GLP-1 medications for weight loss have become some of the most widely discussed drugs of the past decade. Evidence continues to grow around their long-term health benefits—including improved cardiovascular outcomes, protection for the liver and kidneys, and reduced severity of sleep apnea. Emerging research also points to the possibility of lowering risks for neurocognitive diseases, offering another promising tool in the fight against conditions such as Alzheimer’s.
While few dispute their potential long-term value, the immediate cost of GLP-1s has become a lightning rod in public discourse. The tension between ensuring access and containing costs has led to significant policy activity over the past year. GLP-1 MEDICATIONS Access, Affordability, and What Comes Next
Federal Developments
At the federal level, the White House announced an agreement in November with Eli Lilly and Novo Nordisk to reduce prices and expand Medicare and Medicaid coverage, including lower prices through direct-to-consumer programs. Medicare beneficiaries will now be eligible for obesity treatment coverage if they meet certain conditions—such as having a BMI over 27 combined with prediabetes or cardiovascular disease. While details are still being finalized, this represents an important step toward ensuring access, though it does not provide immediate relief for commercial plans.
In addition, the second cycle of IRA drug-pricing negotiations resulted in agreements for a 71% discount for three well-known GPI-1s, Wegovy, Ozempic and Rybelsus that will take effect on January 1, 2027.
Activity Here in Mass
Here in Massachusetts, carriers are facing similar pressures. Blue Cross Blue Shield of Massachusetts and Point32Health are discontinuing coverage of GLP-1 medications for weight loss, and CVS Caremark has restricted its formulary to Wegovy, removing Zepbound. These changes have prompted several public plan sponsors to scale back coverage as well, while others are actively evaluating options for the upcoming plan year.
In October, the 17-member Group Insurance Commission (GIC) voted on a proposal aimed at balancing rising costs with the need to maintain access to GLP-1’s. The GIC selected Vida Health as its Center of Excellence for weight-loss management beginning January 1, 2026. Delivered through a partnership with CVS, the program will support members throughout their weight-loss journey with a multidisciplinary team that includes physicians, endocrinologists, dietitians, mental-health therapists, and care navigators. Participants will also receive resources such as scales, food and activity trackers, and personalized exercise plans. The program emphasizes evidence-based, inclusive obesity care, with culturally sensitive plans and a diverse care team.
Vida Health will serve as the sole prescriber of GLP-1s for obesity treatment. To receive coverage for weight-loss GLP-1s, members will be required to engage with the program and obtain prescriptions through a Vida medical provider.
The projected impact is significant, with the program expecting to generate approximately $30 million in annual net savings on GLP-1 medications and including performance guarantees tied to treatment outcomes. Members will continue to have access to GLP-1s when clinically appropriate and will benefit from coordinated, multidisciplinary support—whether their treatment involves GLP-1s or other weight-management strategies.
Taken together, these actions reflect a critical turning point in how the healthcare system manages high-impact, high-cost medications. Continued coordination and thoughtful policy design will be essential to ensuring that members can benefit from innovations like GLP-1s without compromising the long-term sustainability of our plans.
Those currently prescribed a GLP-1 will be contacted by the GIC/Vida by 1/1/26.