Investing in Health Equity | Why Massachusetts Should Ensure Access to FDA-Approved Anti-Obesity Medications

Executive Summary

Massachusetts is at a critical inflection point. Like many states, obesity is on the rise. Currently, 61% of adults in Massachusetts struggle with obesity or are overweight. This trend disproportionately affects communities of color, with roughly 43% of Black and 40% of Latinos in Massachusetts suffering from obesity. And the problem is only getting worse, over the past decade, the percentage of adults with diabetes, a common condition coinciding with obesity, has increased 28%. Despite these concerning trends, and at the urging of Gov. Maura Healey, Massachusetts’ Medicaid program, MassHealth, decided to end coverage for GLP-1s, one of the most effective treatments for obesity. While this decision may save some money for Massachusetts in the short run, in the long run it will only further this health equity crisis and pose a threat to the state’s Medicaid program, public health infrastructure, and long-term economic stability.

As obesity rates climb, Massachusetts will face an urgent challenge: without early, evidence-based intervention, today’s obesity crisis will become tomorrow’s diabetes, cardiovascular disease, or disability crisis, all leading to ballooning Medicaid expenditures. Obesity is a chronic disease linked to more than 200 serious health conditions, including type 2 diabetes, heart disease, stroke, kidney disease, and certain cancers.

Treatments like GLP-1s, are increasingly recognized as part of the clinical standard of care and are covered in other public and private health plans. This policy gap undermines health equity, limits access to medically necessary care, and leaves low-income patients in Massachusetts without effective treatment options. The sudden emergence in this gap also disrupts doctors’ treatment plans and causes many patients to regress in the treatment of their disease.

When safe, evidence-based care is inaccessible, patients are pushed toward unsafe alternatives, including counterfeit and illegally compounded drugs. These products are increasingly marketed in low-income communities and pose serious health risks.

Massachusetts has the opportunity to reverse this decision and continue to provide Medicaid coverage of FDA-approved anti-obesity medications (AOMs) like GLP-1s for the treatment of weight loss and obesity. Re-expanding Medicaid coverage allows patients to continue on treatment plans that work for them and provide stable, reliable care that prevents them from seeking out cheaper and potentially dangerous alternatives. We know that covering obesity treatments advances health equity, improves health outcomes, and helps bend the cost curve, it’s time we maintain our investments so we can reap the rewards and protect patient health.

The evidence is clear, the need is urgent, and the timing is right. This is why we urge Governor Healey, the Massachusetts Executive Office of Health and Human Services, and state lawmakers to take the necessary administrative and legislative steps to restore MassHealth coverage of FDA-approved AOMs and strengthen protections against unsafe and illegally marketed compounded medications.

Obesity is a Health Equity Crisis

Obesity affects more than 42% of adults nationwide and is among the leading drivers of chronic disease in the United States, with profound implications for healthcare costs, workforce participation, and public programs such as Medicaid.¹

Despite its scale and impact, obesity has been widely stigmatized and for years was viewed as a matter of individual behavior rather than a chronic and multifactorial disease. As the American Academy of Pediatrics observed in 2023, obesity has been “long stigmatized as a reversible consequence of personal choices,”² even though it is shaped by complex genetic, physiologic, socioeconomic, and environmental factors. This misunderstanding has real consequences for policy, particularly because the burden of obesity is not evenly distributed across the population.

Nationally, disparities are stark. Nearly 46% of Hispanic adults live with obesity, and close to 79% of Hispanic women are overweight or obese, compared with 64% of non-Hispanic white women.³ Black Americans are 28% more likely than U.S. adults overall to have obesity.⁴ These national trends are reflected in Massachusetts where 43% of Blacks and 40% of Hispanics struggle with obesity.⁵ These trends can also be compounded by other factors such as income and unequal access to:

• affordable healthy food
• safe outdoor and recreational spaces
• reliable transportation
• primary and preventive care
• chronic disease management
• culturally competent healthcare providers

Because Massachusetts’ Medicaid program disproportionately serves low-income individuals, communities of color, and people with chronic diseases, obesity rates among its beneficiaries are often higher than those observed across racial or income groups individually. Medicaid is therefore uniquely positioned to address these health inequities. Rolling back coverage will only exacerbate existing disparities, particularly as access to obesity treatments increasingly depends on individuals’ ability to pay out of pocket through direct-to-consumer channels.

Though the decision to roll back coverage may save money in the short term, leaving obesity unaddressed represents not only a threat to individual health outcomes and economic stability, but a growing risk to the sustainability of MassHealth, and the broader healthcare safety net. Treating obesity as the chronic disease it is is no longer optional; it is a fiscal and public health imperative. For Massachusetts, failing to act now does not save money, rather it defers costs until they are larger, harder to manage, and more inequitable.

The Cost of Inaction | Obesity as a Gateway to Medicaid Spending Growth

Obesity is not an isolated condition. It is a primary risk factor for type 2 diabetes, cardiovascular disease, and numerous other costly chronic illnesses. An estimated 60% to 90% of individuals with type 2 diabetes also live with obesity or have a history of obesity.⁶

This connection has direct fiscal consequences:

• Diabetes drives lifelong medication use, frequent hospitalizations, dialysis, amputations, and disability-related care.
• These downstream costs are predictable, recurring, and fall heavily on public payers -- particularly programs like Medicaid and Medicare.

