The blockbuster weight-loss drugs Wegovy and Ozempic are arguably as omnipresent in the American zeitgeist as Taylor Swift or the iPhone. The drugs and others in its class are associated with the sparkle of Hollywood, on the lips of Oprah and considered transformative by doctors.
But the giant market for drugs like Wegovy, including not just the roughly 11% of adults who have diabetes but also the 42% of adults who have obesity, has conjured one of the demons of American healthcare – price.
Americans paid 10 times more for Ozempic than patients in the United Kingdom in 2023 – $936 a month compared with $93. Wegovy costs Americans $1,349 a month, compared with $296 in the Netherlands (the drug is not yet available in the UK).
That wild discrepancy has captured the attention of one of the drug industry’s loudest critics, the US senator Bernie Sanders.
“Prices vary all over the world, but we are paying far, far, far more for the same products than other countries,” Sanders told the Guardian in an interview. “And that is unacceptable to me.”
Sanders, an independent from Vermont and chairman of the powerful Senate health, education, labor and pensions (Help) committee, has used his pulpit to haul pharmaceutical executives before the public and demand lower prices.
Although it’s hardly akin to the drug negotiation programs imposed by America’s peer nations – where companies bargain with the government for access to universal health programs – the committee has lowered the prices on both asthma inhalers and insulin.
“What we’re focusing on right now is what may end up being one of the best-selling pharmaceutical products in the history of humanity, and that is Ozempic and Wegovy,” said Sanders. “These are very important gamechangers helping people with diabetes and obesity.”
Sanders is preparing to square up against the chief executive of the Danish pharmaceutical giant that makes both drugs, Novo Nordisk. Under threat of subpoena, its CEO, Lars Fruergaard Jørgensen, agreed to testify before the same committee in September. But even for Sanders, the challenge is formidable.
“You’re taking on a company which will make billions of dollars every single year, many billions of dollars from the US, on just this product,” said Sanders. “So, do I think this is going to be a difficult challenge? I do.”
In response to questions from the Guardian, a Novo Nordisk spokesperson said Fruergaard Jørgensen, “[looks] forward to discussing solutions that ensure access and affordability for all patients within the complex US healthcare system”.
The class of medications that includes Wegovy are called glucagon-like peptide-1 agonists or GLP-1s. The drugs can help people lose up to 15% of body weight, which makes them potentially appealing to a large portion of the 42% of American adults the Centers for Disease Control and Prevention (CDC) says are obese.
“It’s been transformational in the management of obesity,” said Dr Scott Hagan, an assistant professor of internal medicine at the University of Washington School of Medicine who researches obesity. “There’s just a lot more interest in weight management from patients because these drugs are now available.”
Arguably the last drugs to court a market this size were statins, introduced in the 1980s to control cholesterol, and which are now prescribed to 47 million Americans. With monopoly protections and explosive market potential, researchers worry GLP-1s have the potential to “bankrupt” the American health system.
“These drugs are really expensive for a huge patient population theoretically for the rest of their lives,” said health economist Melissa Barber, a postdoctoral fellow with a joint appointment at Yale University’s School of Law and School of Medicine.
If half of all people with obesity in the US took the drugs, it would cost roughly $411bn a year – more than the $406bn Americans spent on all retail drugs in 2022.
Already, GLP-1 agonists account for 9% of all private insurance drug spending and have the potential to be the costliest drug category within three years, according to the health analytics company Nomi Health. Novo Nordisk says roughly 25,000 new people try the drugs each week and 6% of all American adults are already taking them, according to a survey by Kaiser Family Foundation.
One US state has thus far buckled under the financial strain. The state of North Carolina dropped GLP-1 agonists from its employee insurance plan in March, citing the potential for monthly premiums to double for the 740,000 people the state insures.
This is happening as use remains constrained by manufacturing capacity, spotty insurance coverage and expense. Some people also have difficulty tolerating the side-effects of the medications. Nausea, vomiting, diarrhea, constipation and “Ozempic face” – a hollowed appearance, sunken eyes and changes to the size of lips, cheeks and chin possible with any GLP-1 – can dissuade some. Notably, as the drugs are new, long-term side-effects are still unknown.
At the same time, researchers argue companies don’t need to force existential financial choices. Barber led an investigation published in JAMA Network Open that “blew up” this March. Her analysis found GLP-1 agonists could be manufactured for as little as $0.89 per weekly dose, not including research and development costs, for humanitarian organizations and low-income countries.
The price of GLP-1 drugs “is forcing us to realize that the extension of the logic we have afforded to many drugs would result genuinely in the bankrupting of Medicare and Medicaid”, Barber said, referring to the public programs that jointly insure more than 116 million Americans.
“The cost being charged to other countries is quite important, because even if I’m wrong, and I don’t think I am, it’s not a charity. It’s clearly prices that are sustainable.”
Like many drugs, the early development of GLP-1 agonists happened in the public sector. The US Veterans Affairs endocrinologist Dr John Eng discovered a hormone he called “extendin” in the venom of gila monsters – large lizards native to the American south-west – after he learned the reptiles slowed down their metabolism and maintained blood sugar levels in response to long periods without food.
Eng licensed the discovery to a pharmaceutical company to bring the first GLP-1 to market in 2005, a drug that was approved to help treat type 2 diabetes. Wegovy represents the leading brand name of a second generation of GLP-1 agonists – one among 10 on the market, three to treat obesity and 51 in clinical trials.
Still, GLP-1 agonists are available to only a slice of the Americans people who might like to try them, to say nothing of the hundreds of millions of adults with diabetes who live in low- and middle-income countries.
Without the ability to meet market demands in the US, Nordisk has not even marketed the drugs elsewhere, Barber said. The demand for GLP-1 agonists in the US is so profound that it appears to be impairing insulin pen availability in at least one lower-income country.
Nordisk recently ended its 10-year contract with South Africa to supply multi-use insulin pens for about $2 each. South Africa’s health department procurement specialist accused the company of shifting focus to more profitable weight-loss drugs. Novo Nordisk said it is increasing production of vials of insulin with a focus on South Africa.
