- The list prices for Ozempic, Wegovy, and other drugs prescribed for weight loss are much higher in the U.S. than in similar countries.
- Few people with insurance coverage of a drug pay the list price, but out-of-pocket costs vary.
- A bill introduced to Congress would provide Medicare coverage of anti-obesity drugs, which may spur private insurers to follow suit.
Anti-obesity drug Wegovy and diabetes drug Ozempic (both of which have skyrocketed in popularity for their ability to aid with weight loss) are priced much higher in the U.S. than in other, large high-income countries, according to an analysis released in August.
In its report, health policy organization KFF found that the average list price for these and similar drugs in the U.S. is roughly $1,000 per month, several times higher than in other countries.
KFF used website searches to compare list prices for four weekly shots or a 30-day supply of anti-obesity medications. Prices in other currencies were converted to U.S. dollars.
A month-long supply of Novo Nordisk’s diabetes drug Ozempic has an average list price of $936 in the U.S., reports KFF. This is more than five times higher than the next-highest list price — $169 in Japan.
Other countries have even lower list prices for Ozempic — $93 in the U.K., $87 in Australia and $83 in France.
Novo Nordisk’s Wegovy, which uses the same active ingredient semaglutide, has an average U.S. list price of $1,349, more than four times higher than Germany’s $328 list price.
The governments of some countries negotiate directly with pharmaceutical companies to set lower prices for medications, but the U.S. does not, which contributes to the large differences in list prices.
In a recent development, Medicare now has the ability to negotiate drug prices directly with drug makers, part of the Inflation Reduction Act signed into law last year.
The Biden administration announced on Aug. 29 the names of the first 10 drugs subject to Medicare price negotiations — none were treatments for obesity, which are currently not covered by the program.
Alison Sexton Ward, PhD, a research scientist at the USC Schaeffer Center, said it’s not unusual for drug list prices to be significantly higher in the U.S. than in other countries. This applies to a wide range of medications.
However, ”it’s uncommon for most people to pay the list price in the U.S.,” she told Healthline.
Manufacturer rebates and patient coupons may lower the out-of-pocket costs for patients.
For example, people with private insurance that covers Wegovy can save up to $225 per 28-day supply for up to one year through patient coupons. If their plan doesn’t cover Wegovy, they can save $500 per 28-day supply.
Pharmaceutical companies also provide rebates to pharmacy benefit managers (PBMs) and other intermediaries in the drug distribution system.
However, Ward said recent trends show that these rebates have been increasing, which has driven up list prices. On average, for each $1 increase in rebates, the list price increases by $1.17, according to research from the USC Schaeffer Center.
As a result, manufacturer rebates may not lead to lower out-of-pocket costs for consumers.
Currently, Medicare does not cover anti-obesity drugs. But the bipartisan Treat and Reduce Obesity Act introduced in Congress this year would expand Medicare Part D to provide coverage of approved medications for the treatment of obesity.
If this bill is signed into law, it could open up access to these drugs, not just for Medicare enrollees but also for people with other types of health insurance.
“A lot of people believe that if Medicare starts to cover these drugs, so will more of the private insurers,” said Ward.
In addition, “as you get more uptake of these drugs, the competition in the space will increase,” she said. “And that competition will drive down prices.”
Right now, access to anti-obesity medications in the U.S. is mainly limited to those who can afford the out-of-pocket costs.
Those costs vary, depending on a person’s health insurance, availability of patient coupons, and other factors. But for some people, the high costs can deter them from accessing these treatments.
“An individual who doesn’t have health insurance that covers anti-obesity medications — or other obesity treatments — will often pay high out-of-pocket costs,” said Cristy Gallagher, research project director of the STOP Obesity Alliance at George Washington University.
“And even if they do have insurance that covers these drugs, the copay on these medications are often higher, so people may end up spending a lot of their own health care dollars,” she told Healthline.
Ward is concerned that with the focus on list prices, the true value for society of treating obesity with these medications is getting lost.
She and her colleagues found that Medicare coverage of anti-obesity drugs would decrease the rates of related conditions, such as heart disease and diabetes. It would also save the program up to $245 billion in the first 10 years of coverage.
Gallagher thinks a wide range of obesity treatments need to be available to people, regardless of their health insurance.
“At the Stop Obesity Alliance, we really advocate for a full, comprehensive benefit to be available to all patients through their health insurance,” she said. “And that includes nutrition therapy, lifestyle changes, medication, and bariatric surgery.”
People whose insurance doesn’t cover Wegovy or other GLP-1s for weight loss have a few options to reduce their out-of-pocket costs.
This includes looking for patient coupons (like the one offered for Wegovy) that cover part of the cost of the drug for people with private health insurance. However, even at $500 off per month, a person’s out-of-pocket costs will still be significant.
Ward has also heard of people who have accessed these drugs at lower prices through compounding pharmacies, which hospitals use to produce specific medicines for patients.
Working with a reputable healthcare provider and compounding pharmacy is likely to be safe. But some experts have raised concerns that there are additional risks with less reputable compounding pharmacies or online retailers.
Although blockbuster medications such as Wegovy are currently in demand, other effective weight-loss treatments are available.
A qualified obesity medicine clinician can help people find other medicines or interventions, such as nutrition and exercise, that may work for them.
The list prices for anti-obesity drugs such as Wegovy and Ozempic are higher in the U.S. than in other large, high-income countries. However, experts say few people with insurance coverage pay the list price.
Currently, Medicare and many private insurers do not cover newer anti-obesity drugs. A bill introduced in Congress would expand Medicare coverage to include these treatments.
Patients coupons can lower the cost of anti-obesity drugs. Less expensive obesity are also available, including older medications and nutrition and exercise interventions.