Amid continued demand and coverage restrictions around GLP-1s, the prices of Novo Nordisk's Ozempic and Rybelsus have dropped significantly for individuals covered by Medicare and commercial insurance, according to a new report from HHS.
Currently, Medicare Part D does not cover GLP-1s when used solely to treat obesity, only for managing Type 2 diabetes. In March 2024, Wegovy was approved to address cardiovascular events in patients with either obesity or who are overweight and have cardiovascular disease. Shortly after, CMS issued guidance allowing Part D plans to cover anti-obesity medications if they are approved for additional health benefits and used for those conditions.
On Nov. 26, the Biden administration shared a proposal for Medicare and Medicaid to cover weight loss drugs for obesity. About a dozen state Medicaid programs already cover the drugs for that purpose.
It's estimated that 53% of U.S. adults, about 136.8 million people, are eligible for semaglutide (Ozempic, Rybelsus, and Wegovy) to treat Type 2 diabetes, obesity, and/or obesity-related heart conditions. If 50% of U.S. adults with obesity took a GLP-1 medication for weight loss, it would cost the nation $411 billion annually and bankrupt Medicare, according to the Senate Committee on Health, Education, Labor, and Pensions.
In 2024, the U.S. list price for a one-month supply is $1,349 for Wegovy and $968 for both Ozempic and Rybelsus, according to HHS. However, after payer negotiations and rebates, the net prices for Ozempic and Rybelsus have decreased in recent years. In 2024, the net price is $649 for Wegovy, $296 for Rybelsus, and $290 for Ozempic. In the U.S, net prices for GLP-1s are between 24% and 73% lower than list prices, indicating that most payers are paying less than the manufacturer's list price.
Since 2018, Ozempic's net price has fallen from $531 to $290, or 45%. Since 2020, Rybelsus' net price has dropped from $376 to $296, or 21%. In contrast, Wegovy's net price has increased 21% since 2021, rising from $534 to $649.
"In the net prices, we see evidence of the impact of competition as new drugs in the class enter the market," HHS wrote. "While list prices are consistently stable or increasing, for many of these drugs, including Ozempic, Rybelsus, Saxenda, and Victoza, net prices fell."
"In addition, the future path of prices of drugs in this class will be affected by the number of approved conditions for each drug, whether any of the drugs are selected for price negotiation by Medicare, and the number of new drugs that become available, including potential future new entrants into the market," the agency said.
Novo Nordisk introduced Ozempic as a diabetes treatment in 2018. In 2021, the company launched Wegovy as a treatment for obesity and Rybelsus in 2019 as an oral diabetes treatment.