Senate Probes Cost, Coverage of Popular Weight Loss Drugs, Ozempic and Wegovy

Sen. Bernie Sanders (I-Vt.) announced on Sept. 24 that the nation’s top pharmacy benefit managers (PBMs) will expand coverage for Ozempic and Wegovy if the company behind the popular diabetes and weight-loss drugs lowers the list prices. Sanders’ announcement was made during Senate hearings Tuesday on the high cost of popular drugs Ozempic and Wegovy.

As part of the Senate’s investigation into the affordability of the two drugs, prescribed for millions of patients for weight loss or diabetes management, Sanders reassured the drug manufacturer that it would not be penalized by leading PBMs for lowering the list price of the medications.

PBMs are the middlemen between drug manufacturers and insurance providers. They negotiate drug prices and control which drugs are listed on formularies—lists of prescriptions covered by insurance plans.

Although in theory PBMs should lower drug prices, critics say that PBMs actually lead to increased list prices of drugs as drug manufacturers hike list prices to offset discounts or rebates offered in exchange for a place on PBM formularies. Higher list prices mean bigger rebates, and therefore more profits, for the middlemen.

The major PBMs are CVS Caremark, Express Scripts, and Optum Rx. They make up almost 80 percent of the PBM marketplace.

Manufactured by Denmark-based pharmaceutical company Novo Nordisk, Ozempic and Wegovy contain the same active ingredient: semaglutide. Ozempic is FDA-approved to treat Type 2 diabetes and cardiovascular risk in some patients.

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Wegovy—which has a higher maximum dose and comes in a single use injectable pen—is FDA-approved for weight loss and reducing cardiovascular risk in overweight adults.

“I am delighted to announce today that I have received commitments in writing from all of the major PBMs that if Novo Nordisk substantially reduced the list price for Ozempic and Wegovy, they would not limit coverage,” Sanders said during a hearing held by the Senate Health, Education, Labor and Pensions Committee.

“In fact, all of them told me they would be able to expand coverage for these drugs if the list price was reduced,” said Sanders, chair of the committee.

Sanders called the affordability of the drugs “a profound moral issue.”

“One out of four Americans are unable to afford the prescription drugs that their doctors prescribe,” he said, citing the Kaiser Family Foundation.

“That means that millions of Americans go without the treatment that their doctors recommend,” said Sanders. “The result: some will actually die, and others will become much sicker than they should, and millions will unnecessarily end up in emergency rooms or hospitals at great expense to our healthcare system.”

Higher List Prices in US

Without insurance, a 28-day supply of Wegovy costs just over $1,349, while a similar supply of Ozempic costs around $969.

“It is not our intention that anyone should pay the list price,” said Jorgensen.

“The list price is the starting point for our negotiation against the PBMs and insurance companies in bringing coverage of our medicines to patients,” he continued.

Nonetheless, net prices are expensive, responded Sanders.

“Even factoring in all of the rebates that PBMs receive, the net price for Ozempic is still nearly $600, over nine times as much as it costs in Germany, and the estimated net price of Wegovy is over $800, nearly four and a half times as it costs in Denmark,” he said.

Sanders repeatedly asked Jorgensen why drug prices are higher in the United States than elsewhere.

“Please tell me why you think it is appropriate to charge Americans nine times more for the same exact product that you sell in Germany,” Sanders asked the Novo Nordisk CEO.

In response, Jorgensen said, “I think it’s important to say that these are not comparable data.” Most Americans with insurance have access to the medicine at $25 or less for a month’s supply, he said, adding, “It’s the price point at the pharmacy counter we have to talk about.”

When Sanders countered that Americans may not be paying the price directly at the pharmacy, but are doing so indirectly in the form of higher insurance premiums, Jorgensen said that “Premiums have not gone up … while profit goes up for the middleman.”

Jorgensen declined to make immediate assurances that he would work with PBMs to lower the prices of the drugs.

“I don’t know under which conditions such a promise comes. I haven’t seen any of that,” he said, adding that he would be “happy to do anything that helps patients.”

Assurances from PBMs

UnitedHealth Group, the parent company of Optum Rx, told Sanders in a letter, obtained by The Epoch Times, that OptumRx would not limit access or give less-favorable treatment toward Ozempic and Wegovy if their list and net prices decreased.

“We prioritize our choices based on the evidence supporting medical appropriateness and lowest net cost,” wrote UnitedHealth Group CEO Andrew Witty in the letter.

“We believe list prices for medicines are too high and support policy solutions and manufacturer actions that lead to lower list prices,” he said. “Assuming the net price remains the same or lower, a manufacturer lowering a medicine’s list price would not lead to less favorable formulary placement by Optum Rx—particularly for high-demand drugs like Ozempic and Wegovy.”

In her letter to Sanders, Melissa Schulman, senior vice president for government and public affairs at CVS Health, also said that her company would not have a less-favorable formulary placement for Ozempic and Wegovy.

She said that “when Novo-Nordisk drastically reduced the price of their insulin, Novolog, in 2023, it did not result in a less favorable formulary placement with Caremark.”

“There is simply no way for our clients to make these drugs available to everyone who will eventually qualify at their current price points,” she added.

This year, Nova Nordisk withdrew from Express Scripts’ Patient Assurance Program, which caps drugs covered under the program at $25, $50, and $75 for 30-day, 60-day and 90-day prescriptions, respectively.

Anti-Trust Complaint

On Sept. 20, the Federal Trade Commission (FTC) announced it had brought an antitrust complaint against Express Scripts, CVS Caremark, Optum Rx and other groups “for engaging in anticompetitive and unfair rebating practices that have artificially inflated the list price of insulin drugs, impaired patients’ access to lower list price products, and shifted the cost of high insulin list prices to vulnerable patients.”

Rahul Rao, deputy director of the FTC’s Bureau of Competition, said in a Sept. 20 statement that medication gatekeepers “have extracted millions of dollars off the backs of patients who need life-saving medications.”

The Epoch Times reached out to Express Scripts, CVS Caremark, and Optum Rx for their reaction to Sanders’ announcement and to the lawsuit.

David Whitrap, vice president of external affairs at CVS Health, told The Epoch Times that the FTC suit against CVS Caremark “has missed the mark entirely.”

“Three brand drugmakers control nearly the entire insulin market, and without competitive lower cost generic alternatives, they raised their list prices by as much as 500 percent in lockstep with one another prior to 2012. That’s when CVS Caremark fueled increased competition by creating new formulary options to fight back against these manufacturer price hikes,” he said.