GLP-1s are popular in Maine, but not with insurance providers

Tammie Rogers had never heard of GLP-1 medications until she started taking them a year ago. 

Her pulmonologist’s office told her she needed to lose weight in order to address her sleep apnea. They recommended Zepbound, which she could inject at home and would mimic a hormone that controls appetite. Rogers’ insurance covered it and she became part of the one in five adults in the U.S. who say they’ve used a GLP-1 drug.

“I didn’t even realize until I was on it how much control my mind had over my eating,” said Rogers, 52, who lives in Dayton.

She saw a dietician to help her get more protein, and with the help of the drug, she lost 40 pounds. Pain in her back and hips went away. Her sleep apnea improved. 

Most importantly it relieved some worry about her long-term health. Rogers saw her obesity as “basically a death sentence” since so many family members, including her father, died of heart problems. She set a goal to lose another 40 pounds.

Then last fall, she got a letter from her insurance company. In January, GLP-1s would no longer be covered for her.

This is the paradox of GLP-1s. Doctors see the medications as an unprecedented tool in the fight against obesity, yet because they’re so popular and powerful, they’ve gotten very expensive, so only a small percentage of insurance plans in Maine cover them and that number continues to go down.

Insurers like Anthem and Harvard Pilgrim excluded coverage of GLP-1s for weight loss from most of the plans they offered in 2026, and large employers that set their own coverages have largely followed suit. 

Eric Jermyn, a licensed insurance broker and consultant with Bangor-based Cross Insurance, estimates that fewer than 10% of the thousands of employers he works with cover GLP-1s for weight loss, though many more cover it for certain conditions like diabetes.

He can’t remember another time in his 33-year career when a type of medication has been so in demand so quickly and caused such a significant jump in costs. 

The medications’ ubiquity has also come as the science about the long-term efficacy and unintended side effects of GLP-1s is still emerging. And, there aren’t large studies yet that show whether GLP-1s and the weight loss they can produce will help employers save money on healthcare costs down the road.

Yet for patients like Rogers and several others that spoke with the Portland Press Herald, GLP-1s have achieved something they didn’t think was possible. The drugs have transformed the way they see food and given them the energy to improve their health.

Rogers doesn’t think she’ll be able to pay out of pocket for her GLP-1 prescription now that it’s not covered. She and other patients say the trend of further reducing insurance coverage for GLP-1s is short-sighted, and that obesity is being unfairly singled out.

They’re supported by doctors and medical research that increasingly shows it’s a disease that can and should be treated. The Maine Medical Association told the state Legislature last year it expects GLP-1s will ultimately reduce healthcare costs and improve public health.

“If our primary care physician feels confident we need a medication for our health, our insurance should cover it,” Rogers said.

RISE IN OBESITY

GLP-1s wouldn’t be so popular, and the sudden costs wouldn’t be so high, if obesity wasn’t so prevalent in the U.S. 

About a third of Mainers are considered obese, with excessive body fat that leads to other health issues, and the state’s obesity rate has risen almost 300% since 1990. It has the highest prevalence in New England.

The reasons are complex. A 2022 “Call to Action” report pointed the finger at genetic, behavioral, environmental and economic factors, including the proliferation of calorie-dense foods. The healthcare system contributes to the problem, too, because excessive weight gain often goes untreated until it gets severe. The state called obesity “a tremendous economic burden.”

The American Medical Association has classified obesity as a disease and said there are lots of risks to not treating it, including joint problems, heart disease and cancer. Dr. Rushika Conroy, medical director of obesity medicine at MaineHealth, said newer research shows there’s urgency to deal with excess weight gain sooner rather than later.

Research has also revealed that a person’s body can strongly resist efforts to lose weight. If they reduce their calorie intake, their body can go into a survival mode to get the person to return to a higher weight.

It can be treated with medication, though while demand was building for something that would help people lose weight, Conroy didn’t have a lot of options to suggest to her patients.

Then GLP-1s became mainstream.

