“It was definitely not a willpower thing,” he said. “It was chemical. [Zepbound] gave my body the biological help it needed to overcome the weight gain.”
Like Tierno, more than 40,000 customers of the state’s two biggest insurers, Blue Cross and Point32Health, have lost coverage of GLP-1s for obesity this year, according to the latest data provided by the companies. An unspecified number of customers of smaller insurers have also lost the benefit, according to the Massachusetts Association of Health Plans.
Their ranks will rise given a vote Thursday to end coverage of GLP-1s for weight loss by the Group Insurance Commission, which provides insurance to over 460,000 state employees, retirees, and relatives. MassHealth, the state’s Medicaid program, could also make a similar move in upcoming months. Overall, about 140,400 patients with obesity were prescribed the medications in 2024 in Massachusetts, the Globe has reported. That class of medicines includes Zepbound, Wegovy, Ozempic, and Mounjaro.
With the end of insurance coverage, people who have spent decades trying to lose weight, including by undergoing surgery to shrink their stomachs, are scrounging for ways to afford to pay out-of-pocket for GLP-1s, or exercising and counting calories in the hopes of keeping the weight off without the drugs.
“I don’t take this medicine for the fun of it. I take it because I need it,” said Michelle Markert, a 55-year-old interior designer in Newton who lost at least 35 pounds on GLP-1s before insurers ended the benefit.
Markert said she used to pay $80 for her monthly prescription under her plan with Harvard Pilgrim Health Care, which is owned by Point32Health. Now Markert, who switched to Blue Cross this year, will pay $500 a month out of pocket, the equivalent of a car payment.
“That $420 is going to have to come from somewhere else,” she said. “I’ll think twice about going out to eat or even going out to the movies.”
Blue Cross, the state’s largest insurer, said it has notified 25,670 members so far that they no longer qualify for GLP-1s for obesity. The second-largest insurer, Point32Health, has notified more than 15,000 of its members that they have lost eligibility. Both still cover GLP-1 drugs for diabetes.
Tierno, who has struggled with his weight since childhood, said the trend doesn’t make sense given the costly long-term consequences of obesity. When he began taking Zepbound, he had high blood pressure and blood sugar levels classified as prediabetic. Now he doesn’t.
“For me, this has literally been a miracle drug,” he said. “It was not just about weight loss for vanity. It truly was a health issue.”
Doctors who treat people with obesity agree.
Dr. Paul Copeland, an endocrinologist and obesity medicine specialist at the Massachusetts General Hospital Weight Center, said GLP-1s have given many of his patients their first opportunity to improve their health and quality of life. Now, he spends much of his time trying to cobble together weight loss regimens with far less effective drugs.
Some of his patients who lost coverage have started to regain weight, he said. He worries they will suffer serious health consequences. A recent study projected that people who stop taking GLP-1s would regain their lost weight within about 18 months.
“There are substantial dangers in having these medications pulled away from patients,” said Copeland. “Not only is there a rapid weight gain for most patients, but there is documented re-worsening of comorbidities such as cardiovascular risk factors.”
The new insurance restrictions have fueled the use of direct-to-consumer programs such as NovoCare and LillyDirect, where prices range from $149 to $449 a month, depending on the drug and dosage. (Prices are similar on the new government website, TrumpRx.gov.)
Unfortunately, Copeland said, such programs are leading to a two-tier system that disadvantages those who can’t afford those prices.
Insurers, for their part, blame the situation on the two pharmaceutical giants that dominate the GLP-1 market: Eli Lilly and Novo Nordisk.
Those companies, insurers say, have charged exorbitant amounts for the weight loss medicines, and the costs to insurers were unsustainable. Zepbound and Lilly’s rival drug Wegovy have list prices ranging from about $900 to more than $1,300 a month.
Blue Cross said it spent $515 million on GLP-1s in 2025, up from $140 million in 2023. The cost of the drugs was projected to reach nearly $1 billion this year if the insurer hadn’t restricted coverage. Point32Health has experienced a similar trend.
Facing steep losses from GLP-1 costs, both insurers shed hundreds of employees from their workforces last year.
When Blue Cross and Point32Health stopped coverage of GLP-1s for weight loss, they said employers with 100 workers or more could keep coverage by paying extra. But, only 20 percent of employers chose to maintain coverage, which was “telling,” said Blue Cross spokesperson Amy McHugh.
“Lowering the cost of GLP-1 medications to a reasonable level based on the overall health improvements and cost savings they bring is the single most important step toward removing the primary barrier to coverage,” she said.
Novo acknowledged insurers’ criticism last week when it announced plans to cut the list price for GLP-1s by up to half in 2027.
“Private and public payers, as well as patients, want access and have been calling for lower list prices,” Jamey Millar, Novo’s executive vice president for US operations, said. “Our actions today answer that call.”
But Novo executives also faced competitive pressures. Novo initially dominated the GLP-1 market, but Lilly has overtaken it with more effective drugs.
Lilly has given no indication it will lower list prices. A company spokesperson said Lilly is disappointed insurers are denying coverage of medications for the “serious, chronic disease” of obesity. Even without insurance, the spokesperson said, customers can get Zepbound from LillyDirect starting at $299 a month for the lowest dosage.
Like Tierno, several Massachusetts residents on GLP-1s say they can’t afford that.
Robert Atterbury, an audiology office coordinator who lives in Dorchester, said he has lost 20 pounds on GLP-1s and now weighs about 250 pounds. Zepbound had cost him about $30 a month with his Harvard Pilgrim insurance. Paying hundreds of dollars per month isn’t in his budget.
His weight is “inching back up,” he said, and he’s worried about heart disease and diabetes, as he has high blood pressure.
“The drug company and the health insurer made the decision for me,” said Atterbury, 60. “I had nothing to do with it except not making enough to be able to afford to pay for it out of pocket.”
Susan Elsbree, a 55-year-old public relations executive in Jamaica Plain, also lost her insurance coverage of Zepbound.
She said she was furious because she has lost 35 pounds, lowered her blood pressure, and no longer needs cortisone shots for her arthritic knees. She had struggled to shed weight for years, exercising at least five days a week — doing hot yoga and playing tennis — but nothing worked like the GLP-1.
She can afford to pay $199 a month to continue to get Zepbound through Mochi Health, a telehealth platform.
She lamented, though, that the health gap is widening between the haves and have-nots. “I’m furious with the insurance companies,” she said. “This is about equity as much as anything else.”
Jonathan Saltzman can be reached at jonathan.saltzman@globe.com.
