In June 2021, the insurance coverage plan for North Carolina state staff was paying for 2,800 people to take weight-loss medication.

Final 12 months, it paid for practically 25,000. Medicines like Wegovy value the North Carolina State Well being Plan $100 million final 12 months, rising seemingly out of nowhere to characterize 10 % of its spending on prescribed drugs.

“That is one thing we by no means anticipated,” mentioned Dale Folwell, the state treasurer, whose workplace runs the well being plan.

Alarmed by the ballooning prices, the well being plan’s governing board voted on Thursday to end all coverage of medicines for weight reduction, together with Wegovy, which accounts for the overwhelming majority of its spending on weight problems medication. The plan will proceed overlaying variations of the medication for folks with diabetes.

Prior to now few years, appetite-suppressing medication have surged in recognition as a result of they’re terribly efficient in serving to sufferers shed extra pounds. Analysis suggests the drugs could pay for themselves and even get monetary savings in the long term, by stopping coronary heart assaults and strokes that result in big hospital payments.

However for the employers and well being plans that cowl most of the price of prescribed drugs, the invoice for these drugs is overwhelming — and now coming due. In current months, the University of Texas system and the hospital chain Ascension have stopped paying for the medication for his or her staff. People who proceed to cowl the medication are imposing new restrictions meant to chop prices. The Mayo Clinic, for instance, will now present a lifetime good thing about solely $20,000 for the medication for its staff.

Medicare, by comparability, doesn’t cowl drugs prescribed for weight reduction, however does cowl weight-loss surgical procedure.

In North Carolina, the vote on Thursday to finish protection gave the impression to be the primary within the nation by a state well being plan. The plan makes use of state funds to pay most prescription drug prices for 740,000 public staff, academics, retirees and their relations.

The state well being plan is in monetary misery. Final 12 months, its money place declined $250 million. The trustees who voted to finish protection mentioned that they had an obligation to do probably the most good for the most individuals.

“Our accountability as fiduciaries is to the state well being plan,” mentioned Rusty Duke, a trustee. “It is a small variety of people who we’re speaking about relative to all of the members.”

Protection of the drugs for weight reduction will finish on April 1 until a last-ditch deal might be reached to cut back prices.

To proceed taking the medication for weight reduction, sufferers must pay out of pocket. The drugs can value greater than $16,000 a 12 months with out insurance coverage protection — a frightening prospect for staff whose common annual wage is $56,000. Most sufferers regain the load they’ve misplaced in the event that they cease taking the medication.

In current weeks, state well being plan officers explored whether or not they might reduce prices by inserting restrictions on who might get the medication, however they had been advised they might not achieve this with out shedding $54 million in reductions this 12 months from the medication’ producers.

Jessica Uhrick-Rieger, a 44-year-old state worker, began taking Wegovy in October 2022. She has since misplaced 103 kilos and not has pre-diabetes. However she won’t be able to afford Wegovy’s sticker worth of $1,349 per thirty days.

“That’s greater than my mortgage,” she mentioned.

Mr. Folwell, the chair of the well being plan’s governing board, who didn’t vote on Thursday, has been outspoken concerning the plan’s unsustainable spending on weight-loss medication. (Exterior of his day job, he’s working as a Republican for North Carolina’s governor on a substance-over-style coverage platform.)

He talks concerning the dilemma dealing with the well being plan in easy-to-understand phrases: For instance, had the plan lined the drugs with out limits this 12 months, the price can be sufficient to pay for a 0.5 percent pay raise for all state staff. And he has sharply criticized Novo Nordisk, Wegovy’s producer, for what he calls worth gouging. The plan has been spending about $800 per thirty days per affected person for Wegovy, whereas sufferers are liable for a mean $37 month-to-month co-pay.

“I’m not questioning the efficacy of this,” he mentioned. “I’m questioning what we’re being charged.”

Allison Schneider, a spokeswoman for Novo Nordisk, known as the trustees’ determination to finish protection “irresponsible,” including that the corporate had been working with state well being plan officers to handle issues about value. “We don’t help insurers or bureaucrats inserting their judgment in these medically pushed choices,” she mentioned.

Some in North Carolina see a bitter irony in the truth that Novo Nordisk manufactures and packages Wegovy in Clayton, N.C. — only a brief drive from the federal government workplaces the place state well being plan officers attempt to determine tips on how to pay for the drug.

The corporate’s critics have known as consideration to the tens of tens of millions of {dollars} in incentives that Novo Nordisk has acquired from the state in addition to from the county the place its crops sit.

“It definitely provides insult to harm,” mentioned Ardis Watkins, government director of the State Workers Affiliation of North Carolina, a bunch that lobbies on behalf of state well being plan members. “Our financial local weather that has been made so enticing to companies to find right here is getting used to fabricate a drug that’s wildly marked up.”

Ms. Schneider mentioned Novo Nordisk employs greater than 2,500 North Carolinians and has poured greater than $5 billion in capital spending into the state.

State well being plan employees have been intently monitoring the expansion in Wegovy spending. A few 12 months in the past, it turned the costliest remedy for the well being plan, outpacing the plan’s longstanding prime expense, the blockbuster anti-inflammatory drug Humira.

“Wegovy swiftly was simply working free,” mentioned Sonya Dunn, a supervisor for the well being plan who routinely critiques stories displaying the plan’s prescription drug spending hitting new highs.

The North Carolina State Well being Plan has been extra lax than different employers and insurance coverage packages in the way it lined the weight problems medication. Till lately, sufferers might get protection with out supplying documentation that that they had the physique mass index or sure medical situations that the Meals and Drug Administration has authorized for eligibility for the drugs.

Workers on the plan pay month-to-month premiums starting from $25 for a person to $720 for a household. The plan has not raised premiums for members for seven years — a precedence, Mr. Folwell mentioned, to recruit younger staff to affix and keep in state authorities. Had protection of the weight-loss medication continued with out limits, well being plan officers had forecast that premiums would improve by $50 per thirty days subsequent 12 months.

Meghan Ray, a state worker who takes Wegovy, mentioned she was dissatisfied by the trustees’ vote. She began Wegovy two years in the past due to a medical situation that might jeopardize her eyesight if she weighs an excessive amount of. Since then, she has misplaced 32 kilos and stopped taking a blood-pressure remedy.

Ms. Ray, 41, who spoke on the board assembly on Thursday, mentioned she feared she must finally endure one other stomach-reduction surgical procedure that will be expensive for the state well being plan as a result of she didn’t have the cash to pay out of pocket for Wegovy.

“The state doesn’t pay me effectively sufficient for me to have the ability to afford that,” she mentioned in an interview. “It’s extra vital that I can afford fuel to get to work, or meals to feed my household.”

The board voted narrowly, 4 to three, to finish protection of the medication.

Wayne Fish, a trustee who voted in opposition to ending the protection, is himself a state worker, working in meals service in corrections. He mentioned he agonized concerning the trade-offs.

“These are laborious choices,” he mentioned. “We see the solvency of the plan and so forth, however these are folks’s lives, additionally. I don’t know if there’s a method to stability this.”