Jeffrey S. Barkin, MD, DLFAPA, is a practicing psychiatrist in Portland and the former president of Maine Medical Association. He co-hosts “A Healthy Conversation” on WGAN.
Few medicines in recent memory have promised so much to so many as the new GLP-1 drugs. Ozempic, Wegovy, Mounjaro and Zepbound were designed to treat diabetes; they also help people lose weight.
For many patients, the results are striking. Pounds come off, blood sugar improves and the risk of heart disease drops. One large study even showed a 20% reduction in serious cardiac events among people with diabetes. That means more birthdays, more graduations, more years of life.
But there’s another side to the story. These drugs carry a heavy price tag, and in a system where costs are shared, the bill doesn’t stop with the person taking the medicine. It spreads across the insurance pool, raising costs for everyone. Here in Maine, the effects are already being felt.
Insurers have asked state regulators to approve premium increases — some by double digits — citing the rapid uptake of these expensive drugs. Maine’s largest insurers point directly to the cost of GLP-1s as a major driver. That means whether you take the medicine or not, you could end up paying more each month just to keep your coverage.
And GLP-1s aren’t the only factor. New cancer therapies — targeted drugs and immunotherapies — can cost hundreds of thousands of dollars per patient each year.
For families facing cancer, these medicines are lifesaving. But for the broader insurance pool, they add another layer of upward pressure. Together, GLP-1 demand and escalating cancer care costs are reshaping the health insurance landscape in ways already squeezing Mainers.
Take Sarah, a 58-year-old from Bangor. She works part time at a grocery store and recently started a GLP-1 medication prescribed by her doctor to help manage diabetes. The drug is working — she’s lost 15 pounds, feels healthier and her blood sugar numbers are finally under control. But because of high co-pays, she now skips her Thursday night dinners with friends.
She told me she avoids the restaurant not because she doesn’t want to go, but because she feels guilty spending money on herself when the prescription costs so much. At night, she lies awake worrying that if premiums keep rising, she may lose coverage just as her health is improving. Sarah is grateful for the medicine, but she wonders whether the ground beneath her is steady enough to carry her forward.
For patients like Sarah, the paradox is painful. On the one hand, these treatments offer new hope: better diabetes control, longer survival from cancer, fewer hospitalizations, less risk of heart disease. On the other, they threaten to make insurance unaffordable for families already stretched thin. In a state where wages lag the national average and many small businesses struggle to offer coverage, even modest rate hikes can push people out of the system entirely.
Sarah’s dilemma echoes through the larger system. The same financial pressures that force her to skip dinners are also destabilizing relationships between hospitals and insurers.
Northern Light Health, one of Maine’s largest health care systems, has been unable to reach an agreement with Anthem, the state’s biggest private insurer. For months, patients have lived with the uncertainty of whether their doctors and hospitals would remain in-network.
Those caught in the middle face impossible choices: pay more out of pocket, switch doctors or go without needed care. What looks like a contract dispute is really another symptom of the same disease: a system buckling under unsustainable cost growth.
This is not a temporary spike. It is the start of a new cost era. If millions of Americans begin long-term GLP-1 therapy, and if cutting-edge cancer care continues to expand, the costs will only compound.
A drug that costs over $1,000 a month or a therapy that costs $150,000 a year doesn’t just pressure insurance pools today; it reshapes tomorrow’s premiums. Left unchecked, this trend risks creating a two-tier system in which wealthier patients can access the best medicines, while ordinary families are priced out of coverage altogether.
That’s why Maine’s policymakers face a difficult balancing act. Denying coverage for drugs that prevent heart attacks or extend the lives of cancer patients is hard to justify. But approving steep premium increases that push people out of coverage is equally untenable.
The path forward isn’t about saying yes or no — it’s about negotiating smarter. Maine’s Bureau of Insurance should press insurers for transparency about how drug costs drive rate requests, so the public can see what’s behind each increase.
Lawmakers can build on that work by exploring affordability review boards, as Massachusetts and Oregon have done, which help states decide what they will reasonably pay for certain medicines. At the national level, Medicare’s new power to negotiate drug prices must expand quickly, because when Medicare moves, private insurers often follow.
For Maine, this isn’t abstract policy. Our households earn less than the national average, and many rural employers struggle to afford coverage even before these drugs are factored in. Without guardrails, double-digit rate hikes land harder here than almost anywhere else.
For Sarah — and thousands like her — every percentage point on a premium is the difference between staying insured and being priced out. For them, “transparency” and “affordability boards” aren’t policy jargon; they are the line between security and fear.
Each of these steps, taken together, shares a single goal: restoring balance between lifesaving innovation and what families in Maine can actually pay.
But Maine cannot simply legislate its way out of the crisis. We also need to invest in prevention. Lifestyle interventions — nutrition, exercise, preventive screenings — remain essential, affordable tools to fight diabetes, obesity and cancer.
Maine already has models that work. The YMCA Diabetes Prevention Program has helped residents adopt healthier habits and avoid costly hospitalizations. Local schools have improved nutrition and physical activity, proving that prevention can be scaled if it is supported.
Employers, too, can play a role by incentivizing wellness programs that reduce downstream costs. Coverage should prioritize these efforts, not just the latest blockbuster therapies.
At the same time, we must acknowledge the fragility of Maine’s health care system. Rural hospitals already operate on razor-thin margins. Workforce shortages, an aging population and the cost of maintaining services in sparsely populated regions all erode their stability.
Add soaring drug expenses and contract disputes like Northern Light versus Anthem, and the foundation begins to crack. Premium increases are only the most visible symptom of a deeper illness.
Mainers deserve both access and affordability. That will take hard conversations: with drug companies about pricing, with insurers about transparency, with hospitals about efficiency and with ourselves about priorities. We cannot afford to ignore the growing gap between what modern medicine can achieve and what our communities can realistically pay for.
Sarah’s skipped dinners may seem small, but they are the first ripple of a rising tide. If we get this right, we can ensure that lifesaving medicine does not become everyone’s unpayable bill. If we fail, the consequences will arrive in canceled policies, delayed treatments and families forced to choose between rent and coverage.
No one in Maine should have to choose between insulin and groceries, or between cancer care and keeping the heat on.