Maja Smedberg is faced with a dilemma — she lost 30 pounds in five months with the help of a potent new appetite suppressant, but might gain it all back when her employer stops paying for the drug.

The social worker was among the employees who were stunned Monday when Hennepin Healthcare announced it was cutting Wegovy and other injectable weight-loss drugs from its health plan next year because of budget pressures. At more than $1,200 per month out of pocket, Smedberg can't afford the prescription on her own.

"It's devastating to get your hopes up and feel like, 'Hey, I can achieve a normal weight' with a life-changing medication and then be told that's not an option," she said. "Statistically, most people gain the weight back within five years if they go off the medication. I do intend to fight that in terms of not trying to regain the weight."

First, she and coworkers are going to fight her employer, urging it to maintain access to a medication that in months has improved their weight, health, self-image and happiness. Some felt duped, having only started the drug after joining Hennepin Healthcare's weight-loss incentive program, the Great Slim Down.

The dispute casts Hennepin Healthcare into a raging national debate about the costly medications in the GLP-1 class and whether they can reverse the worsening U.S. obesity epidemic. Minnesota's adult obesity rate has doubled since 2000 and surpassed 33% in 2022, according to federal health survey results.

Leaders of the urban, safety-net health system acknowledged they were caught off guard by the popularity of the drug — which has been widely promoted in ads and on social media. Hennepin Healthcare's decision was influenced by a $120 million budget gap for 2024 and a 20% increase in the cost of its Medica health plan without benefit cuts.

"We spent like $7 million on one drug, and that's a lot," said Dr. David Hilden, chairman of Hennepin Healthcare's medical department.

Hilden said its not just a money matter, because he fights for medications that his patients need, but there are questions about whether patients tolerate GLP-1 drugs and stay on them long enough to maintain the benefits. He sympathized with workers on the drugs at risk of losing access, especially if they haven't supplemented the medication benefits with healthy eating and fitness habits.

"I have to be honest, yes, they are at risk of putting weight back on," he said.

The cost-effectiveness of the drugs is an open question. Prime Therapeutics reported a 63% increase over the past year in spending on GLP-1 drugs by Blue Cross and Blue Shield of Minnesota, and a larger 83% increase among commercial insurers nationwide.

But the Eagan-based pharmacy benefits manager found that patients with obesity who were on the medications ended up costing more than comparable patients who weren't.

Clinicians like Natalie Ikeman are believers, having seen patients not only lose dramatic weight but attain healthy blood pressure and blood sugar levels.

"I have seen some people lose 20% to 30% of their total body weight," said Ikeman, a physician assistant with the Bhatti Weight Loss Center in Chaska and leader of the Minnesota Obesity Society. "This medication has been life-changing for hundreds of my patients."

Psychiatric nurse Steve Hoffer said Wegovy has been a "miracle" that helped him lose 30 pounds in four months. But it wasn't an easy choice to start, because he knew he would likely need to take the drug for life.

"I weighed that decision and thought, 'If it's covered ... at least I can afford it if I decide to take it,'" he said.

Wegovy was federally approved in 2021 for people who have obesity or health problems related to excess weight, but is identical to other drugs such as Ozempic that are approved to treat diabetes and offer weight loss as a side benefit.

Hennepin Healthcare is joining with other employers and government health plans that balked at the cost of these drugs for weight loss alone, but will pay for them if people have diabetes or are in the at-risk category of prediabetes.

Smedberg said her struggle began a decade ago when she took steroids for a medical issue that resulted in weight gain. The 36-year-old mother of two doesn't have diabetes, and is preparing to lose access to the medication unless she can persuade her employer to maintain it. Hennepin Healthcare is offering a weight management program and health coaches as one alternative.

Hoffer might not stick around. He said he doesn't have time to add more fitness activities to counteract the loss of the medication, because he is working, raising two children, and going to school to become a nurse practitioner. He said he isn't going to tolerate weight gain and a return to unhealthy blood pressure levels, so he will look for an employer that covers Wegovy.

"Do I have to become diabetic to get the medication?" he asked.

Manufacturer Novo Nordisk said Wegovy's high initial cost is necessary to recoup investments in drug research and development, but Hilden said it is needlessly high and forcing his health system to make cuts. Prices are four to 10 times lower in Europe and Canada. Hoffer pondered the ethics as a licensed nurse of traveling to Mexico or Canada to stay on the medication.

Smedberg previously lost 45 pounds — first through diet and exercise alone, and then with metformin, a low-cost drug that regulates blood sugar and offers less-dramatic weight-loss benefits.

Her doctor proposed Wegovy when Smedberg's weight loss plateaued. The drug nauseated her, and the loss of appetite was immediate.

"I'm not craving carbs and sweets and stuff like that," she said. "So I can eat a salad or less food in general and it helps me not feel hungry all the time."

Smedberg said the drug has brought her within 30 pounds of her healthy target, but won't have been worth it if the weight returns.

"Weight loss is very visible," she said, "and so other people see us gaining weight, losing weight. It affects self-esteem, confidence, how other people treat you."

The loss of access will hit workers in other ways. Julie Corrin, 44, has worked administratively in a Hennepin dental and oral surgery clinic, and lost more than 50 pounds following bariatric weight loss surgery in 2011. She gained some weight back when she suffered a back injury before the COVID-19 pandemic.

Corrin sought Wegovy after taking part in the Great Slim Down, and lost 60 pounds this year. She got rid of thousands of dollars of old clothes that became too loose, only to now realize she might need them again. She said she can't afford another wardrobe overhaul.

"I am already stressing out," she said, "and feeling really down just thinking about it."