“It’s just way more effective for more people” in the way it works on the brain and reduces the body’s effort to fight back, she said. “It’s not cheating or a lazy person’s ‘out.’”

She and others interviewed for this story emphasized that GLP-1s must be paired with lifestyle changes and counseling, particularly to avoid deficiencies of key nutrients and muscle loss, and that patients should be prepared to stay on a maintenance dose long-term.

For Dennis Price, who’s 48 and lives in Readfield, GLP-1 drugs are not a quick fix. He’d been overweight his whole life and tried dieting for years, then he decided he’d had enough. 

He started a GLP-1 medication about a year ago and while progress hasn’t been linear, he’s lost 30 pounds and his old favorite food, chicken wings, isn’t appealing anymore.

“It’s like your brain calms down,” Price said. 

He sleeps better. He’d always been active but now he doesn’t miss a workout. In between three jobs, he rides a Peloton, plays golf and tracks his steps.

But his insurance has never covered the medication, so he uses a cheaper, riskier form of GLP-1 that’s not approved by the Food and Drug Administration.

RISE IN COSTS

Dr. Matija Burtis, former medical director of obesity management at Maine Medical Center, said that as society’s views shifted to see obesity as a disease that needs treatment, instead of some kind of personal failure, “People never anticipated how much it would impact the bottom line.”

Blue Cross’ costs for GLP-1 drugs doubled in one year, from $150 million to $300 million, Maine’s insurance superintendent told the Legislature.

The medications have been more than $1,000 a month. Per employee per month spending on GLP-1 drugs increased 70% year-over-year from 2020-2024 for employers who covered them for weight loss and are part of the Healthcare Purchasers Alliance of Maine. Employers that covered them for diabetes alone saw spending increase 40% annually.

Overall health insurance costs rose by 7-12% for employers who covered them for weight loss, Cross Insurance’s Jermyn said.

Jermyn and Purchaser’s Alliance president Trevor Putnoky agreed that employers would like to provide access, but they also need to consider the impact on all employees, particularly when the cost of living in Maine has already risen precipitously, and public employers that rely on tax money to cover their costs are in a particular bind.

Health insurance prices went up so much in 2026, in part because of the prevalence of GLP-1s, that Maine’s superintendent of insurance said he was losing sleep.

“Everything is moving in the wrong direction. So I think employers are increasingly desperate to find ways we can actually control the spend,” Putnoky said.

The city of Portland will save $850,000 by ending coverage of GLP-1s for weight loss as of July 1. About 80 of its 1,400 employees have been taking them. And as the city points out, other local governments in Maine never offered employees insurance coverage of GLP-1s for weight loss in the first place.

Even so, healthcare costs are going up about 10% in several of Maine’s largest cities in the next year, according to preliminary budgets they released. If they covered GLP-1s beyond diabetes, said James Gailey, vice chair of the trust that provides healthcare plans to nearly 500 local governments, employee premiums would rise substantially. 

“I don’t think the staff would appreciate that, especially if they were not prescribed the drug,” he said in an email.

MaineCare, Maine’s Medicaid program, would’ve had to grow by tens of millions of dollars to cover GLP-1s for weight loss. Even with coverage limited to diabetes and certain other conditions, MaineCare spent $42 million in the past year and demand rose 25% year-over-year.

State lawmakers heard dire budget figures like these last year when they considered bills that would’ve required some employers and MaineCare to cover the drugs for weight loss. Lawmakers rejected both bills.

When it comes to treating obesity, employers recognize the benefit the medications can provide, Putnoky said. “It’s just, how do we pay for it when we already are struggling to pay for what we have?”

OBESITY SINGLED OUT

When Maya Cohen first tried to get coverage for a GLP-1 in 2019, her insurer told her it didn’t cover “vanity drugs.” 

“An insurance company was basically telling me that my health didn’t matter, and I was doing this for vanity, which could not be further from the truth,” she said.

Cohen, who is 59 and lives in Cape Elizabeth, said the company’s perception is a common one and helps employers and insurers justify treating obesity medications differently than they do medicines for other conditions.