Evidence shows that treating obesity earlier can significantly reduce the incidence of type 2 diabetes by as much as 58%⁷ and delay or prevent the onset of other high-cost complications. Yet despite the availability of effective treatments, obesity pharmacotherapy remains severely underutilized: fewer than 2% of eligible adults nationwide receive anti-obesity medications.⁸ Failing to address prevention and treatment of obesity means we are giving up on the more than 100 million Americans who already live with this disease and continue to face social stigma.

Already, obesity places tremendous strain on the healthcare system and Bay Staters. Citing cost as its primary justification, Massachusetts rolled back MassHealth coverage of anti-obesity medications in July 2026, disrupting treatment for 22,000 beneficiaries who had relied on these medications to manage their obesity. This decision put these beneficiaries’ health at risk and reinforced the stigma folks so often face by suggesting the state’s bottom line is more important than their care and that effective treatments like GLP-1s are not a right but a privilege. However, ensuring that all eligible Bay Staters can access effective FDA-approved weight-loss therapies would not only improve health outcomes, but also deliver enormous economic value to the Commonwealth. Fewer obesity-related complications mean less disability, less pain, and nationally up to $100 billion annually in combined healthcare savings and quality-of-life gains.

AOMs are Evidence-Based, Cost-Effective Care

FDA-approved anti-obesity medications are now widely recognized as part of the standard of care for chronic obesity management, particularly when combined with nutrition counseling and lifestyle interventions. It is unacceptable that many patients do not receive the standard of care needed for obesity, a chronic disease that requires a continuum of evidence-based interventions, beginning with nutritional counseling and structured physical activity and, when clinically appropriate, extending to metabolic and bariatric surgery and FDA-approved anti-obesity medications.⁹ Clinical evidence shows that these medications can:

• produce sustained weight loss
• improve quality of life
• lower the risk of progression to type 2 diabetes
• reduce cardiovascular risk

Independent economic evaluations increasingly demonstrate that FDA-approved AOMs can deliver substantial health benefits relative to their costs. In its December 2025 assessment,¹⁰ the Institute for Clinical and Economic Review (ICER) concluded that semaglutide and tirzepatide were highly cost-effective, reflecting their ability to improve health outcomes and reduce the incidence of serious obesity-related complications. And even though the widespread need for treatment presents legitimate budget challenges, these findings demonstrate that the value of obesity treatment cannot be assessed through pharmacy expenditures alone. A comprehensive fiscal assessment must also account for avoided medical complications, improvements in patients’ quality of life, and the long-term economic burden of untreated obesity in a diverse population like the Commonwealth of Massachusetts.

Cost concerns often reference official list prices that do not reflect the real, net cost. After rebates and concessions, the estimated net price for medications such as Wegovy is substantially lower — approximately $274 per month¹¹ — than official list prices. In addition, the federal government pays part of a state’s Medicaid costs through the Federal Medical Assistance Percentage (FMAP). The federal government’s FMAP payment to Massachusetts is around 50%,¹² meaning the federal government pays for approximately 50% of Medicaid services in the state.

Additionally, recent commitments made by pharmaceutical companies to lower list prices may further improve the ability of states to budget for an expansion of care. Importantly, Medicaid programs already use utilization management tools to manage access to specialty medications. Coverage of AOMs does not require abandoning these practices; it requires recognizing obesity as the chronic disease it is and the necessary tools that support long-term disease management — similar to how medications are used to manage hypertension, asthma, or high cholesterol.

Yet nationally, fewer than 2 percent of eligible adults receive anti-obesity medications.¹³ This gap is driven largely by lack of coverage and affordability barriers. If Medicaid beneficiaries cannot access clinically appropriate obesity pharmacotherapy, the state risks reinforcing a two-tier system in which higher-income patients receive modern evidence-based care while low-income patients are left with limited options.

When patients cannot access legitimate, FDA-approved treatments, many look for alternatives. Across the country, counterfeit and illegally compounded GLP-1 drugs have proliferated, particularly through online vendors and informal markets. These products are not FDA-approved and are not subject to appropriate safety standards.

The FDA has identified significant risks, including:

• unknown or incorrect ingredients
• unsafe dosing
• contamination and improper storage
• adverse events requiring medical care
• fraudulent labeling and counterfeit packaging

These risks disproportionately affect low-income communities, where patients are more likely to face barriers to accessing safe and legitimate treatment through the healthcare system.

Ensuring Medicaid beneficiaries have access to evidence-based obesity care is therefore not only a chronic disease strategy — it is also a public health safety strategy.

Coverage Gaps Fuel Unsafe Alternatives to Massachusetts

The rapid proliferation of counterfeit and illegally compounded GLP-1 products poses a serious and growing public health concern. As stated before, these products are not FDA-approved and are not subject to adequate safety or quality oversight. Also, the FDA has identified significant risks associated with their use including improper storage, substandard or unknown ingredients, fraudulent labeling, and reported adverse events.

