MassHealth will stop covering weight-loss drugs next week

Effective 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 medications when they are prescribed for other approved medical conditions, such as type 2 diabetes.

Affected medications include Wegovy, Zepbound, Saxenda, Xenical, and phentermine-based medications. According to To Mass Health.

Paying for medications out of pocket will likely be a challenge for MassHealth members, who qualify for coverage because of a disability or low-income status. Wegovy carries a list price of over $1,300 per month, while Zepbound retails for around $1,000. Manufacturer self-pay programs can reduce these costs to approximately $350 to $500 per month, depending on the drug and program.

In unveiling his 2027 budget proposal, Healey acknowledged the difficult decisions facing the state as health care costs continue to rise.

“Faced with a host of bad decisions, we tried to make the best decisions that take care of the people who need care most,” Healey said in January.

Healey pointed to expected federal cuts to Medicaid as an additional budget challenge.

“This is a difficult situation when you take a trillion dollars out of health care nationally,” Haley said of President Donald Trump’s “Big, Beautiful Bill.” “It’s a huge, huge blow to all of us.”

Centers for Disease Control and Prevention (CDC) He specifies Obesity is when the body mass index (BMI) is 30 or higher. In the United States, about 40% of adults are obese, and one in 10 of those individuals is considered obese, which is defined as a body mass index of 40 or higher, according to the agency. About 21 percent of children and teens are obese.

The CDC considers obesity a chronic disease that increases the risk of heart disease, type 2 diabetes, stroke, some cancers, liver disease and other serious health conditions.

Obesity experts say newer GLP-1 drugs like Wegovy and Zepbound help prevent obesity-related diseases. In 2024, the US Food and Drug Administration (FDA) Expanded Wegovy’s approved uses include reducing the risk of death from cardiovascular disease, heart attack, and stroke in adults who are obese, overweight, or have cardiovascular disease.

According to According to the Centers for Disease Control and Prevention, obesity costs the U.S. health care system approximately $173 billion annually. Heart attacks and strokes cost $223.2 billion annually, while diabetes costs $640 billion.

Massachusetts was one of 14 states whose Medicaid programs covered anti-obesity drugs without patients having to have another qualifying medical condition. MassHealth began covering certain obesity medications in January 2024.

The elimination of coverage for anti-obesity drugs follows a broader trend among the nation’s largest providers and insurers, including the Group Insurance Commission (GIC) and Blue Cross Blue Shield of Massachusetts, where officials point to unsustainably high prescription costs.

Dr. Carolyn Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital, He told WBUR Insurance companies practice “blatant bias and stigma against people who are obese.”

“If we pay up front for these life-saving medications, we will be cutting back on health care dollars — billions of dollars we spend on heart disease, diabetes, sleep apnea and liver disease,” she said.