Roughly three-quarters of spending on GLP-1 drugs in Massachusetts was for weight loss in 2025, but spending in 2026 is expected to “drop significantly” due to changes in insurance coverage, according to the Health Policy Commission.
Between 2025 and the first quarter of 2026, 112,000 fewer commercially insured members used a GLP-1 drug for weight loss. That 52% decline contributed to decreased 2026 annualized spending of $662 million, the HPC said Thursday.
The shift comes after a period between 2019 and 2025 when spending on the drugs for weight loss grew at an average annual rate of 99.5%, the HPC said. The data, which will be discussed during a board meeting Thursday, is a preview of GLP-1 drug trends that will be included in the HPC Office of Pharmaceutical Policy and Analysis’s first annual report.
Gross spending on the drugs — before manufacturer rebates and discounts — reached over $2.3 billion in 2025, while net spending on GLP-1 drugs for commercially insured Bay Staters totaled nearly $1 billion, per the HPC.
There was an uproar in Massachusetts after numerous commercial and state health plans discontinued coverage of GLP-1s specifically for weight loss in 2026, including the Group Insurance Commission, MassHealth, Blue Cross Blue Shield of Massachusetts, Point32Health and Mass General Brigham Health Plan. While officials point to costs, patients and clinicians said that the health of those losing coverage was “on the line” if coverage disappeared specifically for weight loss.
GLP-1 coverage continues for people with diabetes.
Health and Human Services Secretary Kiame Mahaniah said in March that he’d “be really surprised if within two years, we don’t see a major price crash in terms of how much GLP-1s cost” and predicted that within two to three years, “we’ll be back to full coverage.”
Net prices of GLP-1 drugs have declined between 2019 and the first quarter of 2026 due to new drugs entering the market, the HPC said. By 2030, 12 new GLP-1s are expected to launch, though “blockbuster GLP-1s” are patent-protected until 2041.
How much GLP-1 use for weight loss dropped in the first quarter of 2026 depended upon the payer. Blue Cross Blue Shield of Massachusetts — which represented the largest share of the HPC sample — saw 3.7% of their members using a GLP-1 for weight loss in Q1 of 2026 compared to 6.1% in Q4 of 2025. The drop at Point32 was from 6.5% to 3.3%; at Health New England from 2.9% to 0.9%; at Cigna from 1.7% to 1.6%; and from 1% to 0.9% at UnitedHealthcare.
Copays account for the majority of patient cost-sharing for GLP-1 drugs, which totaled $45.9 million for diabetes drugs and $136.3 million for weight loss drugs in 2025, according to the data. Monthly cost-sharing for GLP-1s for diabetes averaged $66 and for weight loss averaged $78 in 2025, levels that have “generally remained stable” for several years, according to the HPC.
The HPC said GLP-1 spending in the Bay State “would decrease significantly” if plans paid Centers for Medicare and Medicaid Services negotiated prices or international reference prices. The nearly $1 million commercial market in Massachusetts would be $680 million, or 32%, lower if Ozempic, Wegovy, Moungjaro and Zepbound were repriced among the commercially insured at CMS negotiated prices; $438 million, or 56%, lower if repriced at the second lowest international reference prices; and $386 million, or 61%, lower if repriced at the lowest international reference prices.
Ella Adams is a reporter for the State House News Service and State Affairs Massachusetts. Reach her at ella.adams@statehousenews.com.Â
