At the age of 12, a doctor told Sarah Islam she was too fat to ever have babies.
Islam, now a 29-year-old third-year psychiatry resident at Hennepin Healthcare, has been on medication ever since. But nothing worked. At 273 pounds, she could no longer walk across the hospital without losing her breath. She was experiencing flare-ups of autoimmune arthritis. When she tried diet and exercise, she ended up with an eating disorder. So when her doctor asked if she’d like to try Wegovy, she said yes—even though the injectable medication could cause nausea and other adjustment issues.
She’s lost 58 pounds since January, and her blood sugar is lower than it’s been since she was a child growing up in India, she said. Her arthritis pain has ceased, and her blood pressure has normalized. More important, she said, she lost the weight without shame or guilt, or preventing herself from eating normal meals.
“I have no problem being fat if I’m healthy,” she said, adding that she feels like a burden has been lifted off her shoulders. “I’m not worried about going to a restaurant anymore. I’m a big foodie; I love food. It’s healed that part of my life. I don’t feel guilty about enjoying food anymore.”
But in October, Hennepin Healthcare announced it would be cutting the drug from its employee health plan in 2024. Wegovy, manufactured by Novo Nordisk, costs too much to cover, the healthcare system said. It’s a story playing out across the country as prescriptions have risen by as much as 300 percent for Wegovy and other drugs in its class, such as Ozempic. Wegovy costs three to four times more in the United States than in European countries that negotiate directly with the manufacturer.
Other health systems have announced similar — though less extensive — cuts: Health Partners will limit access for its employees in 2024; The Mayo Clinic capped the lifetime amount employees can spend; and Fairview added criteria, including limiting coverage to those with a minimum body mass index of 40. Nationally, St. Louis–based Ascension and the University of Texas System in Austin recently dropped coverage for weight loss drugs from employee plans, according to Beckers Hospital Review. Minnesota is one of the few states that covers the drug through public health insurance.
At Hennepin Healthcare, about 600 people on the system’s insurance plan filled prescriptions for Wegovy, at a price of between $1,400 and $1,600 per month. Over the course of the year, the cost worked out to about $7.5 million to cover the drug for those 600 employees, according to Dr. Nneka Sederstrom, Hennepin Healthcare’s chief health equity officer.
Employees are asking that Hennepin Healthcare restore coverage of the drug, saying they feel discriminated against because of their obesity. Maja Smedberg, a social worker at Hennepin Healthcare who has become the unofficial organizer of the concerned employees, said she lost 45 pounds in about seven months on Wegovy*. After the October announcement, she gathered names of 32 fellow employees who take the drug, including employees who work in a variety of roles at the downtown Minneapolis hospital and Hennepin Healthcare’s clinics.
Islam can’t afford the drug without insurance coverage, and she is unsure what will happen when her supply runs out.
For Hennepin Healthcare, the issue is purely financial, Sederstrom said. The safety-net hospital provides care for everyone, including those who are uninsured, and is facing a $120 million budget shortfall for 2024. The cost of its health plan, administered by Medica, will increase 19.7 percent without benefit cuts.
“The rationale behind it is, it’s cost-prohibitive,” she said. “It’s not that we don’t believe it works or that it’s a great option for weight-loss management.”
At Wegovy’s current price, it’s impossible to maintain the number of people seeking prescription coverage. The drug will remain eligible for payment from an employee’s Health Savings Account or Flexible Spending Account, and a manufacturer’s coupon would bring the out-of-pocket cost down to about $800 a month, she said. (Smedberg calculated that by using the coupon at the lowest-cost retailer, $803 per month is the minimum she would have to pay for it.)
Employees were also concerned that Hennepin Healthcare planned in 2024 to exclude coverage of all medications designated for “weight loss,” Smedberg said, including drugs such as phentermine that cost less than $20 a month out-of-pocket. Although these drugs aren’t as effective, she said, not covering them would indicate that Hennepin Healthcare isn’t treating obesity as a legitimate medical issue. But a Hennepin Healthcare representative told Sahan Journal that the cheaper weight-loss medications will continue to be covered under the employee insurance plan.
How will it affect people of color?
Semaglutide is the active ingredient in both Wegovy and Ozempic. Ozempic has lower doses of semaglutide and is used to treat type 2 diabetes; Wegovy was approved for weight-loss alone in 2021. The injectable drugs help people feel full by allowing the stomach to empty slowly and regulating blood sugar and insulin. For many patients, they seem to be the “miracle medication” that stops food cravings.
Islam—who identifies as a queer, disabled person of color—worries that cutting the drug from the employee plan impacts certain classes of people more than others.
