State shifts on weight-loss drugs
Partnership seeks healthy, less-costly alternatives for employees as rising demand raises concerns
Ozempic and its generic form have become wildly popular, and the rising costs for Connecticut’s health plan mean state employees who want the drug must join a weight-loss program before the state will cover it.
At the same time, the founder of PhysicianOne Urgent Care, which has 17 urgent-care clinics in the state, as well as Massachusetts and New York, is concerned that semaglutide has become too readily available from medspas and weight-loss programs, without proper oversight by a physician.
The popularity of semaglutide, marketed as Ozempic (approved for diabetes) and Wegovy (for weight loss), has led to shortages of the drug. It also has increased costs for group health plans, according to the Wall Street Journal.
‘Changing your lifestyle’
State Comptroller Sean Scanlon said Connecticut’s costs for weight-loss drugs such as semaglutide have risen 50% since 2020 and could reach $30 million this year.
“When I took office, I was told that our costs were going up on these drugs, and that other companies were saying they weren’t going to cover them anymore,” Scanlon said. “It’s expensive.”
Rather than stop covering the drugs, Scanlon partnered with Intellihealth, a New Canaan company that treats obesity and offers an app to help monitor progress.
“What study after study has shown is that simply taking the medication doesn’t really do much, because if you don’t eat right, if you don’t exercise, if you don’t do all these other things, yeah, you may lose weight, but it’s not changing your lifestyle,” Scanlon said.
“And what this app does is help the person change their lifestyle, which saves the state a lot of money in the long run and makes them healthier,” Scanlon said.
When state employees ask their doctor for Ozempic or another weight-loss drug, they are referred to Intellihealth,
which has an app and a personally tailored website. “And then what the app does is it connects that person with a person who specializes in obesity,” Scanlon said.
“We’re talking about really innovative stuff,” he said. “And so far we’ve had over 300 state employees sign up to use this app and begin the process of this change.”
Before the program, there were 6,200 state employees out of 300,000 on the state health plan who were taking semaglutide, all but 1,900 of them for diabetes, Scanlon said. He said those who were already taking semaglutide will not be retroactively required to use Intellihealth, but he is looking at incentives so people will voluntarily join the program.
The 10-month trial contract with Intellihealth began July 1 under a state program with Connecticut Innovations, the state’s venture capital program. Companies supported by Connecticut Innovations can enter into pilot programs.
“If they have a product that is attractive to the state, they can come in and do the pilot program with the state and not do the normal contracting process,” Scanlon said.
“And at the end of that 10-month period, if it’s going well, we can award a real full-time three-year state contract,” he said. “It’s a way to try to keep some of the companies that we’re spending taxpayer money to fund and get off the ground … in Connecticut and develop relationships.”
‘Comprehensive’
Sloan Saunders, CEO of Intellihealth, launched the company with his wife, Dr. Katherine Saunders, and her mentor, Dr. Louis Arrone, who founded the American Board of Obesity Medicine.
“The key to any effective weight solution is to have a foundational behavior program and then a very rigorous and comprehensive medical evaluation for that specific member,” Sloan Saunders said.
“We have a clinical services affiliate,
which are clinicians ranging from medical doctors that are board certified in obesity medicine to nurse practitioners to registered dieticians to provide care as well, in concert with our technology behavior program,” he said.
Each patient is evaluated to determine the underlying causes of weight gain, which could be a number of things, including side effects from certain antidepressants or sleeping pills, Saunders said.
“And then, to the extent that we can optimize everything around those factors, whether it be behavior or lifestyle, the current medications they’re on, we also then evaluate that patient if they’re suitable for any type of anti-obesity medication,” he said.
“We work with large employers like the state of Connecticut to really critically think about what would be the best clinical solution for that patient, whether or not it’s a generic low-cost medication, or a GLP-1 (semaglutide),” he said.
“And then, throughout the program, that employee or that member has access to our technology but also our clinical team to give that member ongoing support and care throughout the program,” he said.
Not every patient who requests Wegovy is going to be given the medication, Saunders said. Intellihealth offers other weight-loss drugs: Contrave, Saxenda, Xenical, Alli, Qsymia and Imcivree.
And not all employees can join the program.
