Councilors press administration over GLP‑1 coverage as one option to trim $80M health bill

The Boston City Council’s Feb. 26 Ways & Means hearing devoted extended questioning to the administration’s proposal to address escalating health‑care costs by changing plan design, including an option to discontinue city coverage of GLP‑1 medications when prescribed for weight loss.

Councilor Erin Durkin (remarks at the hearing) and others framed the issue as a labor and equity question. "GLP‑1 medications are not vanity medications," Durkin said, adding that many city employees and constituents rely on the drugs to manage diabetes and other cardiometabolic conditions. Durkin told the committee she had led an emergency resolution urging protection of access and pressed the administration for user counts and alternatives.

Administration officials said the city is considering a range of interventions. Lou Mandarini, senior adviser for labor policy, described utilization management as a ‘‘common‑sense cost control mechanism’’ that subjects prescriptions to clinical review to confirm appropriateness; the administration said applying utilization management to nonspecialty drugs (not currently in the Blue Cross Blue Shield plan) would reduce the projected rate increase from 22.6% to about 20.3% and save roughly $9.2 million. Grafenberger added that discontinuing GLP‑1 coverage for weight loss only — an approach the Group Insurance Commission moved toward the same morning — would lower projected rate growth to about 17.3% and save just under $18 million relative to no changes.

Councilors repeatedly cautioned that removing coverage would shift costs to employees and could exacerbate racial and income‑based disparities. An unnamed staffer told the committee that, as of last month, roughly 4,000–4,700 plan members were on GLP‑1 medications overall and roughly 3,000 were using them specifically for weight loss.

Administration witnesses said discontinuing coverage would preserve access through direct‑to‑consumer purchases but acknowledged that affordability and equity would be the central concerns in negotiations with PEC union partners. Officials said the decision on plan design changes must be reached through PEC bargaining and that the city is engaging unions and collecting department data ahead of budget adoption.

Councilors asked for: a clear breakdown of GLP‑1 spending versus other pharmacy costs; the enrollment and cost trends over recent years; and impacts on retirees and BPS. The administration agreed to provide follow‑up data and to continue PEC discussions before any plan design change is implemented.