A dosage of Wegovy, a drug used for weight loss, is displayed in Front Royal, Va., March 1, 2024. (Amanda Andrade-Rhoades/Associated Press)

The health plan that covers 26,000 state employees and retirees under 65 is changing its rules for coverage of highly popular weight loss medications known as GLP-1s that are marketed under brand names such as Wegovy and Zepbound.

Currently the state, which is the largest employer in Maine, is among an increasingly small group of employers that cover the cost of GLP-1 medications for weight loss just as they do for other prescription drugs. 

But as the costs of providing coverage have grown exponentially, the state says it is initiating this change to promote “responsible prescribing.” With open enrollment beginning this week, state employees were notified that they will be required to enroll in a guided nutrition and lifestyle program in order for their insurance to continue to cover the costs of GLP-1s for weight loss.

Employees who use GLP-1s for diabetes or other approved conditions will continue to have their medications covered without enrolling in the program.

Jonathan French is a transportation engineer for the state and a member of the Maine Service Employees Association-SEIU, the union that covers most state workers. He’s part of the joint labor and management committee that helps design benefits for employees. He said the state’s health plan got more expensive last year because of the growth of GLP-1s.

The state estimates 2,600 people, or a 10th of people covered by its health plan, use GLP-1 medications for weight loss or diabetes treatment. The medications have exploded in popularity since 2021 because of social media and new approvals from the U.S. Food and Drug Administration.

“We understand the amazing results these GLP-1s can have,” French said. Going into discussions this year about healthcare benefits, as a labor leader, “we wanted to make sure that we didn’t cut it off.”

At the same time, he said, labor leaders wanted to keep costs as low as possible for everyone else on the state’s health plan. Part of the cost savings would come from employees deciding not to go through the monitoring program and coaching, he said, because they will lose the chance for insurance to cover the medications. 

A one-month supply of Wegovy has a list price of $1,350, according to the GoodRx website. The Wegovy website said patients could pay as low as $149 a month out of pocket, depending on whether the medication was in the pill or injectable form, for the lowest dose. Many patients take larger doses that cost more.

A spokesperson for the state’s Department of Administrative and Financial Services did not make anyone available for an interview.

Some private employers in Maine have also started requiring employees to enroll in wellness programs in order to get insurance coverage of GLP-1s, according to Trevor Putnoky, president of the Healthcare Purchaser Alliance of Maine, a nonprofit research organization.

“I think all of them are moving in the direction of making sure that (the medications) are directed towards the people that really need them, and that you’re pairing it with lifestyle change,” he said.

State employees will have to start the guided program by late October. It will be free to employees and will be administered by Virta Health, which provides other existing weight management services to state employees. Virta’s website promises the company will help employers contain the costs of GLP-1 medications while still helping employees lose weight. In response to an interview request, the company referred questions back to the state.

French said the program will provide specific weight loss goals and coaching, which could reduce long-term healthcare costs for obesity-related conditions. He said it could also provide employees a way to transition off GLP-1 medications over time, if they choose.

“There are a lot of guardrails put in there to make sure that the member is going to have success with the drug,” French said.

Employees will also have to get their GLP-1 prescription from a Virta provider, instead of their normal physician, according to the state’s website.