The popularity of glucagon-like peptide-1s, commonly known as GLP-1s, has soared over the last decade. They treat conditions like diabetes and cardiovascular disease -- and more recently their ability to spur weight loss has hugely increased their ubiquity. The Ozempic brand alone rose from fewer than 150,000 Medicare Part D users in 2019 to almost 2 million in 2024, per a study by independent research group KFF.
While GLP-1s are helping people in Massachusetts shed pounds, Democratic state Sen. Paul Mark of the Berkshire, Hamden, Franklin, and Hampshire District says their impact on state and municipal budgets is adding a significant load.
“They're expensive, and they're a resource that a lot of people have discovered over the last year or two,” he told WAMC.
Massachusetts has made up its mind about GLP-1s. As of July 1 – the first day of the 2027 fiscal year – the commonwealth no longer covers GLP-1s for state employees. It’s more complicated at the town and city levels.
“Those are the tough choices that are being made, is, do we offer this new service that people are taking advantage of, or do we shift more of that cost onto the people that want to use it?” explained Mark.
Insurance trusts that cover the commonwealth’s municipalities are trying to make those choices in the face of major cost increases.
“They had been able to keep their health insurance rates at like a 5% increase for the past six, seven years, and all of a sudden they're even faced with a situation where they have to go up like 20%," said the state senator. "And that is the number one driver of it, is the weight loss drugs.”
In Pittsfield, the largest municipality in largely rural Berkshire County, health insurance is the hardest cost to estimate when assembling annual budgets.
“You're waiting for the agencies to set their rates, and so you can't really plan on that," said Mayor Peter Marchetti. "Where, if we're talking retirement costs, we have the retirement schedule, so you know what that schedule is for the next 10 years, as you can begin that process. Even with salaries, you've got your three-year union contract, so you know what to plan.”
Marchetti says the city has seen health insurance costs rise by over 30% from fiscal year 2020 to fiscal year 2026, with spikes as high as over 10% in recent budget cycles. He says there’s no competition -- it’s the fastest rising line item on Pittsfield’s budget, even if Berkshire County’s largest community isn’t as hard-struck as other Massachusetts municipalities.
“Luckily for Pittsfield, we're still at the lower end of that range, but there are other communities seeing far more increases than we are,” said the mayor.
Pittsfield’s insurance comes from the Massachusetts Interlocal Insurance Association’s Health Benefits Trust, a wing of the Massachusetts Municipal Association. Like other mayors of cities with a membership in the MMA, Marchetti learns the coming year’s rates at the association’s annual meeting. Before April, the city was bracing for a worst-case scenario.
“We had heard rumblings that the increase could be as high as 25% for fiscal year ’27," he told WAMC. "We learned when we were there that the tradeoff was the GLP-1 medicines are not included any longer in the health insurance plans for payment, which brought the average costs down tremendously.”
The final increase from FY26 to FY27 was ultimately around 7% -- a difference of millions of dollars for Pittsfield taxpayers.
Marchetti says the question of who should pay for GLP-1s is a complicated one.
“I take one for my diabetes," he said. "It's a necessary piece. But if you're taking it for weight loss, and it's not really an integral part of your health overall healthcare, you're doing it because you want to lose weight- I think there's that piece there, and that that particular drug is expensive.”
That said, he acknowledges the reality goes beyond a binary.
“Obesity leads to other health issues like diabetes and others," said Marchetti. "And so, are we looking to be a preventive medicine or a reactive medicine? So, I think there needs to be some more conversations and some more data provided to show those pieces.”
This month, the federal government rolled out its Medicare GLP-1 Bridge program, which makes some weight loss drugs available to eligible users under Medicare Part D drug coverage for $50 a month.
Marchetti believes Massachusetts still has major questions ahead when it comes to how to better address the issue on the state and municipal levels.
“Is there overarching legislation that the state can dictate who, what, when, where, and why?" the mayor told WAMC. "If that's the case, if the municipalities rule that everybody can have it, can then we handle the increases? And is there state aid to back up that increase?”