These risks are especially intensified when Medicaid beneficiaries suddenly lose access to FDA-approved treatments, leaving patients with access to only unsafe and unregulated substitutes. Permanently expanding Medicaid coverage for evidence-based obesity treatment would not only improve chronic disease management, but also reduce reliance on products that place patients at unnecessary risk.

Why Action is Needed Now

This moment calls for action. Without action, health disparities will only continue to rise in Massachusetts, pushing more people to unregulated treatment options, magnifying long-term Medicaid exposure and making inaction increasingly costly. At the same time, there is broad clinical consensus that obesity is a chronic disease requiring comprehensive, evidence-based treatment, not episodic or incomplete care.

Leading health policy experts have reached the same conclusion. As the Institute for Clinical and Economic Review (ICER) recommended in 2022:

“States should include coverage of weight loss medications under the auspices of the Medicaid program… Obesity is a growing health problem in the United States that has a particularly large impact on certain racial and ethnic groups… Considerable concern was [also] expressed by patient advocates and clinical experts that despite improvements in weight loss with existing medications and those undergoing clinical evaluation that current coverage policies and medication costs are likely to worsen disparities in accessing care unless specific action is taken.” ¹⁴

Market dynamics further strengthen the case for action. Increased competition and emerging federal pricing signals are expected to continue placing downward pressure on the cost of anti-obesity medications, making expanded coverage more affordable now — and likely even more sustainable over time.

Against this backdrop, Massachusetts’ long standing leadership on health equity creates both an opportunity and a responsibility. Expanding Medicaid coverage for obesity treatment represents a logical extension of the state’s commitment to equitable, preventive care. Delaying action will only exacerbate existing disparities and drive higher long-term costs. Acting now offers the chance to improve health outcomes, protect vulnerable communities, and strengthen the long-term sustainability of MassHealth.

The Health Equity Coalition for Chronic Disease (HECCD) believes that all people deserve the best possible health care. Continuing to allow outdated coverage policies to restrict access for communities dependent on public programs is counter to the principles of health equity. The Health Equity Coalition for Chronic Disease’s mission is to ensure that community experts, policy makers, providers, and other stakeholders work together to eliminate barriers to healthcare for rural communities, seniors, and communities of color, especially as related to access to care and treatment for obesity. Learn more at HealthEquityAction.org.

Learn about the Health Equity Coalition for Chronic Disease and our partners at www.HealthEquityAction.org

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1. HECCD. “Comprehensive Care Necessary to Successfully Treat Disease of Obesity,” September 2024. https://bit.ly/46sXn1B. ↩︎
2. Hampl, Sarah et al. “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity,” American Academy of Pediatrics. Vol. 151, Issue 2, February 2023. https://bit.ly/4pORlPP. ↩︎
3. CDC. “Adult Obesity Facts,” May 12, 2024. https://bit.ly/3OzH78U. ↩︎
4. Office of Minority Health. “Obesity and Black/African Americans. Feb. 17, 2026. https://minorityhealth.hhs.gov/obesity-and-blackafrican-americans ↩︎
5. OAC. Massachusetts Obesity Fact Sheet. https://www.obesityaction.org/wp-content/uploads/Massachusetts.pdf ↩︎
6. HECCD. “The Dangerous Link Between Diabetes & Obesity,” July 2023. https://bit.ly/4bGjLZ9. ↩︎
7. Bramante, Carolyn T. “Treatment of Obesity in Patients with Diabetes.” Diabetes Spectrum 2017 Nov;30(4): 237-243. https://bit.ly/3OxGz3q. ↩︎
8. Baig, Khrysta et al. “Medicare Part D Coverage of Anti-Obesity Medications -- Challenges and Uncertainty Ahead,” New England Journal of Medicine 2023;388(11): 961-963. https://bit.ly/4tbopEy. ↩︎
9. HECCD. “Comprehensive Care Necessary to Successfully Treat Disease of Obesity,” September 2024, p.3. https://bit.ly/3MafdzB. ↩︎
10. ICER. “Semaglutide and Tirzepatide for Obesity: Effectiveness and Value,” December 2025, p.18. https://bit.ly/47qMX2L. ↩︎
11. CMS. “Fact Sheet: Medicare Drug Price Negotiation Program: Negotiated Prices for Initial Price Applicability Year 2027,” November 2025, p.2. https://bit.ly/46ASHa2. ↩︎
12. KFF. “Federal Medical Assistance Percentage (FMAP) for Medicaid and Multiplier,” accessed September 17, 2026. https://bit.ly/4r0KaFw. ↩︎
13. Baig, Khrysta et al. “Medicare Part D Coverage of Anti-Obesity Medications — Challenges and Uncertainty Ahead,” New England Journal of Medicine 2023;388(11): 961-963. https://bit.ly/4tbopEy. ↩︎
14. Institute for Clinical and Economic Review. “Treatments for Obesity Management: Final Policy Recommendations,” October 20, 2022. https://bit.ly/4cejMU5. ↩︎