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The change will leave an estimated 22,000 MassHealth members on the hook to pay out of pocket for the pricy GLP-1s and other anti-obesity drugs.
Beginning July 1, MassHealth will stop covering GLP-1 and other anti-obesity medications prescribed solely for weight loss, a policy change expected to affect at least 22,000 Massachusetts residents.
The move, announced as part of Gov. Maura Healey’s fiscal 2027 budget proposal in January, is expected to save an estimated $15 million annually. MassHealth will continue to cover the medications when they’re prescribed for other approved medical conditions, like Type 2 diabetes.
The affected medications include Wegovy, Zepbound, Saxenda, Xenical, and phentermine-based drugs, according to MassHealth.
Paying out of pocket for the drugs will likely be a challenge for MassHealth members, who qualify for the coverage due to disability or low-income status. Wegovy carries a list price of more than $1,300 per month, while Zepbound retails at around $1,000. Manufacturer self-pay programs can lower those costs to roughly $350 to $500 per month, depending on the medication and program.
When unveiling the 2027 budget proposal, Healey acknowledged the difficult decisions facing the state as healthcare costs continue to rise.
“Faced with an array of bad decisions, we tried to make the very best decisions that took care of the people that needed most to be taken care of,” Healey said in January.
Healey pointed to anticipated federal Medicaid cuts as an additional budget challenge.
“This is a tough situation when you take a trillion dollars out of healthcare nationally,” Healey said of President Donald Trump’s “One Big Beautiful Bill” Act. “That’s a huge, huge hit for all of us.”
The Centers for Disease Control and Prevention (CDC) defines obesity as having a body mass index (BMI) of 30 or higher. In the U.S., about 40 percent of adults have obesity, with nearly one in 10 of those individuals considered severely obese, which is defined as a BMI of 40 or higher, according to the agency. About 21 percent of children and teens have obesity.
The CDC considers obesity a chronic disease that increases the risk of heart disease, Type 2 diabetes, stroke, certain cancers, liver disease, and other serious health conditions.
Obesity experts say newer GLP-1 medications such as Wegovy and Zepbound help prevent diseases tied to obesity. In 2024, the U.S. Food and Drug Administration (FDA) expanded Wegovy’s approved uses to include reducing the risk of cardiovascular death, heart attack, and stroke in adults who are obese, overweight, or have established cardiovascular disease.
According to the CDC, obesity costs the U.S. healthcare system nearly $173 billion a year. Heart attacks and strokes cost $223.2 billion per year, while diabetes costs $640 billion.
Massachusetts was one of 14 states whose Medicaid programs covered anti-obesity medications without requiring patients to have another qualifying medical condition. MassHealth began covering certain obesity medications in January 2024.
The elimination of coverage for anti-obesity medication follows a broader trend among major state providers and insurers, including the Group Insurance Commission (GIC) and Blue Cross Blue Shield of Massachusetts, with officials citing unsustainably high prescription costs.
Dr. Caroline Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital, told WBUR the insurance companies are practicing “blatant bias and stigma against people with obesity.”
“If we pay upfront for these life-saving medications, down the line we will reduce healthcare dollars—the billions of dollars we spend on heart disease and diabetes and sleep apnea and liver disease,” she said.
Morgan Rousseau is a freelance writer for Boston.com, where she reports on a variety of local and regional news.
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