School health insurance rates are increasing across New Hampshire. There’s more at play than just GLP-1 weight loss drugs

Duane Ford has managed budgets for the Bow and Dunbarton school districts for more than a decade, but nothing quite prepared him for this year’s health insurance bill: a 16% jump in premiums, the steepest increase he’s ever seen.

“It’s a part of the budget that we don’t have any control over,” he said.

The districts are far from alone. School districts across New Hampshire are grappling with soaring health insurance costs that have quietly become the single biggest pressure point in their budgets.

Few drugs have attracted more attention — or more controversy — recently than weight loss medications like Ozempic and Wegovy, also known as GLP-1s. Health insurance companies, including Anthem Blue Cross Blue Shield, the largest insurer in New Hampshire, have dropped coverage for this class of drugs in cases where it is not considered medically necessary. For uninsured individuals, a 30-day supply of these drugs can cost up to $1,000 out of pocket.

But the issue isn’t tied to any one drug or medical claim, at least not in the public sector.

Most school districts and public entities in the state rely on nonprofit risk pools like SchoolCare and HealthTrust to manage employee health plans.

These pools report that rising expenses are primarily linked to cancer treatment, musculoskeletal conditions and specialty prescription medications, a category that does not include GLP-1s but refers instead to the non-generic treatments that are often advertised on television.

Scott DeRoche, executive director of HealthTrust, said the cost of health care has been rapidly accelerating since the pandemic, fueled by medical breakthroughs, cutting-edge technology and new drugs that alone can tack on 4 to 5% to total premiums in a single year.

“As these new medications come out, they’re amazing, they’re life changing,” he said. “You don’t want to limit somebody’s ability to have access to them, but at the same time, the price tag that they come associated with is astronomical.”

Bow School District and Dunbarton School District are enrolled in the benefits program run by HealthTrust. The change in premiums has resulted in a proposed budget increase of $770,089 for Bow and $124,372 for Dunbarton.

“That is for just that one budget item,” Ford said. “In my world, that is a very significant increase for one cost center.”

Cost impact of weight-loss drugs

Neither SchoolCare nor HealthTrust currently covers the use of GLP-1 drugs for weight loss, but they do foot the bill when the medications are prescribed for secondary conditions such as sleep apnea, cardiovascular disease and diabetes.

But executives said that, during the time when the drugs were covered for weight loss, they caused significant financial stress.

HealthTrust stopped covering GLP-1 medications for weight loss on March 1, 2025, according to a statement the organization sent to its members.

Certain specialty drugs, like treatments for autoimmune disorders, can cost even more than GLP-1 medications, but since these are used by relatively few people, their overall impact on insurance costs remains limited, DeRoche said. 

Between July 2024 and June 2025, HealthTrust reported 803 users of Ozempic, which is used to treat diabetes, and 1,348 users of Wegovy, a drug approved for obesity and certain cardiovascular conditions.

In fiscal year 2024, HealthTrust’s expenses for anti-obesity medications rose to $6 million.

These drugs remain costly, even when prescribed only to address underlying medical conditions.

Over at SchoolCare, which covers the Concord School District and a wide swath of other districts statewide, GLP-1 medications prescribed for diabetes management alone burned through more than $5 million in 2024.

Rising costs

Risk pools like SchoolCare have been unable to keep pace with the rising costs. 

They were designed to save money. Rather than buying coverage directly from for-profit insurers like Cigna or Anthem, member districts pool together under nonprofit administrators who keep overhead low and give members a say in decision-making.

But the model has a built-in vulnerability: When claims outpace contributions, the pools absorb the loss. Reserves can cover a bad year, but string together enough of them, and those reserves dry up, forcing member districts to pay assessments to cover the gap and rebuild the fund.

The Concord School District’s premiums through SchoolCare climbed 10.2% this year, a drop from the 13.3% increase it absorbed the year before.

Jack Dunn, the district’s business administrator, said that even with the decrease, the trend “isn’t sustainable.”

Insurance data from July 2024 through June 2025 show that spouses generated significantly higher per-member costs than employees in the Concord School District.

Spouse costs rose 22%, compared with 13% for employees, while costs for dependents declined. 

Among Concord’s pharmacy claims, antidepressants account for the highest volume, with 381 unique members filling prescriptions. 

Health care costs are often the second-largest expense after personnel costs in school and municipal budgets, which can be hard for taxpayers to digest, especially when incomes have not risen to meet expenses.

“It’s getting higher, even faster than it was before,” DeRoche said. “That’s a trend that in the industry is expected to continue, and that’s why you’re seeing significant rate increases throughout the country.”

Industry trends

Medical trends have always reshaped how healthcare expenses trickle down to consumers.

When MRI imaging was first introduced, it was primarily used as a diagnostic tool for neurological conditions. Today, however, it is increasingly being used for broad screening purposes, even in situations where less expensive imaging such as X-rays might suffice.

Every upgrade in standard care comes with a larger price tag, and those costs ultimately are reflected in health insurance premiums.

At the same time, the growing influence of private equity in healthcare has introduced new financial dynamics. Investment-driven ownership models often prioritize returns, and that focus can contribute to upward pressure on prices throughout the system.

DeRoche said cutting GLP-1 weight-loss coverage at HealthTrust helped to blunt expenses. But with so many other cost drivers accelerating, one policy change can’t reverse the broader trajectory.

“It’s one part of the puzzle,” he said. “If there’s a question about the cost of care, it really has to do with some of these very large industry trends overall.”

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