Over the past two years, GLP-1s have transformed Carolina Martinez’s lifelong struggle to lose weight. She shed 80 pounds and reversed the high blood pressure she developed after her second child’s birth. Now, the 33-year-old is down to her last two doses of the weight loss drug Zepbound. She won’t be able to get more.

On Friday, the state’s Medicaid administrator, MassHealth, ended coverage of GLP-1s and other medications when they’re prescribed solely for weight loss, saying the expense has become overwhelming. Martinez is among roughly 22,000 people statewide who rely on Medicaid to cover anti-obesity drugs for weight loss alone, MassHealth reported. They now fear they are doomed to regain weight and the health problems that accompany it.

“We’re dreading it,” said Martinez, of Chelsea. “We don’t want to go back to the way it was before.”

Stark Options for Those Losing Coverage

Those losing coverage face stark options, according to the doctors who treat them. They can go without, which in most cases will result in significant weight gain within months; switch to less expensive, less effective drugs; or pay out of pocket. For people who rely on Medicaid, including Martinez, the last option is not possible.

Though costs have come down since GLP-1s such as Ozempic and Wegovy became available for weight loss, they still typically cost hundreds of dollars a month, said Dr. Florencia Halperin, an endocrinologist and chief medical officer at the Boston weight loss clinic Form Health and spokesperson for The Obesity Society, a national professional organization focused on weight loss.

Martinez is considering alternative drugs, but those have side effects, including high blood pressure — a condition GLP-1s helped alleviate.

The FDA approved Wegovy, the first GLP-1 exclusively for weight loss, in 2021, and in the past five years, prescriptions for this class of drugs have more than quadrupled. The results are dramatic. Halperin said patients commonly lose 15 to 20 percent of their weight, equivalent to the results of bariatric surgery. But the drugs’ high cost has prompted several commercial insurance companies to drop coverage. Until Friday, MassHealth was among just 13 states’ Medicaid programs to cover GLP-1s, according to the health news site KFF.

Doctors consider being overweight or obese a serious medical condition associated with an array of life-threatening problems, including 13 types of cancer, heart disease, diabetes, and liver disease. Weight loss from GLP-1s can also reduce or eliminate arthritis, joint pain, or hypertension. The loss of Medicaid coverage risks making these highly effective drugs available only to the wealthy, physicians said.

Medicare Moves in the Opposite Direction

As MassHealth ends coverage for GLP-1s to treat weight loss, Medicare is moving in the opposite direction. The federal health insurance program for seniors began a pilot program Wednesday covering some GLP-1s for Medicare Part D beneficiaries.

MassHealth officials say they have few options after last year’s federal Medicaid reforms that will reduce enrollment and cost the state funds.

“We are beginning to see the real-life impact of those cuts at the state level,” said Stacey Nee, a MassHealth spokesperson. “Our proposed change to GLP-1 coverage for weight loss is a targeted approach to control costs, bring us in line with other states, and protect access to care as much as possible.”

Cutting coverage of GLP-1s for weight loss is expected to save about $15 million, Nee said. MassHealth will continue covering the drugs if they’re prescribed to treat diabetes, their original use, or other medical conditions, or if they are being used to treat obesity in combination with moderate to severe sleep apnea, metabolic liver disease, or cardiovascular disease to reduce the risk of a heart attack or stroke.

A Patient’s Story

Martinez, who is 5 feet 7 inches tall, used to struggle to keep her weight below 200 pounds. “It was really frustrating doing everything right since I can remember: watching my calorie intake, being active, exercising, and no matter what I did, nothing worked,” she said.

After the birth of her son Kevin in April 2023, she reached 230 pounds. It was the persistently high blood pressure that prompted Dr. Richard Siegel, a Tufts endocrinologist, to prescribe Wegovy in 2024 and then switch to Zepbound. Now, she weighs around 150 pounds.

“It was the greatest thing that happened to me, being introduced to this medicine,” she said. Her blood pressure returned to normal and stayed there, despite the stress of raising two children, working for a caterer, and caring for her father, who lives with her as he is treated for two different types of cancer. “I feel like I’m healthy. I feel like I have more energy.”

Physicians Scramble as Policies Shift

Siegel, co-director of Tufts Medical Center’s Diabetes and Lipid Center, said he has discussed less expensive alternatives to GLP-1s with Medicaid-enrolled patients for weeks. Some have talked about getting second jobs just to afford the medication. Others may pay out of pocket but take smaller doses or inject less often — resulting in less effective treatment than the proper prescribed dosage.

His office’s pharmacy team has been scrambling to negotiate authorizations with both MassHealth and Medicare as the two programs move in opposite directions on GLP-1 coverage. The patients with co-morbidities who still qualify for GLP-1s under MassHealth tend to be older, leaving many younger patients without coverage.

“Patients have felt like the floor is taken out from under them,” Siegel said.

Impact on Young Patients

That includes roughly 1,700 Massachusetts young people on GLP-1s solely for weight loss, who pediatricians say stand to re-experience the depression, anxiety, and bullying that can accompany being an overweight young person. They also risk developing serious, lifelong health conditions related to obesity, said Dr. Jason Zhang, a gastroenterologist with Boston Children’s Hospital.

“We expect that any gains that they had in disease resolution — all that will go away too,” he said.

For patients under 21, MassHealth will still cover GLP-1s if there is medical necessity, but that qualification concerns pediatricians. “I am not sure how rigorous they’re going to be in terms of needed justification,” said Dr. Benjamin Weintraub, a Watertown pediatrician who noted that roughly 15 to 20 percent of his patients rely on Medicaid. MassHealth said it would consider medical necessity on a case-by-case basis.

Eric-Paul Olsson, a psychiatric nurse practitioner who works with patients in Newton, Northampton, and Marshfield, said GLP-1s have been a critical resource for patients dealing with weight gain caused by antipsychotic medications. “They’re fearful there’s going to be a resurgence of weight gain,” he said. “Some people just started feeling like they got control of their lives.”

Looking Ahead

Despite her busy schedule as a parent, daughter, and worker, Martinez works out at the gym at 6 a.m. every day. She is hopeful that staying active, eating well, and possibly taking a less expensive medication will help her maintain the weight loss she worked so hard to achieve.

“The anxiety is there,” she said. “I’m just trying to be optimistic.”