The steep increase was fueled by Massachusetts’ broad insurance coverage of the pricey medicines, which are straining the budgets of insurers and employers but delivering life-changing results for many patients.
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“I finally feel comfortable in my own skin, my joints don’t hurt, and exercise is much easier,” said Kip Kransdorf, 60, a Sudbury management consultant who lost almost 100 pounds in little over a year on Mounjaro, made by Eli Lilly.
His doctor prescribed the medication because Kransdorf was borderline prediabetic and obese. Kransdorf injects it into his thigh weekly. He now weighs 228 pounds, his lowest weight in about 30 years, and says Mounjaro has changed the way he thinks about eating.
“Food is no longer an obsession,” said Kransdorf, who went from a size 40 waist to a size 34 in pants. “If anything, I have to remind myself it’s 3 o’clock and I haven’t eaten.”
His insurer, Blue Cross Blue Shield of Massachusetts, covers most of the cost of the drug, although he has a co-pay of about $100 a month. The average monthly retail price of the new class of obesity medications is $1,200 without insurance, according to Amy McHugh, a spokesperson for Blue Cross Blue Shield.
About 7.5 percent of obese residents in Massachusetts are taking the new medications, according to Real Chemistry, which analyzed hundreds of millions of insurance claims nationwide. That’s the seventh-highest proportion in the country.
Although Rhode Island had the second-biggest surge in the use of the drugs, it still has one of the lowest adoption rates, with fewer than 3 percent of obese patients taking the medicines.
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In some ways, it’s counterintuitive that Massachusetts would have one of the largest increases. Massachusetts has the third-lowest obesity rate in the nation, with about 27 percent of the population considered obese, according to federal data.
Insurance coverage is a key driver of skyrocketing use, experts say. Nearly 68 percent of insured people in the state had plans that covered medications to treat obesity as of last October — the highest share of any state, according to a report by the Robert Wood Johnson Foundation, a prominent philanthropy.
The state itself may have played a role in expanding private coverage. Many private insurers in Massachusetts believe the state Division of Insurance expects them to cover the drugs for weight loss, said Lora Pellegrini, chief executive of the Massachusetts Association of Health Plans. A spokesperson for the agency, however, said the state has not issued any such directive, though it has warned insurers against making blanket exclusions for the drugs.
Massachusetts is one of at least 14 states where Medicaid pays for drugs to treat obesity without requiring that patients also suffer from other weight-related conditions. The Medicaid program in Massachusetts, MassHealth, began covering the entire cost of some obesity medicines last January.
The cost to MassHealth last year was less than $25 million after the insurer negotiated “substantial” rebates with drug manufacturers and received federal funding, according to MassHealth. At first, MassHealth designated Wegovy and Saxenda as the preferred drugs, but as of Oct. 1 the agency said Zepbound was the medicine it will cover for obesity.
To qualify for the medications, private and public insurers have generally required patients to have a body mass index of at least 30, or 27 if individuals have a weight-related medical condition. However, obesity specialists say some insurers have begun to require even higher BMIs.
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The revolutionary medications are known as GLP-1s because they mimic a hormone called glucagon-like peptide-1. That substance stimulates the secretion of insulin and regulates appetite by communicating fullness between the gut and brain.
The US Food and Drug Administration approved the first GLP-1 in 2005, for treatment of type 2 diabetes. In the past few years, the agency has approved several GLP-1s for obesity after patients lost 20 percent or more of their body weight in clinical trials.
Former Massachusetts Public Health commissioner Christine Ferguson, whose firm, Leverage Global Consulting, created the national insurance landscape report for Robert Wood Johnson, said she wasn’t surprised that public and private insurers in Massachusetts had generous coverage of GLP-1s.
“Massachusetts tends to be accepting of new technologies and approaches,” Ferguson said. “But I also know that concerns about the impact of the cost to the public sector and private sector will intensify.”
