The Fight Over GLP-1 Coverage Is Happening Right Now

Massachusetts is currently considering changes that could eliminate Medicaid coverage for obesity management medications.

I wrote about this this week in a letter published in The Boston Globe because I do not think enough people understand what is beginning to happen around the country. For years, the conversation around GLP-1 medications focused mostly on whether they worked. Increasingly, the conversation is becoming about access, affordability, and who gets to continue treatment long term.

Read My Letter

For many people living with obesity, these medications are not cosmetic or optional. They are the first treatments that have meaningfully addressed the biology of a chronic disease that affects nearly every aspect of a person’s health and quality of life. I know that personally. I lost 128 pounds after starting a GLP-1 medication following a type 2 diabetes diagnosis at age 50. My diabetes is now in remission. My health changed dramatically because I finally had access to treatment that worked with my body instead of constantly against it.

One of the things I have learned through advocacy work is how fragile that access can be. Many people still assume that once treatments exist, coverage naturally follows. It does not. Coverage decisions are constantly being renegotiated in state budgets, insurance plans, employer coverage, and Medicaid programs. Increasingly, those decisions are shaping who gets access to modern obesity treatment and who does not.

And the people most vulnerable to losing access are often the people least able to absorb the consequences financially.

MA Resident? Take Action Here.

That is part of what makes this Massachusetts proposal so troubling to me. We often talk about the cost of obesity medications in isolation, but we rarely talk honestly about the long-term cost of untreated obesity. Delayed care does not eliminate disease. It often leads to more hospitalizations, more disability, more cardiovascular disease, worsening diabetes, and higher long-term healthcare costs. The costs do not disappear. They simply show up somewhere else later.

There is also a larger question underneath all of this. As a society, we celebrated the arrival of these medications as breakthroughs. We highlighted the innovation, the science, and the potential to improve millions of lives. But now we are entering the harder phase of the conversation, where access itself is being debated and where affordability may increasingly determine who gets the opportunity to benefit from these treatments long term.

I worry we are slowly moving toward a system where effective obesity treatment remains stable for people with financial resources while becoming increasingly fragile for lower-income patients whose health outcomes are often already worse.

This is not just a Massachusetts issue. Similar conversations are happening across the country right now. Patients, providers, and advocates need to pay attention to what is happening in their own states and insurance systems because these decisions are shaping the future of obesity care in real time.

I am glad The Boston Globe gave space to this issue. But one letter is not enough. Once coverage disappears, getting it back becomes much harder. And I do not think enough people realize how close some of these decisions already are.