Op-ed: Bill that would mandate payment for obesity drugs would create cost crisis at Maine employers
File photo / Jim Neuger
Trevor Putnoky
The Maine Legislature is in full swing right now, with over 1,000 of an expected 2,200 bills already printed.
Many of those have the potential to affect health care costs for Maine businesses and consumers, but none as much as LD 627, "An Act to Require Insurance Coverage for Glucagon-like Peptide-1 Receptor Agonist Medication."
Sponsored by state Rep. Holly Stover, D-Boothbay, the bill requires health plans in the fully-insured market to cover GLP-1s for weight loss, capping member cost sharing at $35 per month and prohibiting employers and insurers from putting in place any prior authorization requirements or other limitations on access.
GLP-1s have been widely heralded as miracle drugs for those struggling to lose weight and, indeed, studies have shown they can lead to significant weight loss in those with obesity.
Given the impact that obesity has on many cardiovascular, musculoskeletal and other conditions, it’s perhaps no surprise there is a push to mandate access. But unfortunately, that push to cover these drugs for weight loss is bumping up against the reality that GLP-1s are expensive.
A month’s supply of Wegovy or Zepbound averages around $1,300, and patients are expected to continue taking the drug long-term to sustain weight loss.
With approximately 38% of commercially insured adults under 65 meeting the clinical criteria for taking GLP-1s for weight loss, we are looking at some truly eye-popping numbers. At 10% utilization — or roughly a quarter of eligible patients taking the drug — this mandate translates into an additional $2,464 in spending per employee annually (per every employee, not just those taking the drug).
For a Maine business with 100 employees, that’s an annual increase in health care premium of around $250,000, or almost 12%. And this increase would be on top of what is expected to be a brutal year for health care trend. Premiums grew 40% between 2018 and 2024, and 2025 brought an average premium increase of 9.4% in the small group market. Can Maine employers and consumers absorb a 20% or more increase going into 2026?
The question is often asked, but what about rebates on the drugs and downstream savings? Won’t they mitigate some of the added cost?
Well, to some extent, yes. Rebate data is difficult to obtain, but available research suggests that rebates for GLP-1 drug Wegovy could offset up to 40% of GLP-1 costs for weight loss.
For a group with 100 employees, that would drop the additional expense to around $150,000 annually, but those rebates come with strings attached. To receive them, employers often cannot impose any restrictions on eligibility — like only offering the drugs to those with a BMI of more than 35 or requiring patients to see a nutritionist prior to getting their prescription. The lack of such guardrails would decrease the cost per unit but would also likely increase utilization, making potential savings impossible to quantify.
Similarly, downstream savings from the drugs are likely to offset some of their costs, but a study from the Congressional Budget Office found that even after a coverage mandate has been in place for 9 years, savings from improved health outcomes would offset just 14% of Medicare’s GLP-1 costs. And that estimate is based on a Medicare purchase price of only $467 per month — about two-thirds less than the price paid by employers and employees in commercial plans in Maine.
The Healthcare Purchaser Alliance provides claims analytics to Maine employers, and we have been watching the trajectory of weight loss drug spending closely. While a minority of HPA members cover GLP-1s for weight loss, those that do have seen the drugs steadily creep into their top drugs by spend as utilization more than doubled annually over the past four years. This trend is expected to continue, with market analysts projecting spending to increase from $20.9 billion to $48.8 billion in the next five years.
Employers do not want to make the weight loss drug conversation all about cost — they see clinical value in GLP-1s — but the fact of the matter is that there is a health care affordability crisis in our state. In a recent survey, nearly 4 in 10 Mainers reported that they skipped or delayed going to the doctor when they were sick due to costs, and nearly one-third struggled to pay for basic necessities like food, heat or housing due to medical bills. Almost half of all Maine households have medical debt.
Rising healthcare costs are stagnating wages, eating into crucial public services, and putting untold strain on working families throughout the state. Of course, we all want patients to have access to weight loss medications, but right now, we simply cannot afford it.
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