“If you had high cholesterol and you ate right and worked out, you’d need medication. That’s kind of how this is as well,” she said.

“This is the nature of insurance, that we get coverage to take care of our health. Why should obesity be any different than any other chronic illness?”

Rep. Holly Stover, D-Boothbay, sponsored one of the bills that would’ve required broader GLP-1 coverage in Maine. She works in addiction and recovery and says if insurance covers the cost of a medication to reduce cravings for alcohol, for example, it should do the same with medications to treat food cravings.

“I’ve always believed that medical decisions are best made by physicians and people who treat diseases,” she said.

Despite the lack of insurance coverage, Cohen started taking a GLP-1. She’s lost 54 pounds and reduced the pain she felt in her knee from carrying around so much weight. 

While she’s always been active, she never thought she’d be capable of a multi-day hike, but last year, she hiked eight hours a day around Mont Blanc in Europe. Now, instead of fixating on food, she has the headspace to daydream about her next adventure.

Cohen considers herself lucky that she can afford to pay for it out of pocket. That’s become more of an option because patients can now go straight to manufacturers. She pays $500 a month, less than half of what it used to cost her, and some patients report paying even less.

But that’s still cost prohibitive for some people. When Rogers, the patient in Dayton, found out her insurance would no longer cover Zepbound, she started rationing the medication, trying to stretch it out as long as possible.

She said her urge to eat has come back, leaving her angry and discouraged. So has the pain in her neck and back. Rogers expects she’ll have to go to a doctor to get injections for the pain, which will be covered by insurance.

Price has also looked for a lower-cost option to get a GLP-1, since his insurance through his wife’s employer doesn’t cover it. He goes to a medical spa and takes a compound medication mixed by a pharmacist. 

Compounds, which are also sold online, are not FDA-approved and Conroy at MaineHealth does not recommend them. But many patients have found them to be the only option they can afford. The cost is $100 or more less than going straight to a drug company for a name-brand drug.

Price said he’s aware of the risks but that compared with the side effects of being morbidly obese, he’s willing to take them on given the many benefits of getting treated.

He’s frustrated that his insurance pays for his CPAP machine, which he uses for sleep apnea, but it won’t pay to fight his underlying weight issue. His goal is to shed enough pounds that he can literally blow up the CPAP machine.

“I want to detonate it. I want to see it explode,” he said.

UNCERTAIN FUTURE

Price tries to mitigate the risks he’s taking with compounds by getting his primary care doctor to monitor his bloodwork, and he only gets the compounds from a certified nurse practitioner he trusts.

Other patients are resorting to even riskier options online where they can essentially diagnose themselves, said Dr. R. Scott Hanson, a practicing physician and recent president of the Maine Medical Association.

While he supports insurance coverage to help people with obesity access treatment, he cautions against the perception that GLP-1s are a miracle drug. He fears serious safety issues could still arise because of how powerfully the medications alter hormones in people’s brains and guts.

He also worries about what will happen to people when they are forced to stop taking them because they lose the ability to pay for it. If they quickly regain the weight they lost, as research shows, that could have serious psychological consequences, he warns.

Experts agree that the cost of GLP-1s will come down, and much more research will come out about their medical and economic impacts. But no one is certain how quickly that will happen. Cross Insurance’s Jermyn said employers and insurers are constantly reevaluating coverage decisions based on the newest facts.

Until then, some employers are looking for ways to make GLP-1s available to employees for weight loss while still controlling their costs. The largest employer in Maine, the state government, will cover GLP-1s for weight loss only if an employee allows a private company, Virta Health, to monitor them and act as a gatekeeper to get the medication.

Another option under discussion is to figure out a way to limit insurance to cover only people with a certain Body Mass Index, a common measure to help diagnose obesity.

The federal Medicaid program is trying to figure out how to make GLP-1s more accessible, which is important given low-income people are more likely to become obese, the state found.

For now, patients like Rogers are caught in the middle of the economic debate over a medication that has improved their lives. 

Rogers expected it would help her finally reset her weight and her health. Instead, she has just a few doses left in her refrigerator.