualifying diagnoses.
Cardiovascular Risk Reduction (MACE)
To qualify, a patient must have established cardiovascular disease, such as a prior heart attack, stroke, or symptomatic peripheral arterial disease. BMI must be 27 or higher. Hemoglobin A1c must be below 6.5 percent. The patient must be actively participating in lifestyle interventions like diet and exercise. Patients with Type 1 or Type 2 diabetes, and patients with severe heart failure, are excluded.1CT DSS Map. Wegovy for MACE Prior Authorization Request Form At renewal, patients have to show at least five percent weight loss from baseline to keep the authorization.
MASH (Metabolic-Associated Steatohepatitis)
Coverage for MASH took effect November 3, 2025. The clinical bar is high. Patients need biopsy-confirmed steatohepatitis, an NAFLD Activity Score of 4 or higher, a MELD score of 12 or below (or hepatic decompensation), and liver enzymes no more than five times the upper limit of normal. Patients with diabetes are excluded, and the bulletin is explicit that coverage is not available when Wegovy is prescribed solely for weight management.2CT DSS Map. Provider Bulletin 2025-54
For either indication, the prescriber submits a prior authorization form, the prescription must include a diagnosis code tied to established MACE or established MASH, and the authorization has to be renewed annually.3CT DSS Map. Pharmacy Information
Why Weight Loss Alone Doesn’t Qualify
Cost is the short answer. In fiscal year 2024, GLP-1 drugs cost Connecticut’s Medicaid program roughly $85 million after manufacturer rebates. That was 35 percent of the state’s entire $242 million Medicaid pharmaceutical budget. GLP-1 prescriptions in the program grew more than 500 percent between 2019 and 2023, and a single patient’s monthly supply typically runs around $1,000.4CT Mirror. CT GLP-1 Weight Loss Drug Coverage5WSHU. CT Medicaid Weight Loss Drugs
The longer story involves a 2023 state law that was supposed to open the door. Senate Bill 977 required the Department of Social Services to cover FDA-approved weight loss drugs, nutritional counseling, and bariatric surgery for Medicaid enrollees with a BMI of at least 35.6CPAC. Senate Bill 977 DSS did not add Wegovy or any other GLP-1 to the Medicaid formulary for obesity. Instead, through state plan amendment SPA 25-0014, approved by CMS and effective June 1, 2025, the agency added two older, cheaper drugs: orlistat and phentermine. Those are the only weight-loss medications Connecticut Medicaid now covers, and they are available for patients with a BMI above 40, or above 35 with comorbid conditions.7Medicaid.gov. CT-25-0014
Governor Lamont proposed repealing the 2023 GLP-1 obesity mandate outright, projecting about $45.6 million in savings over two fiscal years. The administration estimated that leaving the mandate in place would push GLP-1 costs above $65 million in fiscal year 2026 alone, against a broader Medicaid deficit of roughly $290 million.8CT.gov. SB 1251 Legislative Proposal The administration kept coverage for GLP-1s prescribed for Type 2 diabetes and for Wegovy’s cardiovascular indication, and ended it for weight loss alone.
What Happened to Patients Already on Wegovy
Some Medicaid patients had been receiving GLP-1 drugs for weight loss through what DSS described as a bureaucratic oversight. In early 2025, the agency notified prescribers that coverage for those patients would end on June 15, 2025.9Hartford Courant. CT Wants to Cut Off Weight Loss Drug Payments for Some Residents If you were on Wegovy through Medicaid for weight loss and your coverage stopped, this is why. Continuing coverage now depends on whether a prescriber can document one of the two qualifying diagnoses.
The State Employee Plan Is a Separate Program
Connecticut’s state employee health plan does cover GLP-1 drugs for weight loss, through a program called Flyte that pairs the medication with virtual obesity care. Eligibility begins at a BMI of 30, or 27 with a weight-related condition.10Milliman. FlyteHealth Comprehensive Obesity Care Program, State of CT That plan is only available to state employees and their dependents. HUSKY Health enrollees cannot access Flyte or its benefits.
What Could Change
Two federal programs and one state law could shift Connecticut’s approach, though none has yet.
The CMS Innovation Center’s BALANCE model lets the federal government negotiate lower GLP-1 prices for participating state Medicaid programs. States can begin applying in May 2026, with applications due by July 31, 2026, and the model runs through December 2031. Participating states adopt standardized coverage criteria and give patients access to manufacturer-funded lifestyle support.11CMS. BALANCE Model12KFF. What to Know About the BALANCE Model for GLP-1s in Medicare and Medicaid Whether Connecticut will apply has not been publicly announced.
Separately, CMS announced a five-year experiment in August 2025 that allows Medicare Part D plans and state Medicaid programs to cover GLP-1s including Wegovy, Ozempic, Mounjaro, and Zepbound for weight management.13Washington Post. Medicare Medicaid Weight Loss Drugs Senator Matt Lesser has urged DSS to consider participating.14CT Senate Democrats. Senator Lesser Welcomes Pilot to Expand Coverage of Weight Loss Drugs The state has not reported applying.
At the state level, Public Act 25-167, signed by Governor Lamont on July 8, 2025, authorizes Connecticut to pursue hiring a generic drug manufacturer to produce low-cost versions of GLP-1 drugs including Wegovy and Ozempic for Medicaid enrollees and state employees.15BillTrack50. HB 719216LexisNexis. CT’s Unique Bid to Lower Cost of GLP-1 Drugs It is a procurement authorization, not a coverage expansion, and no generic GLP-1 is in production under it yet. A direct coverage bill, Senate Bill 1474, would have required HUSKY Health to cover GLP-1 drugs for weight loss at BMI above 35. It passed the Human Services Committee but did not clear both chambers in the 2025 session.17CT General Assembly. Raised Bill No. 147418LegiScan. SB 01474
Where Connecticut Sits Nationally
Medicaid coverage for GLP-1s to treat obesity remains optional under federal law. As of January 2026, only 13 state Medicaid programs cover them for that purpose under fee-for-service, and the recent movement has been toward restriction: California, New Hampshire, Pennsylvania, and South Carolina have each dropped obesity coverage for GLP-1s, citing cost.19KFF. Medicaid Coverage of and Spending on GLP-1s Connecticut’s position, covering Wegovy only for cardiovascular risk and MASH, is in line with that trend.
If You Need Wegovy
Talk with your prescriber about whether you meet the clinical criteria for the MACE indication or the MASH indication. Those are the only two routes to Medicaid coverage of Wegovy in Connecticut right now. If neither fits, your options under HUSKY Health are orlistat or phentermine, prescribed through your provider and subject to the BMI thresholds in SPA 25-0014. Coverage for Wegovy as a weight-loss drug could change if DSS joins the federal pilot, if the state legislature passes a direct mandate, or if generic manufacturing under Public Act 25-167 produces a cheaper version. None of those has happened yet.