The Senate Health, Education, Labor and Pensions (HELP) Committee intensified scrutiny of pharmaceutical pricing as Committee Chair Bernie Sanders confronted Novo Nordisk CEO Lars Fruergaard Jorgensen over the pricing of semaglutide medications in the United States.
During the heated exchange, Sanders highlighted stark pricing disparities between the U.S. and other countries. Even after PBM rebates, Ozempic's net price remains around $600 monthly in the U.S. - nine times higher than in Germany. Similarly, Wegovy's estimated net price exceeds $800, more than 4.5 times its cost in Denmark.
Access and Coverage Challenges
The pricing issue has significant implications for public health. Over 190 million insured Americans lack coverage for semaglutide as a weight loss treatment. A coalition of 250-plus physicians has urged Congress to address affordability, warning that current pricing particularly affects low-income and minority patients.
Research suggests broader access to GLP-1 receptor agonists could save over 40,000 American lives. This impact is particularly significant given semaglutide's unique position as the first weight loss medication also approved for preventing major cardiac events in adults with cardiovascular disease and obesity.
Corporate Defense and Development History
Jorgensen defended Novo Nordisk's pricing strategy by outlining the company's extensive investment in development and manufacturing. He detailed a timeline spanning from early 1990s research through FDA approvals in 2017 for diabetes and 2021 for obesity treatment. The company has committed $30 billion to expand manufacturing capacity, primarily for GLP-1 medications.
The CEO emphasized current coverage statistics:
- 99% of commercial health plans cover semaglutide for diabetes
- 50% of commercial plans cover it for weight loss
- Coverage extends to Medicare, Medicaid in 50 states, VA, military, and federal employees
- 80% of insured Americans access these medications for $25 or less per prescription
PBM Role and Pricing Complexity
The hearing revealed complex dynamics between manufacturers, PBMs, and insurers. Jorgensen noted that Ozempic's net price has decreased 40% since its 2018 launch, while PBMs and insurers have nearly tripled their profits. He emphasized that final patient pricing is determined by insurance companies, not Novo Nordisk.
Potential Breakthrough
A significant development emerged when Sanders presented written commitments from the three largest PBMs stating they would maintain access if list prices were reduced. This new information prompted Jorgensen to agree to discussions with PBMs and Senate leadership about potential price reductions.
Congressional Perspectives
The hearing revealed divided congressional opinions. Some Republicans, including Sen. Roger Marshall and Sen. Mitt Romney, directed criticism toward PBMs rather than Novo Nordisk. Marshall highlighted that PBMs consume 76% of profits in the system, while Romney emphasized the challenge of balancing innovation investment with price control.
Looking ahead, semaglutide for diabetes could face Medicare price negotiations in the next round, potentially affecting its market dynamics and accessibility. The outcome of planned discussions between Novo Nordisk, PBMs, and Senate leadership could mark a turning point in U.S. pharmaceutical pricing strategies.
