The health of state employees and MassHealth members “is on the line,” clinicians and patients warned on Tuesday, due to diminishing coverage for GLP-1 drugs for weight loss.
The cries come against a backdrop of surging health care costs in Massachusetts tied to the popularity of GLP-1 drugs, and concerns from insurers about the rising costs of premiums as a result.
A chronic disease management specialist and president of the New England Obesity Society, Dr. Giovanna Leddy says obesity has been recognized as a chronic disease by the American Medical Association since 2013.
“Without treatment, it is a chronic and relapsing chronic disease that leads to substantial morbidity and mortality,” Leddy said at a briefing. GLP-1s not only show meaningful weight loss long term, but marked improvements in weight-related metabolic conditions, type 2 diabetes, sleep apnea, fatty liver disease and cardiovascular disease, she explained at the discussion about obesity management treatment.
“Just like any other chronic disease — diabetes, high blood pressure, high cholesterol, rheumatoid arthritis — treatment with medication is intended for long-term use,” Leddy said. “We would never consider withdrawing effective treatment for any of these other chronic diseases. Discontinuing obesity medication for patients with demonstrated benefit is bordering unethical.”
For GLP-1 users like Michael Donnelly-Boylen, who was able to get off of antidepressants and blood pressure medication and stave off longer-term medical care as a result of using GLP-1s for weight management, the drugs are a “lifeline.” He said since the age of eight, everything he had tried to address his weight had failed.
“Two years ago, I was prepared to die,” Donnelly-Boylen said at the briefing. “I had reached almost 400 pounds. I couldn’t walk two blocks without being in excruciating pain. I started getting all the documents together so that my spouse would be okay when I wasn’t here anymore.”
The Health Policy Commission found last year that GLP-1 prescriptions grew from 3,000 per 100,000 commercial members in 2018, to 22,000 per 100,000 in 2023. Demand for the drugs, which were initially designed to treat type 2 diabetes, increased since the Food and Drug Administration approved Wegovy for weight loss in 2021.
“The diabetes versions of GLP-1s are well-covered by most plans. So why is it that obesity medications are stigmatized and not covered for the exact same molecule? It’s not covered for obesity, but it’s covered for diabetes,” physician assistant Joe Zucchi said.
“We have patients who, sadly, are hoping their panel comes back from their lab work and shows that they have diabetes so that they can get coverage for medication,” Zucchi added.
The Alliance for Patient Access, the American Diabetes Association and the Obesity Action Coalition hosted the discussion and said that one in four adults in Massachusetts live with obesity. Each year, untreated obesity drains $11.8 billion from the state’s economy and adds $757 million to state health care spending, according to the groups. They are urging the state to “treat obesity like the chronic disease is it,” and suggested that the state adopt utilization management strategies and clinical guidelines to maintain coverage and manage costs. They also suggested it “leverage” federal opportunities like opting into the Center for Medicare and Medicaid Services’ “BALANCE Model,” which aims to improve access to some GLP-1s.
The advocates did not outline legislative ideas, though Reps. Rob Consalvo and Thomas Stanley attended the panel discussion, both sharing that they use GLP-1 drugs and asking clinicians questions about treatment.
Beginning April 1, people participating in Group Insurance Commission open enrollment will start picking their coverage plans that don’t include GLP-1 coverage for weight loss. The GIC voted in February to eliminate that coverage, following suit with a benefit change that commercial insurers and the Massachusetts Interlocal Insurance Association have also pursued. The GIC provides insurance for more than 460,000 public employees and retirees, and some 22,000 GIC members take GLP-1 drugs for weight loss at a total cost of $46 million.
Though costs tied to GLP-1s have been straining the agency’s budget, some GIC commissioners say the decision could increase health disparities and lead to higher costs should chronic conditions worsen. The vote followed Gov. Maura Healey’s suggestion that commissioners consider the recommendation to scrap coverage for GLP-1 drugs for weight loss.
“I think the hardest part of the GLP-1 journey for any patient right now is the constant worry about whether they’re going to have to go back into their disease state and lose their coverage,” Donnelly-Boylen said. His husband is a board-certified obesity medicine doctor, with patients on MassHealth and coworkers on state employee insurance coverage.
“All of them right now, who have been treating their disease, are literally thinking about whether or not the state is going to make the decision to let them get sick,” Donnelly-Boylen said. “As a person not on the state insurance right now, I can tell you, I’m scared all the time. But right now, state employees and people on MassHealth are petrified.”
All carriers with the Massachusetts Health Connector decided to stop covering GLP-drugs for 2026 strictly for weight loss, and additional GLP-1 cost pressure could come from MassHealth. In her fiscal 2027 budget, Healey proposed funding MassHealth at $22.7 billion, compared to $22.1 billion in fiscal 2026. As part of cutting costs, MassHealth wants to eliminate coverage for GLP-1 weight loss drugs.
“MassHealth members are disproportionately impacted by obesity. They have the most to gain from effective treatment and the least ability to absorb costs if coverage is withdrawn,” Leddy said. “Withdrawing coverage does not create a level playing field. If anything, it widens an already devastating gap.”
In a change that began in January, GIC enrollees now must participate in a new program through Vida Health to maintain coverage for GLP-1 prescriptions. A GIC official said last November that the agency determined that using a vendor to manage GLP-1 drugs for weight loss more closely “was the most responsible next step to achieve savings and maintain GIC coverage for GLP-1s for weight loss.”
Zucchi called the new program “infuriating” because he’s been treating patients, like state employee Deb LaValle, for several years with obesity medications. LaValle hadn’t been able to get knee replacement surgery due to a high body mass index. That changed with GLP-1s, she said, which made her feel like she’s “finally progressing to a better quality of life.”
The new program is “creating more issues,” Zucchi said. “What other disease state would they require the medication to be prescribed by a provider through one organization?”
Ella Adams is a reporter for the State House News Service and State Affairs Massachusetts. Reach her at ella.adams@statehousenews.com.