“The only people that are eligible for our program is the standard
of care for clinical intervention,” Saunders said. “That is basically a 27 BMI (body mass index) and a weight-related comorbidity, or a 30 BMI and above.”
Comorbidities include type 2 diabetes, hypertension, dyslipidemia, heart disease, osteoarthritis, obstructive sleep apnea, kidney disease and non-alcoholic fatty liver disease.
‘Because of the weight loss’
Ozempic “was designed to be used for type 2 diabetics to decrease their risk of complications down the road and to treat their diabetes,” said Dr. Jeannie Kenkare, founder and chief medical officer of PhysicianOne, which is based in Brookfield.
“And one of its wonderful side effects is intentional weight loss, and so it’s gained a lot of popularity because of the weight loss,” she said. “So we’re starting to see it being abused, in a sense, because people are using it specifically for weight loss.”
Ozempic was approved by the Food and Drug Administration to treat diabetes. It brings down blood sugar levels as well as weight. Unlike Wegovy, which is approved for weight loss, Ozempic is not. The only difference between Wegovy and Ozempic is the approved dose of semaglutide. Both are administered at home by injection.
“As long as the medication is being used appropriately, with appropriate observation and follow-up from a medical doctor who understands its uses and side effects and risks, it can be a very safe and powerful medication,” Kenkare said. “But what we’re finding is that a lot of people are finding it through compounding pharmacies.”
While compounding pharmacies are commonly used in the pharmaceutical industry, there also is a black market for some drugs, Kenkare said.
The FDA approved compounding semaglutide because of the shortage, but Kenkare said some medspas and others may use semaglutide salts, which are a different form of the drug. They have not been shown to be safe and effective, according to the FDA.
“It’s being used based on the fact that it’s similar but not the same. So it’s being compounded with other vitamins and minerals and things that people believe should be good, but there hasn’t been appropriate use and follow-up,” Kenkare said. “So we’ve seen people end up in some pretty severe situations with severe side effects.”
“I think it could be that there’s people that are prescribing it that don’t understand and have found sources that are not appropriate, legitimate, regulated sources,” she said.
Semaglutide works by slowing down emptying of the stomach and decreasing appetite. It also acts on a hormone, glucagon-like peptide, that is connected to fat storage, Kenkare said. Common side effects are diarrhea, constipation and nausea, but Kenkare said some may experience paralysis of the intestines, which can lead to a medical emergency.
Like weight-loss diets, semaglutide only works as long as someone is taking it.
“It’s not a magic pill that, once you go on it, it changes something in your body forever,” Kenkare said. “Once you stop it, that effect goes away too. So many people, when they stop it, if they haven’t changed their lifestyle, their eating habits, their eating behavior, all those things can return and then the weight can be regained.”
Dr. Lauren Young, a naturopathic physician with Collaborative
Natural Health Partners, said the practice offers primary care and what she calls functional medicine.
“I’ve seen people getting online, never seeing a doctor,” she said. “So our clinic decided to implement a program where they’re overseen closely, and we also monitor their percent body fat, their nutrition, their labs, their kidney liver function, that kind of stuff.”
There are also groups in which patients learn about mindfulness and nutrition, she said.
Her practice, which has six Connecticut locations, does use compounding pharmacies for semaglutide, which Young said is the real thing, not semaglutide salts.
“I think it’s a very safe medication,” she said. “We screen everyone before to see if they’re a good candidate before they’re allowed to do the program. They can’t have any family history of thyroid or medullary cancer.” She said they also watch for anyone with an eating disorder.
“We wanted to do something that was helping our patient base but also in a way that is sustainable and a healthy way of losing weight,” Young said. “Everyone in our program is losing body fat, not muscle. We’re very careful with that.
“We’re very closely monitoring their nutrition and making sure they’re getting adequate macronutrients, especially protein,” she said. “A machine similar to an EKG machine “looks at your body fat and muscle mass. And we’re doing that before they get started and then throughout the program to make sure that they’re staying on target.”
She said patients’ weight-loss goal is 1 to 2 pounds a week.
“A big piece of it is the mindfulness piece,” Young said. “We’re not restricting types of foods. We’re teaching people how to have a better relationship with food. That’s actually a quote I got from a patient last week was, this medication is giving her the relationship with food she always wanted.”