MassHealth Ends Medicaid Coverage of GLP-1 Drugs for Weight Loss

MassHealth will end coverage of GLP-1 medications when prescribed only for weight loss beginning Friday. The policy change affects an estimated 22,000 adults and 2,500 children who currently receive the drugs through the state Medicaid program. The state agency said the decision follows federal Medicaid funding reductions enacted last year.

Officials estimate the change will save approximately $15 million annually.

MassHealth will continue to cover GLP-1 drugs for diabetes treatment and for obesity when combined with moderate to severe sleep apnea, metabolic liver disease, or cardiovascular disease. Coverage for patients under 21 will be decided on a case-by-case basis when medical necessity is documented.

Patients who lose coverage can switch to lower-cost alternatives, reduce dosage frequency, or forgo treatment. Physicians stated that most individuals who stop GLP-1 therapy regain significant weight within months. Doctors reported that younger patients may face renewed depression, anxiety, and bullying linked to weight regain.

Some adult patients have discussed taking second jobs or splitting doses to continue treatment out of pocket. Medicare began a pilot program Wednesday covering certain GLP-1 medications for Part D beneficiaries, moving in the opposite direction from the state policy.