Obesity disproportionately affects people of color. In Minnesota, Native Americans have the highest prevalence of obesity, at 46 percent, according to Centers for Disease Control and Prevention data from 2022. Hispanic and Black people are next at 36 percent, then white people at 32 percent and Asian people at 19 percent,
Although people of color are more likely to experience obesity, they’re also less likely to have access to Wegovy and similar drugs. In New York City in 2022, for example, more people in wealthy neighborhoods were taking these medications than in poorer neighborhoods, according to an analysis by Trilliant Health requested by The New York Times. But poorer people had higher rates of diabetes and obesity.
So, ironically, dropping coverage of the drug may not impact people of color more, Sederstrom said. People of color already encounter too many barriers to access the drug, even though they likely have a greater need for it and may stand to benefit the most.
“The majority of people contacting me are white women,” she said, referring to employees complaining about dropping Wegovy from coverage. Black people, she said, weren’t as likely to know about the drug. People of color are also less likely to have access to other insurance options or be able to pay out of pocket. “That, in and of itself, is a concern. If they never had access to it, I have to question why.”
Health care systems should also be promoting healthier lifestyles for all employees, including better food options and training, Sederstrom said.
“If we look at it from an equity perspective, we should be doing things besides figuring out how to pay drug companies for a ‘magic pill,’” she said.
Lonja Pasley, a dental assistant who is Black, discovered the drug through Hennepin Healthcare’s Great Slimdown program, an obesity treatment program that incorporates nutrition, lifestyle changes, physical activity, and medication therapy. She’s lost 50 pounds since she started in February, Pasley said, and it’s been life-changing.
“As of today I am 170 pounds,” she said. “I have energy, I’m not as fatigued, I’m not sore.”
In her pediatric dentistry work downtown Minneapolis, she needs to be able to bend and squat to work with kids. For the first time since gyms closed during the pandemic, she is able to do all of that. Pasley can also walk up three flights of stairs without getting winded, she said.
When she found out that Wegovy would no longer be covered, it was all she could talk about at home, she said.
“Before Wegovy, it was hard to get up in the morning from not being able to sleep due to back and knee pain,” she said. “Now, when you wake up in the morning you can get out of bed…it’s showtime again!”
The drug has worked so well, she said, that she’s willing to take it for the rest of her life.
“But to give me something that works and then say, I’m going to take it from you?” she said. “Obesity is a disease. It’s an epidemic. And it should be treated as such.”
Islam put it more bluntly: “Medicine doesn’t like fat people. We’re becoming more and more of a marginalized and stigmatized group.”
Lobbying for access
Smedberg, the employee point person, notes that Hennepin Healthcare isn’t the only healthcare system that’s dropping Wegovy, but that it may be the only place where employees are speaking up about it.
“Hennepin Healthcare is special; we are a safety-net hospital and care for the patients that other health systems don’t want,” she said. “We have the most diverse, vulnerable patient population with higher rates of homelessness, poverty, and so many other psychosocial issues and barriers than other hospitals… A lot of people choose to work at HCMC because they believe in the mission and values and want to work with patients that have the most barriers and need care the most. Unlike other hospitals HCMC has employees that aren’t afraid to speak up when something isn’t right.”
The employees’ goal is to restore coverage of the drug. But they’re also making their own individual plans for how to get by without it. They share tips that they’ve discovered, often with the help of their doctors. Some employees, like Pasley, have already started stretching out the time between injections from seven to 10 days, hoping to make their current supply last as long as possible. Others have looked into getting semaglutide from compounding pharmacies that sell custom-made medications
Some have talked to their doctors about whether they could change their dietary habits to raise their blood sugar levels enough to qualify for a drug classified to treat diabetes or pre-diabetes, which remain covered. Others are considering getting second jobs to pay for the drug out-of-pocket. One employee left for a job where he could continue to get coverage, Smedberg said. Pasley’s doctor looked through more than 10 years of her medical history to see if she could be considered prediabetic (no luck).
In the meantime, Sederstrom, the chief health equity officer, said that Hennepin Healthcare is encouraging legislators to pressure drug companies to lower the cost. “It just doesn’t make sense to continue to price-gouge Americans,” she said. “It feels a little like taking advantage of the fact that we have higher rates of obesity in our country. We need legislative support to say this is wrong for American people.”
If the price comes down to something the hospital system can afford, “there’s no reason it won’t go back on the formulary” of available medications, Sederstrom said. “We have never said we will never bring it back.”
*Update (December 13, 2023): This story has been updated with more recent weight loss numbers.
