As a physician assistant specializing in obesity medicine, the recent decision by Blue Cross Blue Shield of Massachusetts to discontinue coverage for anti-obesity medications has raised significant concerns. Effective January 1, 2026, this change will impact residents who depend on essential medications like Wegovy, Saxenda, and Zepbound—medications that have drastically improved the quality of life for many individuals battling obesity.
This decision threatens to undermine the progress made by tens of thousands of Massachusetts residents who rely on these medications to manage obesity, a chronic and complex condition. As someone who provides care in New Hampshire but treats many Massachusetts patients, I’ve found myself in challenging discussions with those who have experienced remarkable health transformations through anti-obesity drugs. Now, they are faced with uncertainty and the potential reversal of their hard-earned achievements.
Obesity is often misunderstood and unfairly stigmatized as simply a lack of willpower. However, medical evidence reveals that it is a condition influenced by many factors, including genetics, environment, and psychological well-being. Treatment for obesity, much like treatment for hypertension and diabetes, often necessitates the use of medications alongside lifestyle changes. These medications serve as vital components in achieving and maintaining weight loss.
Take, for instance, a software engineer from Cambridge whom I have been treating. This individual struggled for years with obesity, pre-diabetes, and various joint issues. After receiving comprehensive treatment that included an anti-obesity medication, he successfully lost over 80 pounds, normalized his blood sugar, and regained energy. The thought of losing access to this medication poses a significant risk, not only to his physical well-being but also to his mental health. His story is just one of many that illustrate the critical role these medications play in the lives of people living with obesity.
The impact of discontinuing coverage is not merely a numerical statistic; it will have real-world repercussions. The SURMOUNT-4 trial, which studied the medication tirzepatide (Zepbound), highlights this concern. Participants saw an average weight loss of nearly 21% after 36 weeks. However, those who were switched to a placebo regained over half of that weight within one year. Conversely, those who continued their medication maintained substantial weight loss, averaging 25% by week 88.
The consequences of forced discontinuation extend far beyond the scale. Patients may face a return of serious health issues like diabetes, sleep apnea, hypertension, and cardiovascular risks. Beyond the immediate health risks, there is a looming financial and emotional burden on individuals who may lose their progress and return to where they began—if not worse.
While Blue Cross acknowledges that these medications hold “great promise,” they cite rising costs as their primary reason for eliminating coverage. They project nearly $1 billion in spending by 2026. However, this short-term focus on cost savings may prove shortsighted. The reality is that the long-term costs associated with untreated obesity—such as diabetes complications, heart disease, and lost productivity—will likely far exceed the savings gained by discontinuing such crucial coverage.
Research supports the argument that while anti-obesity medications initially raise employer healthcare costs, they can significantly reduce major health events and cut the growth rate of medical expenses in half within two years. By prioritizing immediate savings over preventive healthcare, we risk incurring far steeper costs down the line.
Additionally, as legitimate access to FDA-approved treatments is restricted, some patients may resort to unregulated or unsafe alternatives in their desperation for solutions. This potential outcome is not just concerning; it is unacceptable from a healthcare perspective.
Blue Cross may offer alternative coverage options like lifestyle programs, but these are often insufficient by themselves for maintaining the clinically significant weight loss that many need, especially those already benefiting from medication.
While the insurer’s plan appears fiscally responsible, it has significant implications for patient health and could inadvertently lead to higher costs overall. As healthcare providers, it is incumbent upon us to advocate for policies that recognize obesity as a chronic disease that requires a multifaceted approach, including access to effective medications.
I call upon the leadership at Blue Cross Blue Shield of Massachusetts to reconsider this policy before the 2026 implementation. We must prioritize long-term health and invest in proven obesity treatments that provide real value to both our healthcare system and the people of Massachusetts.
It is crucial to understand that obesity is not a personal choice; providing access to effective, FDA-approved treatment should be. We owe it to our patients and communities to make informed decisions based on comprehensive medical knowledge and the shared goal of improving public health.
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