Brophy, of Topsfield, has a co-pay of only $10 a month. Without coverage, however, she was preparing to pay Zepbound’s manufacturer, Eli Lilly, $400 to $500 a month out of pocket to stay on the prescribed medicine, which helped her shed 20 pounds.
Then the Trump administration announced a deal on Thursday that will cut the direct-to-consumer price for the so-called GLP-1 drug to an average of $350 a month and could ultimately lower it to about $150.
“Believe me, I would have loved for it to just stay $10,” said Brophy, but paying $350 a month is better than $500. “That would put a strain on our finances.”
As many insurers and employers backpedal on covering weight-loss medications, Trump has offered a lifeline that could help more people get the medicines they want. But health experts warn that while some patients may like Trump’s plan to broaden access, people still need support in getting proper nutrition and exercise.
Brophy, for her part, is weighing multiple variables. Her insurer is Harvard Pilgrim Health Care, which announced in May that it will stop covering GLP-1s for weight loss next year. Though she could switch to another insurance plan offered by her employer, Mass General Brigham, it, too, intends to eliminate Zepbound from a list of covered drugs.
MGB said it will continue to cover Wegovy, a rival GLP-1 from Novo Nordisk, and three other obesity drugs. But Brophy is reluctant to switch medications because Zepbound has also relieved symptoms of longstanding irritable bowel syndrome. “For the first time in my life, my stomach doesn’t hurt every day,” she said.
Massachusetts has had broad insurance coverage for weight-loss drugs, but that is about to change in January. Many insurers and employers throughout the state plan to restrict or eliminate coverage of the medicines for weight loss next year, leaving patients to sort out whether they can get the treatments and, if so, at what cost.
Trump’s announcement this week added another wrinkle. In addition to lowering the cost of prescription GLP-1s for people who buy the drugs directly from manufacturers through a new website called TrumpRx.gov, the administration struck an agreement with Lilly and Novo that will expand the companies’ access to Medicare and Medicaid. Those are the government health insurance programs for elderly and low-income Americans, respectively.
Only a sliver of Medicare beneficiaries already have coverage for Zepbound or Wegovy; those patients have obesity in addition to an ailment, such as heart problems or sleep apnea, that the medicines have been shown to alleviate.
Massachusetts is among a minority of states where Medicaid pays for GLP-1s to treat obesity without requiring that patients also suffer from other weight-related conditions.
As of October 2024, nearly 68 percent of insured people in Massachusetts had public or private plans that covered medications to treat obesity — the highest share of any state, according to a report by the Robert Wood Johnson Foundation, a prominent philanthropy.
But the state’s two biggest insurers, Blue Cross Blue Shield of Massachusetts and Point32Health, the owner of Harvard Pilgrim and Tufts Health Plan, are ending coverage of GLP-1 drugs for weight loss next year because of spiraling costs. Smaller insurers are following suit.
This class of drugs will still be offered by both insurers for those with diabetes.
Blue Cross and Point32Health have both reported steep operating losses in recent years that have led to layoffs or employee buyouts. Both insurers attributed the situation largely to the popularity of expensive GLP-1s.
“The cost of these medications [to insurers], often ranging from $950 to $1,400 per month, has proven unsustainable and contributes significantly to rising premiums for individuals, employers, and the Commonwealth,” said Lora Pellegrini, president of the Massachusetts Association of Health Plans, which represents Point32Health and about a dozen other insurers.
Blue Cross and Point32Health are giving employers the option of retaining coverage of the drugs for weight loss by paying an extra charge in plans that the insurers administer.
Coverage decisions by large employers vary widely. Boston University and UMass Memorial Health said they will stop covering GLP-1s for weight loss next year, with the latter saying it spent $20 million on the drugs just in the past year. Meanwhile, Boston College and Beth Israel Lahey Health will continue to provide the coverage.
According to Blue Cross Blue Shield of Massachusetts, only 19.5 percent of all its accounts renewing on Jan. 1 have opted to pay more in the coming year to provide GLP-1 coverage for weight loss.
Some groups who still plan to cover GLP-1s have imposed hurdles for patients to obtain and stay on the medications. After spending $120 million on weight-loss drugs in fiscal 2025, the Group Insurance Commission, which provides health insurance to all state employees and retirees, decided it would offer the drugs a new way in 2026.
Employees on a GLP-1 for weight loss will have to get their prescriptions from a vendor, Vida Health, and undergo screening and monitoring. The program may eliminate coverage for some users if they do not enroll.
“Instead of cutting coverage, which was proposed by the governor’s veto in July, we were able to come up with this alternative approach to maintain coverage, albeit in a slightly different way,“ said Erika Scibelli, deputy executive director at the Group Insurance Commission.
With many employers opting not to cover the drugs for weight loss anymore, patients will be forced to buy the medications directly from manufacturers.
David E. Williams, president of the Boston consulting firm Health Business Group, welcomed the move by the Trump administration to lower the cost of GLP-1s.
“Employers and insurers are dropping coverage, and now there’s a lifeboat from the White House,” he said.
The announcement also has the potential to encourage more people into the direct-to-consumer path to accessing expensive drugs, said Benedic Ippolito, an economist at the conservative American Enterprise Institute. Whether that is better or worse than their existing insurance options will depend on their coverage. But even the reduced costs will be out of reach for some patients.
“It may be there is a large portion of this market that will not be tapped until these drugs are very low [cost],” Ippolito said.
However, responsible access to these drugs is paramount, said New York-based obesity-medicine specialist Dr. Rocio Salas-Whalen.
Salas-Whalen, author of the book, “Weightless: A Doctor’s Guide to GLP-1 Medications, Sustainable Weight Loss, and the Health You Deserve,” cited estimates that half of the world population will have obesity by 2030, which has implications on everything from rates of type 2 diabetes to certain cancers.
She was cautiously optimistic about Trump’s plans to broaden access, though she emphasized that patients also needed guidance to improve their nutrition and to exercise.
“Yes, bravo, more people will get access, but we need to prepare the health care [system] to manage the masses who will have access to this medication,“ she said.
Some patients on GLP-1s are still trying to sort out the situation.
Joanne Perry, who works in the health care industry, only recently started taking Zepbound to lose weight. She hoped it would also help with her severe obstructive sleep apnea, high blood pressure, and high cholesterol.
But she is unsure if her employer will keep covering the medicine next year. A human resources employee told her there were no guarantees.
The prospect of paying $500 a month instead of a $25 copay was daunting, though she figured she would find a way to pay it for a while. Trump’s deal with the drug makers might lower the out-of-pocket costs somewhat, but it still felt like a huge jump.
“Anything less than $500 would be great, but $25 a month is way better,” Perry said. “I know there are thousands of people out there who have never gotten insurance approval and have been paying out of pocket all along. So I’m fortunate. But I’m upset.”
Jonathan Saltzman can be reached at jonathan.saltzman@globe.com. Jessica Bartlett can be reached at jessica.bartlett@globe.com. Follow her @ByJessBartlett.