It’s been about a year since Patrick Gilligan took the helm of Point32Health, the state’s second-largest health insurer and parent company of Harvard Pilgrim Health Care and Tufts Health Plan
Gilligan, who has worked for both an insurer and a health system, accepted the role as CEO during a period defined by the blockbuster popularity of GLP-1 weight-loss drugs, soaring health care costs, and the lingering consequences of the COVID pandemic
So far, Gilligan’s tenure has included large layoffs and potentially promising financial results. After the insurer joined others in restricting access to GLP-1 drugs, Point32Health’s operating income rebounded to $86 million in the first quarter of 2026 from a loss of $39 million in the same period of 2025
In an interview, Gilligan reflected on his first year and what he expects for the rest of 2026. This interview was edited and condensed for clarity and brevity
Question: What do you think is at the core of this particularly challenging time for the entire health care system?
Answer: I know it’s been five years since the pandemic, but I think it took a while for the missed care that happened during that time period to come back. There was a lot of pent-up demand, and I think health plans started to see it in 2023
While all that was going on, pharmaceutical costs were increasing both the utilization and the price in significant ways. There are new indications coming out every day for many specialty and branded drugs
We now have the blessing of gene and cell therapies, which are great in terms of their effectiveness, but they are super, super expensive. Health plans and others will need to make choices not only around their efficacy, but around whether they’re affordable to provide to our members
Q: Last year, GLP-1s were the poster child of these drugs that have gotten exorbitantly expensive. Point32Health, along with a number of other insurers, have limited coverage of GLP-1s largely to people with diabetes, and it seems there has been at least some financial recovery. Walk me through that decision
A: We have to price our products well in advance of the start of the year. Then if there are big differences in the costs that come through, that’s where you start to see the bottom line of health plans really suffering
We didn’t project well how many prescribers would put their patients on GLP-1s for weight loss, and the uptick was much bigger than we thought
It’s always hard to take a benefit away from someone. We recognize that
In hindsight, we just realized that this was becoming a true affordability issue for individuals who buy from us directly, from employers who buy from us for their employees and their families. It was not sustainable
Q: How have members reacted?
A:Obviously, many of our members who are on those medications and were successful with them were very, very disappointed
Employers at first questioned whether it was the right decision. I think it’s hard for all of us
But I also think that in the wake of blockbuster drugs, we’re going to continue to have this conversation around when and where it’s prudent to cover these medications
We have a lot more to learn around this, and this story is not over, meaning we and our competitors will be revisiting it over time
Q: Point32Health’s first-quarter results were promising, but the Point32Health chief financial officer said that won’t necessarily translate to a year in the black or cost savings for members. What do you think the rest of the year will look like?
A: We know pretty directly the actions that we took to drive these results. The GLP-1s were a big part of it
We’re looking at our own administrative costs and making sure that we’re as efficient as we can possibly be
We have also enhanced what we call our total cost of care programs — and yes, that does mean utilization management and care management, and sometimes prior authorizations or other ways to make sure that care is necessary and efficacious care
While our CFO is right that we don’t anticipate by the end of the year that we’ll have an operating gain, we do see this as an important bridge year to get us to a position going forward where we can be modestly profitable
Q: How does the end of certain subsidies that were available on the Massachusetts Health Connector affect Point32Health?
A: What it means for us, and unfortunately for the whole market, is fewer members
We had almost universal coverage in this state, and we’re seeing that whittle away because of some of these policy changes. So we lost a significant number of members, as did our competitors
Q: This year has been hard for Point32Health, with pretty significant layoffs. Are those layoffs over? How do you anticipate the company will move forward?
A:I’m not going to say whether it’s over or not
I think we’ve made huge strides in getting more competitive, but I feel like in today’s world, it’s a very competitive environment, and everyone’s got to get a little bit more efficient all the time
Part of our job is to contract with providers, and we’re asking them to get more efficient — doctors and hospitals who are doing the important work of caring for patients. We’re not going to ask them to do that and not be doing it ourselves
Marin Wolf can be reached at marin.wolf@globe.com
