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GLP1 prescriptions and a handful of large claims drive pharmacy costs, Hub tells Westford trustees
Summary
Hub International told Westford trustees that GLP1 weight‑loss drugs and a small number of very large claimants have driven recent pharmacy and overall claim volatility; Mark Chrysetelli said removal of GLP1s from major carrier formularies could reduce pharmacy spend by about $1.2–1.4 million.
Hub International presented March 2023–April 2026 claims data to the Westford Health Insurance Trust on June 11, showing that a small number of large claimants and rising GLP1 prescriptions substantially increased pharmacy spending.
"Our total claims paid were approximately $18 million" in the most recent rolling year, Mark Chrysetelli told the trust, and he said large claimants (members with more than $50,000 in claims over a 12‑month period) accounted for a material share of costs but have declined in recent years. "Those large claimants were a big driver a couple of years ago and those have decreased quite a bit," he said.
Mark flagged GLP1 weight‑loss medicines as a major pharmacy driver: in 2024 the presentation showed roughly $533,000 in GLP1 spending and in the latest 12‑month interval about $1.03 million. He said 126 members used GLP1s in 2025. "Roughly it doubled year‑over‑year," Mark said of GLP1 spending. He added that if Blue Cross and other carriers remove GLP1 drugs from formularies, Westford could see pharmacy savings on the order of $1.2–$1.4 million.
Trustees noted one extremely high‑cost prescription (described in the presentation as roughly $500,000 annually for one individual) had shifted from the medical side to the pharmacy benefit when plan design changed, skewing pharmacy PMPM (per‑member per‑month) figures. Hub told the trust that, excluding that outlier, Westford’s total PMPM (714) was below the Blue Cross benchmark (832), though its pharmacy PMPM (232) exceeded the benchmark (145) because of that one large claimant and the GLP1 trend.
The presentation broke down large claimants by clinical category (cancer, cardiovascular, behavioral health) and payment setting (inpatient, outpatient, pharmacy, professional). Mark emphasized the town’s pattern is consistent with many other groups that offered GLP1 coverage and noted recent carrier decisions to remove those drugs from formularies affected projected pharmacy costs.
Trustees asked Hub to include GLP1 assumptions explicitly in scenario work and to provide member‑level impact examples so trustees and the select board can understand how proposed plan changes would affect out‑of‑pocket costs for low, medium and high users.
What’s next: Hub will include GLP1 removal and large‑claimant scenarios in its cost models and quantify expected savings and member impacts for the June 23 select board packet.
