Maja Smedberg faces a dilemma—she’s lost 30 pounds in five months with the help of a powerful new appetite suppressant, but could gain it all back when her employer She stopped paying for the medicine.
The social worker was among employees stunned Monday when Hennepin Healthcare announced it would cut Wegovy and other injectable weight-loss drugs from its health plan next year because of budget pressures . With payments of more than $1,200 per month, Smedberg is unable to fill his prescriptions on his own.
“It’s terrible to get your hopes up and feel like, ‘Hey, I can get to a normal weight’ with a life-changing drug and then be told that’s not the case,” she said. must be an option.” “Statistically, most people gain the weight back within five years if they stop taking the medication. I really intend to combat that by not trying to gain the weight back.”
First, she and her colleagues will fight their employers, urging them to maintain access to a drug that for months has improved their weight, health, self-image and happiness. Surname. Some feel cheated because they only started taking the medication after participating in Hennepin Healthcare’s Great Slim Down weight loss incentive program.
The dispute plunges Hennepin Healthcare into a fierce national debate over expensive GLP-1 drugs and whether they can reverse America’s worsening obesity epidemic. The obesity rate among adults in Minnesota has doubled since 2000 and surpassed 33% by 2022, according to federal health survey results.
Leaders of the urban, secure health system admit they have been surprised by the popularity of the drug, which has been widely promoted in advertisements and on social media. Hennepin Healthcare’s decision was influenced by a $120 million budget shortfall for 2024 and a 20% cost increase for its Medica health plan without benefit cuts.
“We spent about $7 million on a drug, and that’s a lot of money,” said Dr. David Hilden, president of Hennepin Healthcare’s medical division.
Hilden said it’s not just a matter of money, because he struggles to get the drugs his patients need, but there are also questions about whether patients will tolerate GLP-1 drugs and use them. take them long enough to maintain the benefits. He sympathizes with workers who use drugs at risk of losing access, especially if they don’t supplement the drug’s benefits with healthy eating habits and exercise.
“I have to be honest, yes, they are at risk of gaining the weight back,” he said.
The cost-effectiveness of the drug is an open question. Prime Therapeutics reports a 63% increase in Blue Cross and Blue Shield of Minnesota GLP-1 drug spending over the past year and a larger 83% increase among commercial insurers nationwide.
But the Eagan-based pharmacy benefits manager found that obese patients who took the drug ended up paying higher prices than comparable patients who didn’t take the drug.
Clinicians like Natalie Ikeman are believers, having seen patients not only lose significant weight but also achieve healthy blood pressure and blood sugar levels.
“I have seen some people lose 20% to 30% of their total body weight,” says Ikeman, a physician assistant with the Bhatti Weight Loss Center in Chaska and leader of the Minnesota Obesity Association. “This medicine has changed the lives of hundreds of my patients.”
Psychiatric nurse Steve Hoffer said Wegovy was a “miracle” that helped him lose 30 pounds in four months. But it wasn’t an easy choice to start with, because he knew he might have to take medication for the rest of his life.
“I weighed that decision and thought, ‘If it’s insured… then at least I can afford it if I decide to take it,’” he said.
Wegovy was federally approved in 2021 for people with obesity or health problems related to excess weight, but is similar to other drugs such as Ozempic approved to treat diabetes and has the side benefit of weight loss.
Hennepin Healthcare is working with other employers and government health programs to not cover the cost of these drugs just for weight loss, but will pay for them if people have diabetes or are group at risk of prediabetes.
Smedberg said her struggle began a decade ago when she took steroids to treat a medical problem that led to weight gain. The 36-year-old mother of two does not have diabetes and is preparing to lose access to her medication unless she can persuade her employer to maintain it. Hennepin Healthcare is offering a weight management program and health coach as an alternative.
Hoffer probably won’t stay here. He said he doesn’t have time to add in physical activities to combat medication loss because he’s working, raising two children and going to school to become a nurse. He said he won’t accept the weight gain and return to unhealthy blood pressure levels, so he’ll be looking for a Wegovy recruiter.
“Do I have to have diabetes to take medicine?” he asks.
Manufacturer Novo Nordisk said Wegovy’s high initial costs were necessary to recoup its investment in drug research and development, but Hilden said the costs were unnecessarily high and forced his health system must cut back. Prices are 4 to 10 times lower in Europe and Canada. Hoffer had ethical considerations as a licensed nurse traveling to Mexico or Canada to continue taking the medication.
Smedberg previously lost 45 pounds first through diet and exercise alone, then with metformin, a cheap drug that helps regulate blood sugar and offers less than impressive weight loss benefits than.
Her doctor recommended Wegovy once Smedberg’s weight loss plateaued. The medicine made her nauseous and immediately lost her appetite.
“I don’t crave carbs, sweets and things like that,” she says. “So I can eat a salad or less food and it helps me not feel hungry all the time.”
Smedberg said the drug helped her gain 30 pounds over her healthy goal, but it won’t be worth it if the weight comes back.
“Weight loss is very obvious and so other people see us gaining weight, losing weight,” she said. It affects your self-esteem, confidence and how others treat you.”
Loss of access will affect workers in other ways. Julie Corrin, 44, worked in administrative work at a Hennepin dental and oral surgery clinic, and lost more than 50 pounds after weight-loss surgery in 2011. She gained the weight back after the injury. back injury before the COVID-19 pandemic.
Corrin found Wegovy after participating in the Great Slim Down and losing 60 pounds this year. She got rid of thousands of dollars worth of old clothes that had become too loose, and only now did she realize that she might need them again. She said she couldn’t afford another wardrobe overhaul.
“I’m already stressed,” she said, “and feel really depressed thinking about it.”
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