Conn. Gen. Stat. § 17b-278l: Medical assistance for obesity treatment, surgery. Definitions. State plan amendments, reporting on glucagon-like peptide (GLP-1) drug coverage.

(a)(1) As used in this section, “bariatric surgery” means surgical changes to the digestive system to help a patient with obesity to lose weight;

(2) “Body mass index” means the number calculated by dividing an individual's weight in kilograms by the individual's height in meters squared;

(3) “Medical services” means (A) prescription drugs approved by the federal Food and Drug Administration for the treatment of obesity on an outpatient basis for individuals with type 2 diabetes and prescription drugs approved by the federal Food and Drug Administration on an outpatient basis for the treatment of a comorbid condition for individuals with obesity, subject to prior authorization and only after step therapy when clinically appropriate, and (B) nutritional counseling provided by a registered dietitian-nutritionist certified pursuant to section 20-206n;

(4) “Severe obesity” means a body mass index that is:

(A) Greater than forty; or

(B) Thirty-five or more if an individual has been diagnosed with a comorbid disease or condition, including, but not limited to, a cardiopulmonary condition, diabetes, hypertension or sleep apnea; and

(5) “Obesity” means a body mass index of thirty or higher.

(b) The Commissioner of Social Services may amend the Medicaid state plan and the state plan for the Children's Health Insurance Program to provide for this optional coverage under such programs, in accordance with federal law, for (1) bariatric surgery and related medical services for Medicaid and HUSKY B beneficiaries with severe obesity, and (2) medical services for Medicaid and HUSKY B beneficiaries with a body mass index greater than thirty-five, provided such beneficiaries otherwise meet conditions set by the Centers for Medicare and Medicaid Services for such surgery and medical services. Upon approval of any state plan amendment, the Department of Social Services shall provide said coverage.

(c) Notwithstanding the provisions of subsection (b) of section 17b-274f, any step therapy that may be required by the Commissioner of Social Services pursuant to the provisions of this section may be for a period of time not longer than one hundred eighty days.

(d) Notwithstanding subsections (b) and (c) of this section, step therapy shall not be required to obtain Medicaid coverage for medications approved in the state plan amendment to treat obesity for those individuals with a body mass index of forty or higher who a licensed health care provider certifies in writing are scheduled to undergo surgery requiring anesthesia not later than six months after such certification.

(e) The Commissioner of Social Services shall collect data concerning the use by Medicaid beneficiaries of glucagon-like peptide (GLP-1) drugs and costs and benefits to the state. Not later than January 15, 2026, and annually thereafter, the commissioner shall submit a report, in accordance with the provisions of section 11-4a, to the joint standing committees of the General Assembly having cognizance of matters relating to appropriations and the budgets of state agencies, human services and public health on: (1) The number of Medicaid recipients who received GLP-1 drug treatment in the last calendar year, (2) the number of Medicaid recipients prescribed such drugs primarily due to a type 2 diabetes diagnosis, (3) the number of Medicaid recipients prescribed such drugs primarily due to cardiovascular concerns, (4) the total cost to the state to provide Medicaid coverage of such drugs, and (5) the total amount of rebates or discounts received from pharmaceutical companies associated with inclusion of such drugs in the Medicaid program to the extent permissible.

(f) Not later than thirty days after July 8, 2025, the Commissioner of Social Services shall petition the Secretary of the Department of Health and Human Services pursuant to 28 USC 1498, as amended from time to time, to authorize generic, lower cost forms of glucagon-like peptide (GLP-1) prescription drugs approved by the federal Food and Drug Administration to treat obesity or diabetes.

(g) Upon approval of such petition, the commissioner may enter into a contract with any manufacturer of generic forms of such drugs approved by the federal Food and Drug Administration to supply such drugs to the state for use by HUSKY Health program members. The commissioner may enter into a consortium with officials in other states in contracting with such manufacturer for such drugs.