For people who rely on Medicaid, including Martinez, the last option is not possible. Though costs have come down since GLP-1s like Ozempic and Wegovy became available for weight loss, they still typically cost hundreds a month, said Dr. Florencia Halperin, an endocrinologist and chief medical officer at the Boston weight loss clinic Form Health and spokesperson for The Obesity Society, a national professional organization focused on weight loss. <\/p>\n
Martinez is considering alternative drugs, but those have side effects, including high blood pressure, a condition GLP-1s helped alleviate. <\/p>\n
The FDA approved Wegovy, the first GLP-1 exclusively for weight loss, in 202<\/a>1<\/a>, and in the past five years, prescriptions for this class of drugs have more than quadrupled<\/a>. The results are dramatic. Halperin said patients commonly lose 15 to 20 percent of their weight, equivalent to the results of bariatric surgery. But the drugs\u2019 high cost has prompted several commercial insurance companies<\/a> to drop coverage. Until Friday, MassHealth was among just 13 states\u2019 Medicaid programs<\/a> to cover GLP-1s, according to the health news site KFF. <\/p>\n Doctors consider being overweight or obese a serious medical condition associated with an array of life-threatening problems, including 13 types of cancer, heart disease, diabetes, and liver disease. Weight loss from GLP-1s can also reduce or eliminate arthritis, joint pain, or hypertension. <\/p>\n The loss of Medicaid coverage risks making these highly effective drugs available only to society\u2019s well-heeled, physicians said. <\/p>\n In fact, as MassHealth ends coverage for GLP-1s to treat weight loss, Medicare is going in the opposite direction. The federal health insurance program for seniors began a pilot program<\/a> Wednesday covering some GLP-1s for Medicare Part D beneficiaries.<\/p>\n MassHealth officials say they have few options after last year\u2019s federal Medicaid reforms that will reduce enrollment and cost the state funds.<\/p>\n \u201cWe are beginning to see the real-life impact of those cuts at the state level,\u201d said Stacey Nee, a MassHealth spokesperson. \u201cOur proposed change to GLP-1 coverage for weight loss is a targeted approach to control costs, bring us in line with other states, and protect access to care as much as possible.\u201d<\/p>\n Cutting coverage of GLP-1s for weight loss is expected to save about $15 million, Nee said. MassHealth will continue covering the drugs if they\u2019re prescribed to treat diabetes, their original use, or other medical conditions, or if they are being used to treat obesity in combination with moderate to severe sleep apnea, metabolic liver disease, or cardiovascular disease to reduce the risk of a heart attack or stroke. <\/p>\n Martinez, who is five feet seven, used to struggle to keep her weight below 200 pounds. <\/p>\n \u201cIt was really frustrating doing everything right since I can remember: watching my calorie intake, being active, exercising, and no matter what I did, nothing worked,\u201d she said. <\/p>\n After the birth of her son Kevin in April 2023, she reached 230 pounds. It was the persistently high blood pressure, though, that prompted Dr. Richard Siegel, a Tufts endocrinologist, to prescribe Wegovy in 2024 and then switch to Zepbound. <\/p>\n Now, she weighs around 150 pounds. <\/p>\n \u201cIt was the greatest thing that happened to me, being introduced to this medicine,\u201d she said. <\/p>\n Her blood pressure returned to normal and stayed there, despite the stress of raising two children, working for a caterer, and caring for her father, who lives with her, as he is treated for two different types of cancer.<\/p>\n \u201cI feel like I\u2019m healthy,\u201d she said. \u201cI feel like I have more energy.\u201d <\/p>\n Siegel, co-director of Tufts Medical Center\u2019s Diabetes and Lipid Center, said he has discussed less expensive alternatives to GLP-1s with Medicaid-enrolled patients for weeks. Some, he said, have talked about getting second jobs just to afford the medication. Others may pay out of pocket but take smaller doses, or take injections less often. The result will be less effective than the proper prescribed dosage. <\/p>\n This week, he said, his office\u2019s pharmacy team is scrambling to negotiate authorizations with both MassHealth and Medicare as they reverse policies on GLP-1s. The patients with co-morbidities who still qualify for GLP-1s under MassHealth tend to be older, leaving many younger patients without coverage, he said. <\/p>\n \u201cPatients have felt like the floor is taken out from under them,\u201d he said.<\/p>\n That includes roughly 2,500 Massachusetts children on GLP-1s solely for weight loss, who pediatricians said stand to re-experience the depression, anxiety, and bullying that can accompany being an overweight young person. They also risk developing serious, lifelong health conditions related to obesity, said Dr. Jason Zhang, a gastroenterologist with Boston Children\u2019s Hospital. <\/p>\n \u201cWe expect that any gains that they had in disease resolution, all that will go away too,\u201d he said. <\/p>\n For patients under 21, MassHealth will still cover GLP-1s if there\u2019s medical necessity, but that qualification concerns pediatricians. <\/p>\n \u201cI am not sure how rigorous they\u2019re going to be in terms of needed justification,\u201d said Dr. Benjamin Weintraub, a Watertown pediatrician who said roughly 15 to 20 percent of his patients rely on Medicaid. <\/p>\n MassHealth would consider medical necessity on a case-by-case basis, a spokesperson said.<\/p>\n Eric-Paul Olsson, a psychiatric nurse practitioner who works with patients in Newton, Northampton, and Marshfield, said GLP-1s have been a critical resource for patients dealing with the weight gain that antipsychotic medications can cause. <\/p>\n \u201cThey\u2019re fearful there\u2019s going to be a resurgence of weight gain,\u201d he said. \u201cSome people just started feeling like they got control of their lives.\u201d<\/p>\n Despite her busy schedule as a parent, daughter, and worker, Martinez works out at the gym at 6 a.m. every day. <\/p>\n She is hopeful that staying active, eating well, and possibly taking a cheaper medication will help her keep the weight loss she was so stunned to achieve. <\/p>\n \u201cThe anxiety is there,\u201d she said. \u201cI\u2019m just trying to be optimistic.\u201d<\/p>\n Jason Laughlin can be reached at jason.laughlin@globe.com<\/a>. Follow him @jasmlaughlin<\/a>.<\/p>\n![\"Carolina](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/07\/BKAAKHZK76UIZEUP2W2TOWFYEM.JPEG\")
Carolina Martinez, 33, of Chelsea, lost 80 lbs with a GLP-1 prescription after the birth of her son. She is a MassHealth member, and her prescription will no longer be covered as of Friday.Submitted Photo<\/p>\n