Indeed, Blue Cross Blue Shield of Massachusetts says that the cost of the medications is unsustainable for the insurance company and employers who help pay their employees’ health care expenses. Blue Cross Blue Shield, the state’s largest insurer, spent about $200 million on five GLP-1s in 2024 and expects that to soar to $300 million this year.
“We have 2,000 members who are starting these drugs every month,” said McHugh, the insurer’s spokesperson. “We’re trying to find the right balance. We know that these drugs can be life-changing. But we have employers who are saying, ‘These costs are killing us.’”
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A photograph of Kip Kransdorf, taken at his wedding seven years ago.
(Suzanne Kreiter/Globe Staff)
Kip Kransdorf, photographed at his Sudbury home. He has lost almost 100 pounds in little over a year on the drug Mounjaro. His insurer, Blue Cross Blue Shield of Massachusetts, covers most of the cost of the drug.
(Suzanne Kreiter/Globe Staff)
Point32Health, the state’s second-largest insurer, also predicts a $100 million increase in its spending on the drugs this year.
Prominent national leaders have criticized the costs of the medicines. Last May, Senator Bernie Sanders of Vermont warned that “the outrageously high prices of these drugs have the potential to bankrupt our entire health care system.”
And on Friday, in one of its last acts in office, the Biden administration said Wegovy and Ozempic would be included on the next round of drugs that Medicare will negotiate for price discounts.
A spokesperson for Novo Nordisk, the Danish pharmaceutical company that makes both Wegovy and Ozempic, on Thursday said insurers and pharmacy benefit managers are responsible for the prices consumers pay. He also said weight-loss medicines treat an expensive health problem, citing a Milken Institute estimate that obesity costs the United States more than $1.7 trillion a year.
To be sure, doctors who prescribe the drugs and many patients who take them say they are game-changers, although GLP-1s are not without drawbacks. They can have side effects, including constipation and nausea, and studies suggest patients can often regain much of their lost weight if they stop taking them.
Dr. Jody Dushay, an endocrinologist at Beth Israel Deaconess Medical Center who specializes in weight management, says the medicines are “very effective” in most patients — even more effective, for some obese people, than bariatric surgery, which shrinks the stomach to limit food intake. “I’ve had a fair number of patients who had surgery for weight loss, regained weight, and are now using GLP-1 medications,” Dushay said.
Among the Massachusetts residents delighted with the obesity drugs is Cassie Marsh, 40, who owns a consulting firm in Scituate.
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After years of restricting her food intake, riding a Peloton stationary bike daily, losing weight, and then regaining it, Marsh began taking Wegovy about a year ago. She has shed 50 pounds and now weighs about 240. And she’s lost more than weight.
“The loss of ‘food noise,’ as they call it, is wild,” she said. “After a lifetime of thinking about food all the time — what I can eat next, what I’m craving, feeling guilty about what I’ve already eaten — it’s such a relief. I honestly didn’t know that was possible: to think about food when I’m hungry, then eat something until I’m full, and move on.”
But Marsh’s experience has been tempered by a setback with her insurance coverage. At one point, she was only paying $25 a month for Wegovy. But in April, CVS Caremark, the pharmacy benefit manager that covers her prescriptions, told her it had mistakenly authorized coverage of the medication. As it turns out, her plan excludes payment for weight-loss drugs.
So Marsh is getting the active ingredient in Wegovy, semaglutide, from a compounding pharmacy that she found online. She pays $350 a month out of pocket. She said it would have cost her $1,600 a month for Wegovy without insurance.
The FDA said in December that a “compounded drug might be appropriate” under certain circumstances but consumers should be aware that “compounded drugs are not FDA approved.”
Marsh is undeterred.
“I’m not thrilled about the situation, but at this point I really like the results of Wegovy, and I’m really enjoying the results of the compounded [drug]” she said. “If my insurance started covering me tomorrow for Wegovy, I’d switch right back.”
Jonathan Saltzman can be reached at jonathan.saltzman@globe.com. Scooty Nickerson can be reached at scooty.nickerson@globe.com.