Key TakeawaysA U.S. Senate panel criticized Novo Nordisk for the high prices of Ozempic and Wegovy.Novo Nordisk CEO blamed high prices on industry middlemen known as pharmacy benefit managers (PBMs), saying that these intermediaries have the power to remove drugs from their formularies in response to a price cut.Senator Bernie Sanders said that he had written commitments from major PBMs to protect access to the drugs if the list price is reduced.

Key Takeaways

A U.S. Senate panel criticized Novo Nordisk for the high prices of Ozempic and Wegovy.Novo Nordisk CEO blamed high prices on industry middlemen known as pharmacy benefit managers (PBMs), saying that these intermediaries have the power to remove drugs from their formularies in response to a price cut.Senator Bernie Sanders said that he had written commitments from major PBMs to protect access to the drugs if the list price is reduced.

Last week, a U.S. Senate panel questioned Novo Nordisk’s top executive about the high price of the company’s blockbuster obesity and diabetes medications, Ozempic and Wegovy.

Novo Nordisk CEO Lars Fruergaard Jørgensen appeared before the Senate Health, Education, Labor, and Pensions Committee to explain why the drugs cost much more in the United States than in other countries.

The committee stated that the current list price for Wegovy is $137 per month in Germany and $92 in the United Kingdom, compared to $1,349 in the U.S.

Inhis opening statements, Sanders said he received written commitments from major “pharmaceutical middlemen”—including UnitedHealth Group’s Optum, CVS Health’s Caremark, and Cigna’s Express Scripts—that they would not limit access to Ozempic and Wegovy if the drugmaker lowered their list prices.

Wegovy vs. Ozempic: How Are They Different?

Who Are the ‘Middlemen?’ Meet PBMs

Pharmacy benefit managers (PBMs), often called “middlemen,” act as intermediaries between health insurance plans, drug manufacturers, and pharmacies.

But Sanders disagreed, stating, “If Novo Nordisk substantially reduced the list price for Ozempic and Wegovy, they would not limit coverage. In fact, all of them told me they would be able to expand coverage to these drugs if the list price was reduced.”

Throughout the meeting, Jørgensen expressed doubt that PBMs would continue to include Wegovy and Ozempic on their formularies if the list prices were cut.

When asked for a commitment to lowering list prices, Jørgensen said that Novo Nordisk would “be happy to do anything that helps patients” but that “the experience we have is one of losing access when we lower price.”

The majority of committee members recognized the need for pharmaceutical companies to gain revenue to support research and development, but they also expressed frustration that the U.S. drug pricing system gives so much power to PBMs.

How to Quality for an Ozempic Prescription

Why Does Insurance Coverage Fall Short?

“It is not our intention that anyone pays the list price,” said Jørgensen.

Jørgensen added that nearly all U.S. commercial insurance plans now cover Ozempic and around half cover Wegovy. More than 80% of U.S. patients with insurance coverage for the drugs pay less than $25 for a month’s supply. Novo Nordisk also offers Ozempic for free to people who make less than 400% of the annual poverty line—which is $120,000 per household.

Still, many people don’t have an insurance plan that covers the drugs well—if at all. People who are uninsured or have a high-deductible plan are still paying the full list price. If they have a co-payment, the price that a patient pays will be based on the list price of the drug, not the net price.

Senator Ben Ray Luján said that Black and Hispanic communities in the U.S. have higher rates of obesity and type 2 diabetes and also have lower median household incomes, which only worsens the divide in access to these potentially life-changing treatments.

What About Insulin and Medicare Price Negotiation?

Several senators questioned Jørgensen about the company’s decision to stop producing Levemir, a long-acting insulin to treat type 1 and type 2 diabetes. Novo Nordiskremoved the drug from the marketin February of this year.

Inhis testimonyon Tuesday, Jørgensen said that slowing demand for Levemir made it unprofitable for the company to continue making the drug.

Senator Hassen emphasized that some patients, including many pregnant people, who opted for Levemir no longer have the option.

Jørgensen said that Novo Nordisk would be willing to work with other manufacturers if they want to make Levemir but that no companies have yet to express interest.

Last month, theCenters for Medicare and Medicaid Security announcedthe results of their first round of drug price negotiations. The timing was of interest to those who are waiting to see if there’s any chance of popular anti-obesity drugs being included.

In astatementreleased before the hearing, Jørgensen said that it was likely Ozempic would be targeted for its next round of negotiations. When asked if he would commit to not presenting legal challenges to negotiations, Jørgensen repeated the concern that lower list prices would cause PBMs to avoid including the drug on their formularies.

“If it is a real negotiation, I support that,” said Jørgensen. “But if it’s price setting, I think it will have unintended negative consequences” for patients’ access and for innovation.

Experimental Oral Drug Shows ‘Remarkable’ Weight Loss, Novo Nordisk Says

What This Means For YouIf you rely on medications like Ozempic or Wegovy, ongoing discussions about pricing could affect your future costs. Keep an eye on policy changes and explore available patient assistance programs to potentially reduce your drug costs.

What This Means For You

If you rely on medications like Ozempic or Wegovy, ongoing discussions about pricing could affect your future costs. Keep an eye on policy changes and explore available patient assistance programs to potentially reduce your drug costs.

1 SourceVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Senate Committee on Health, Education, Labor and Pensions.MEDIA ADVISORY: Sanders to lead HELP Committee hearing on outrageous Ozempic and Wegovy prices with Novo Nordisk CEO.

1 Source

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Senate Committee on Health, Education, Labor and Pensions.MEDIA ADVISORY: Sanders to lead HELP Committee hearing on outrageous Ozempic and Wegovy prices with Novo Nordisk CEO.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Senate Committee on Health, Education, Labor and Pensions.MEDIA ADVISORY: Sanders to lead HELP Committee hearing on outrageous Ozempic and Wegovy prices with Novo Nordisk CEO.

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