HUSKY Health covers Ozempic only when it is prescribed for type 2 diabetes. If you are looking for Ozempic, Wegovy, Mounjaro, or Zepbound to treat obesity or for weight loss alone, Connecticut Medicaid will not pay for it. The pharmacy claim has to carry an ICD-10 diagnosis code for type 2 diabetes, and without that code the prescription will be rejected.
The Diabetes-Only Rule
Ozempic sits on the Connecticut Medicaid preferred drug list as a preferred agent for type 2 diabetes, alongside Trulicity, Victoza, and Byetta. All four require a type 2 diabetes diagnosis code on the pharmacy claim to be dispensed under HUSKY.
The Department of Social Services made this explicit in Provider Bulletin 2024-66, issued in late 2024. The bulletin required every new GLP-1 prescription for Ozempic, Mounjaro, Trulicity, Victoza, Byetta, Bydureon, and Rybelsus to include the type 2 diabetes diagnosis code. Prescribers were instructed to move any patient who had been getting a GLP-1 for another reason onto a different therapy. Members who had been receiving these drugs for weight loss were told their coverage would end on June 15, 2025.
Public Act 25-168, effective July 1, 2025, wrote the restriction into state law. It limits GLP-1 coverage to people with type 2 diabetes or qualifying comorbid conditions, subject to prior authorization and step therapy. For a diabetes prescription to be renewed, the prescriber has to document ongoing compliance, safety monitoring, and improvement in blood sugar backed by recent lab values.
Wegovy, Zepbound, and Other Weight-Loss GLP-1s
Wegovy and Zepbound are FDA-approved specifically for weight loss. Neither appears on the Connecticut Medicaid preferred drug list at all. HUSKY does not cover them.
For weight loss, HUSKY covers only two prescription medications: orlistat and phentermine. The federal Centers for Medicare and Medicaid Services approved Connecticut’s State Plan Amendment (SPA 25-0014) on June 3, 2025, formalizing that limit. As of July 1, 2025, HUSKY also covers services from certified dietitian-nutritionists.
Mounjaro and Other Non-Preferred GLP-1s
Mounjaro, Rybelsus, and generic liraglutide are non-preferred agents. To get one of them covered, the prescriber has to submit a clinical prior authorization and document that you tried a preferred GLP-1 for at least 30 days without success. Even then, the underlying diabetes diagnosis requirement still applies.
Why Some Patients Lost Coverage They Used to Have
Before the 2024 bulletin, some HUSKY members did receive Mounjaro or Ozempic for weight loss. Reporting described this as an apparent bureaucratic oversight: claims were being processed without anyone enforcing the diabetes diagnosis requirement. When DSS tightened the rules, those prescriptions stopped being covered, and appeals have generally not succeeded. In at least one documented case, a member who challenged the loss of Mounjaro coverage for a non-diabetes condition had the appeal denied, with the hearing officer siding with DSS.
If you were getting a GLP-1 through HUSKY for weight loss and lost it, this is why. The coverage was never officially authorized for that use, and the department closed the gap.
How to Appeal a Denial
If HUSKY denies your GLP-1 prescription, you can request an administrative fair hearing through the Office of Legal Counsel, Regulations, and Administrative Hearings. If you lose at the hearing, you have two options: file for reconsideration within 15 days, or appeal to the Superior Court within 45 days.
Realistically, an appeal is most likely to help when the denial involves a diabetes prescription that was rejected on a technicality, a non-preferred drug where step therapy is at issue, or a comorbid condition covered under Public Act 25-168. Appeals asking HUSKY to cover a GLP-1 purely for weight loss run into the current policy and are unlikely to succeed.
What the Legislature Tried and What Might Change
A 2023 law, Senate Bill 977, required DSS to cover FDA-approved weight loss drugs for Medicaid enrollees with a BMI of at least 35, along with bariatric surgery and nutritional counseling. Legislators who wrote the bill, including Senator Matt Lesser, said the intent was to cover GLP-1s like Wegovy. DSS did not implement it that way. The department’s position, according to spokesperson Christine Stuart, is that it satisfied the law by pursuing federal approval for orlistat and phentermine and adding nutritional counseling. Sheldon Toubman of Disability Rights Connecticut called the failure to cover GLP-1s “a blatant violation” of the statute. Senator Lesser said the state was relying on “a couple of ancient non-GLP-1 weight loss drugs that are less effective and not commonly used.”
A follow-up bill in 2025, SB 1474, would have required HUSKY to cover GLP-1s for enrollees with a BMI over 30 and would have kept coverage in place even if the member’s BMI later dropped, as long as a physician certified that stopping the drug would likely cause it to rebound. The bill passed the Human Services Committee 16 to 6 on March 14, 2025, and reached the Senate calendar in April, but it never got a floor vote and died.
The one avenue that remains open is a law Governor Ned Lamont signed on July 8, 2025. Rather than paying market prices for brand-name GLP-1s, it directs the Commissioner of Social Services to petition the U.S. Department of Health and Human Services to invoke 28 U.S.C. ยง 1498, a federal statute that lets the government authorize the manufacture of patented products in exchange for reasonable compensation. The goal is to enable generic production of Ozempic, Wegovy, Mounjaro, and Zepbound at much lower cost. The state rejected compounded alternatives because officials were “not comfortable with the lack of FDA approval for the products.” The law also lets Connecticut join with other states to contract for generic GLP-1 production. Legal experts have said there is little precedent for using Section 1498 this way, and patent holders would likely challenge any attempt in court.
Until something changes on that front, the rule for HUSKY members is the one already in place: Ozempic for diabetes, yes; Ozempic for weight loss, no.