(Image via Pixabay by Clker-Free-Vector-Images)

AS A PHYSICIAN ASSISTANT specializing in obesity medicine, the recent announcement by Blue Cross Blue Shield of Massachusetts that it plans to discontinue coverage for anti-obesity medications hit close to home.  

Effective January 1, 2026, the state’s largest commercial insurer intends to stop covering vital medications like Wegovy, Saxenda, and Zepbound for obesity, impacting potentially tens of thousands of Massachusetts residents. This decision, though offering a rider option for large employers to provide coverage, is concerning and shortsighted for many. 

My practice, based just over the border in New Hampshire, serves many Massachusetts patients covered by Blue Cross Blue Shield of Massachusetts. I’ve already begun difficult conversations with individuals who achieved life-changing health improvements thanks to these GLP-1 medications, patients who are now facing uncertainty and the potential reversal of their progress. 

I’ve witnessed firsthand how anti-obesity medications transform lives. These aren’t cosmetic quick fixes; they are essential tools for managing obesity – a complex, chronic, relapsing disease with profound health implications. The Blue Cross decision, driven by concerns over rising drug costs, risks undermining the well-being of countless families across the Commonwealth. 

Consider a software engineer from Cambridge I treat. For years, he struggled with increasing weight, pre-diabetes, and joint issues. With medically supervised treatment including an anti-obesity medication, he lost over 80 pounds, normalized his blood sugar (avoiding a diabetes diagnosis), and regained energy. The prospect of losing access to the medication that facilitated this turnaround is devastating, threatening his metabolic health. This story represents the potential setbacks facing many Blue Cross members. 

Obesity remains widely misunderstood, often stigmatized as a failure of willpower. Yet, clinical evidence confirms it as a complex condition influenced by genetics, hormones, environment, and psychology. Just as we wouldn’t deny long-term medication for hypertension or diabetes, effective obesity management often requires sustained medical intervention, including pharmacotherapy, to achieve and maintain significant weight loss and associated health benefits. 

The consequences of discontinuing these medications aren’t theoretical. The SURMOUNT-4 trial, studying tirzepatide (Zepbound), illustrates this. Participants averaged nearly 21 percent weight loss after 36 weeks. However, those switched to placebo regained over half their lost weight within a year. Conversely, those who continued the medication sustained their loss, averaging 25 percent total weight loss by week 88. 

For patients, forced discontinuation isn’t just about the scale. It means a potential resurgence of diabetes, sleep apnea, hypertension, joint pain, and cardiovascular risks – conditions that were improving. It means reversing progress and placing immense financial and emotional strain back onto individuals. 

Blue Cross acknowledges the “great promise these drugs hold” but cites soaring costs, projecting nearly a billion dollars in spending by 2026. While immediate costs are real, the calculation is incomplete.  

Short-term savings from cutting anti-obesity medication coverage will likely be dwarfed by long-term expenditures from untreated obesity – diabetes complications, heart attacks, strokes, joint replacements, and reduced productivity. In fact, a new study finds that while GLP-1 drugs initially raise employer health care costs, they significantly reduce major health events and cut the growth rate of medical expenses by half within two years. We are trading manageable, preventive medication costs for potentially catastrophic downstream expenses. 

Furthermore, as access to prescribed, FDA-approved medications is restricted, patients desperate for solutions may be driven towards risky, unregulated compounded versions or unproven alternatives, jeopardizing their safety. This cannot be the desired outcome for a leading health insurer. 

While Blue Cross points to alternative covered options like lifestyle programs, these, while valuable, are often insufficient on their own for maintaining clinically significant weight loss for many, especially those already succeeding with medication. 

Blue Cross’s decision may aim for fiscal responsibility, but the toll on patient health and eventual financial repercussions suggest it will prove far more costly. As health care providers, we must advocate for policies grounded in the medical understanding of obesity as a chronic disease requiring a full spectrum of evidence-based treatments. 

I urge Blue Cross Blue Shield of Massachusetts leadership to reconsider this policy before its 2026 implementation. Let’s prioritize sustained health and invest in proven obesity treatments that deliver true long-term value – both for our health care system and the people of Massachusetts.  

Obesity is not a choice; providing access to effective, FDA-approved treatment should be. 

Joseph Zucchi is a physician assistant specializing in obesity medicine and the clinical supervisor at Transition Medical Weight Loss in Salem, New Hampshire.