In a pivotal moment for drug pricing in the United States, senators questioned Novo Nordisk’s CEO, Lars Fruergaard Jørgensen a few days ago over the staggering difference in cost for GLP-1 drugs like Ozempic and Wegovy in the U.S. versus other countries. These drugs, initially developed for diabetes and now widely used for weight loss, have become emblematic of the skyrocketing prices of drugs in America. While these medications can be purchased for just a few hundred dollars a month in Europe, Americans are paying upwards of $1,000, often out-of-pocket.
At the heart of the Senate hearings was a chart that Sen. Bernie Sanders displayed, illustrating the price disparity. In countries like France, Canada and Germany, GLP-1 drugs are significantly more affordable. Sanders didn’t hold back: “Treat the American people the same way that you treat people all over the world. Stop ripping us off.”
Expensive GLP-1 Drugs
Jørgensen explained that U.S. drug pricing is a complex issue, heavily influenced by negotiations with pharmacy benefit managers (PBMs) and the structure of the American healthcare system. The crux of the issue lies in how the U.S. handles drug pricing compared to other countries. In countries like the U.K. or Germany, governments directly negotiate drug prices with pharmaceutical companies. The U.S. relies on a free-market system where pharmaceutical companies set the initial list price. From there, a labyrinth of negotiations, rebates and deals with PBMs complicate the process.
“Pharmaceutical companies in the U.S. can set prices as high as the market will bear,” says Geoff Cook, CEO of Noom. “There’s very little direct negotiation compared to other parts of the world, and the result is that patients pay the price.”
Acting as middlemen, PBMs negotiate drug prices on behalf of insurance companies and have been accused of prioritizing their profits over patient access. A recent Federal Trade Commission (FTC) investigation into the practices of these PBMs further highlights the complexity of drug pricing in the U.S. “It’s a system where pharmaceutical companies and PBMs both point fingers at each other, but the end result is that patients pay far more than they would in Europe or Australia,” adds Cook.
The Fallout for Patients
For many patients, especially those looking to use GLP-1 drugs for weight loss rather than diabetes management, the high prices and lack of insurance coverage can lead to major health setbacks. In the U.S., weight loss medications like Wegovy and Zepbound are often excluded from insurance coverage, leaving patients to bear the full brunt of the cost.
And while pharmaceutical companies like Novo Nordisk argue that their list prices are just starting points for negotiation, for those without coverage, the list price is often the reality.
“Many of my friends and I are paying out of pocket and can’t afford $1,000 or even $500 a month,” says GLP-1 patient Michelle Turner, who has struggled with both PCOS and weight management. “It feels like a luxury, not healthcare.”
Compounded Medications
Some online wellness platforms, like Ro, Noom and Hers, have begun offering compounded versions of semaglutide to patients. Cook say their compounded semaglutide comes from a 503B compounding pharmacy and costs around $149 per month—making it more accessible for those who can’t afford the branded versions of the drug.
However, this solution may not last long. Currently, the FDA permits the production of compounded GLP-1 medications due to a shortage of the drugs. This could change if the FDA determines that the shortage is over. “Once the shortage ends, patients could lose access to these affordable options overnight,” warns Cook.
A Complex Future for GLP-1s
As the debate over drug pricing unfolds, millions of patients wonder if affordable access to their medication will ever become a reality. Compounded medications may offer a temporary solution, but a long-term fix will likely require significant policy changes.
“We’re working with policymakers to ensure patients have affordable access to these drugs,” says Cook. “But we need systemic change to make that happen.”
For now, patients and advocates alike are watching Congress closely, hoping that the growing scrutiny on pharmaceutical pricing will lead to real reforms—and that the next time senators ask why GLP-1s are so much cheaper abroad, there will be a better answer.
