![\"CEO](\"https:\/\/www.newsbeep.com\/us\/wp-content\/uploads\/2026\/07\/VEBGAAMI4MYVGEZ4C22B2F2UD4.jpg\")
CEO Patrick Gilligan worked at his office at Point32Health in Canton.David L. Ryan\/Globe Staff<\/p>\nIn an interview, Gilligan reflected on his first year and what he expects for the rest of 2026. This interview was edited and condensed for clarity and brevity. <\/p>\n
CEO Patrick Gilligan worked at his office at Point32Health in Canton.David L. Ryan\/Globe Staff<\/p>\n
Question: What do you think is at the core of this particularly challenging time for the entire health care system? <\/p>\n
Answer: I know it\u2019s been five years since the pandemic, but I think it took a while for the missed care that happened during that time period to come back. There was a lot of pent-up demand, and I think health plans started to see it in 2023. <\/p>\n
While all that was going on, pharmaceutical costs were increasing both the utilization and the price in significant ways. There are new indications coming out every day for many specialty and branded drugs. <\/p>\n
We now have the blessing of gene and cell therapies, which are great in terms of their effectiveness, but they are super, super expensive. Health plans and others will need to make choices not only around their efficacy, but around whether they\u2019re affordable to provide to our members.<\/p>\n
Q: Last year, GLP-1s were the poster child of these drugs that have gotten exorbitantly expensive. Point32Health, along with a number of other insurers, have limited coverage of GLP-1s largely to people with diabetes, and it seems there has been at least some financial recovery. Walk me through that decision. <\/p>\n
A: We have to price our products well in advance of the start of the year. Then if there are big differences in the costs that come through, that\u2019s where you start to see the bottom line of health plans really suffering. <\/p>\n
We didn\u2019t project well how many prescribers would put their patients on GLP-1s for weight loss, and the uptick was much bigger than we thought. <\/p>\n
It\u2019s always hard to take a benefit away from someone. We recognize that. <\/p>\n
In hindsight, we just realized that this was becoming a true affordability issue for individuals who buy from us directly, from employers who buy from us for their employees and their families. It was not sustainable.<\/p>\n
Q: How have members reacted? <\/p>\n
A: Obviously, many of our members who are on those medications and were successful with them were very, very disappointed.<\/p>\n
Employers at first questioned whether it was the right decision. I think it\u2019s hard for all of us. <\/p>\n
But I also think that in the wake of blockbuster drugs, we\u2019re going to continue to have this conversation around when and where it\u2019s prudent to cover these medications. <\/p>\n
We have a lot more to learn around this, and this story is not over, meaning we and our competitors will be revisiting it over time. <\/p>\n
Q: Point32Health\u2019s first-quarter results were promising, but the Point32Health chief financial officer said that won\u2019t necessarily translate to a year in the black or cost savings for members. What do you think the rest of the year will look like? <\/p>\n
A: We know pretty directly the actions that we took to drive these results. The GLP-1s were a big part of it. <\/p>\n
We\u2019re looking at our own administrative costs and making sure that we\u2019re as efficient as we can possibly be. <\/p>\n
We have also enhanced what we call our total cost of care programs \u2014 and yes, that does mean utilization management and care management, and sometimes prior authorizations or other ways to make sure that care is necessary and efficacious care.<\/p>\n
By ramping that up, we were able to kind of manage our costs a little bit better than what we had in the past. <\/p>\n
While our CFO is right that we don\u2019t anticipate by the end of the year that we\u2019ll have an operating gain, we do see this as an important bridge year to get us to a position going forward where we can be modestly profitable. <\/p>\n
Q: How does the end of certain subsidies that were available on the Massachusetts Health Connector affect Point32Health? <\/p>\n
A: What it means for us, and unfortunately for the whole market, is fewer members. <\/p>\n
We had almost universal coverage in this state, and we\u2019re seeing that whittle away because of some of these policy changes. So we lost a significant number of members, as did our competitors.<\/p>\n
Q: This year has been hard for Point32Health, with pretty significant layoffs. Are those layoffs over? How do you anticipate the company will move forward?<\/p>\n
A: I\u2019m not going to say whether it\u2019s over or not. <\/p>\n
I think we\u2019ve made huge strides in getting more competitive, but I feel like in today\u2019s world, it\u2019s a very competitive environment, and everyone\u2019s got to get a little bit more efficient all the time. <\/p>\n
Part of our job is to contract with providers, and we\u2019re asking them to get more efficient \u2014 doctors and hospitals who are doing the important work of caring for patients. We\u2019re not going to ask them to do that and not be doing it ourselves. <\/p>\n