After Bonnie had part of her thyroid removed, weight gain accompanied the aftermath of the procedure.
The Connecticut resident, who asked that her full name not be used, tried the obesity drug Zepbound, losing 60 pounds over two years.
She said the drug was critical in helping her to lose weight, but that it alone did not cause her to shed the pounds.
“The cravings are extremely reduced,” she said, adding that she has also incorporated a healthful diet and exercise.
“I can’t sit there and eat cake, fried fish, french fries and ice cream and think I am going to lose weight,” she said.
While on medication known as GLP-1 (glucagon-like peptide-1), which imitates a hormone naturally produced in the gut that regulates blood sugar, slows digestion and signals fullness in the brain, Bonnie had to temporarily stop the medication after a year and a half when her blood work returned to normal. As a result, her insurance company stopping covering the drug, she said.
It became unaffordable and she gained several pounds while off the drug, she said. It wasn’t until Bonnie was tested and diagnosed with borderline sleep apnea that her insurance once again covered the drug.
GLP-1 experts and lawmakers said that the drugs are not affordable; insurance companies often refuse to cover them after a period of time, resulting in patients stopping the drugs. Doctors said the medications are beneficial not only for weight loss but also for cardiovascular health.
To address the issue, state lawmakers passed prescription drug legislation last year that included a proposal for the state to explore making its own GLP-1 drugs. Several lawmakers said the idea, a first for the state, is still being vetted and that it is integral in bringing the price of GLP-1s down. Going forward would require federal approval from Health and Human Services Secretary Robert F. Kennedy Jr.
The largest single prescription growth area in the last year for state employees and retirees was for GLP-1 weight loss drugs, where total state spending exceeded $150 million. In the country, approximately 18% of the population are on GLP-1s, according to doctors.
Making a compelling case
Sen. Matt Lesser, a Middletown Democrat and co-chair of the Human Services Committee, who sponsored the prescription drug legislation with members of the Bipartisan Drug Task Force, said there are a number of legal and practical questions that the state must address to make a compelling case to the federal government to manufacture the drug.
“Nobody has ever done this before,” he said. “It is very doable. We want to make sure that we have the strongest foot forward so we can bring down the cost.”
Sen. Jeff Gordon, R-Woodstock, a physician and a member of the Bipartisan Drug Task Force, said it is going to take hard work, perseverance and time.
“It could take several years and we are beginning the process now,” Gordon said. “It is more of an issue as we are looking at the logistics and mechanics of it. We have phenomenal technology here and a lot of manufacturing base.”
Gordon said the big reason the task force looked into this idea was to better position the state when drug shortages happen nationally.
Sen. Saud Anwar, a South Windsor Democrat and co-chair of the Public Health Committee, said an additional hurdle to the state manufacturing its own GLP-1s is importing the chemicals needed to formulate the drug.
If the state receives permission from the federal government, Anwar said it should not be that complicated to actually manufacture the drug as the chemical substances for making the drug are not as expensive as current market rates.
Rob Blanchard, director of communications for Gov. Ned Lamont said “while the enabling legislation was enacted last year, this initiative is still in early development.
“It’s too soon to share specifics at this stage,” he said.
Lesser said he is coordinating a forum on the issue with the governor’s office to receive feedback on the concept.
“We want to make sure that everyone is in agreement about this,” he said.
High costs and insurance coverage challenges
Dr. Mahima Gulati, a board certified endocrinologist at UConn Health, who is part of a national GLP-1 task force at the American College of Lifestyle Medicine, said most insurance companies are not covering the drug.
“They will cover it for diabetes but they will not cover it for obesity,” she said. “And you know, even other indications like fatty liver disease or pre-diabetes, those are not considered criteria yet. Now these things may change. It’s very fluid. It’s hard to keep up.”
Gulati said the out-of-pocket costs for GLP-1s can be from several hundred dollars a month to $1,000 a month.
“The biggest problem is the price of the drugs,” said Lesser. “I would like to bring the cost down so everyone who needs the drug can get it. That requires that the drug companies be less greedy in squeezing the state’s Medicaid program. These drugs are incredibly important as we face an obesity epidemic. If they are not available to Americans and they are stuck paying astronomical prices, then you create huge health equity issues.”
Dr. John Morton, professor and vice chair, quality division chief of bariatric and minimally invasive surgery at the Yale School of Medicine, said seeing the burden of the cost shift from the insurer to the patient is disturbing.
“We don’t see this in other fields like heart disease and cancer,” he said. “I don’t think it is fair to the patient with obesity. Insurers need to figure out how to cover it.”
Obesity epidemic
The American Diabetes Association said approximately 1 million adults or 29% of Connecticut’s population live with obesity.
“The Connecticut adult obesity rate is projected to increase by 52% by 2030,” the American Diabetes Association said.
Morton said those who have a BMI greater than 27 represent about half the country.
“It is very much a problem,” he said.
Morton said Americans now have a more sedentary lifestyle and how we live, work, play and eat has affected obesity rates.
“I think we deal with sleep deficits,” he said. “A lot of people don’t sleep enough and if you are in a state of stress from sleep deprivation you are not going to lose weight. The obvious culprit is our food supply. These ultra processed foods have made it extremely easy to digest the food, eat the food and want more of the food.”
Morton said it is particularly hard to lose weight through dieting alone after you reach a BMI over 30, adding that only 1 out of 20 patients is able to master it.
“Your body has stored all of these calories,” he said. “It really views calories as treasures and any time it views itself in some sort of stress situation it will not give up many calories. Every time you diet your hunger hormones increase and never go back to the baseline.”
Benefits and side effects of GLP-1s
Gulati said at a minimum 10% of the state’s population is on GLP-1s. She said UConn Health alone filled 6,000 prescriptions for the drugs in 2025.
Morton said a third of his patients are on the drugs.
Gulati said common side effects of the drug are nausea and constipation.
“Some people may have vomiting,” she said. “The drugs are supposed to slow down the stomach emptying into the intestines so the food sits there for longer.”
She said the GLP-1 drugs may increase the risk of manifesting medullary thyroid cancer, a rare cancer, according to a theoretical risk from animal models.
“Again this has not borne out to be true after almost two decades,” she said, noting how long the drug has been on the market.
The drug was first used to treat diabetes and then doctors realized it could also help with obesity management, doctors said.
Morton said there does not appear to be any sort of long-term consequences from the drugs.
“There are definitely benefits of these drugs and the GLP-1s have been recognized by the FDA and in different random trials as providing significant weight loss that leads to downstream benefits like improvements in cholesterol, heart failure, liver dysfunction and sleep apnea,” he said.
He said half of his patients who had to stop the drug gained the weight back.
“They can end up in worse shape than before they started,” he said.
He said drug companies have done studies showing that roughly about 80% of people on the drugs who got off of them gained the weight back.
Gulati said it is important when people are taking the drug that they are instituting lifestyle modifications including nutritious foods, physical activity and sleep patterns.
“So the FDA label clearly states that these drugs are supposed to be used as an adjunct to reduced calorie and diet and exercise intervention,” she said.
Morton said it makes sense for people to stay on the drugs for life.
“From a common disease standpoint it makes sense,” he said. “You don’t stop taking your heart and blood pressure medication.”
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