More than 40 000 Americans risk dying if Novo Nordisk doesn’t lower the prices of its diabetes and weight-loss drugs Ozempic and Wegovy, according to US Senator Bernie Sanders in a hearing last week.
It was the latest in a series of hearings Sanders has led with pharmaceutical company CEOs about the price of medicines in the US, which are higher – often by multiple times – than in other wealthy countries.
But perhaps no drugs have garnered more attention than Novo Nordisk’s Ozempic, approved for diabetes, and its sister drug, Wegovy, for weight loss and reduction of heart risk, reports CNN.
The medicines, also referred to as GLP-1s for the hormone they mimic, are now used by millions of Americans but are still unaffordable and out of reach for many.
Sanders, who launched an investigation of Novo Nordisk in April over what he called “outrageously high prices” for the medications in the US, has focused on the drugs’ comparative cost in other countries.
He noted that the list price for a four-week supply of Ozempic is $969 in America, but the drug can be purchased for $155 in Canada, $122 in Denmark and $59 in Germany. Similarly, Wegovy’s list price is $1,349 in the US, but it costs $186 in Denmark, $140 in Germany and $92 in the United Kingdom, he said.
Last Tuesday’s hearing boiled down to a familiar argument over who is responsible for the US’ higher prices: drug companies that set starting – or “list” – prices, or pharmacy benefit managers, the middlemen who negotiate discounts on those list prices in exchange for favourable insurance coverage and access.
“From a moral perspective, does it bother you knowing that keeping the price of Ozempic and Wegovy so high in the United States could lead to the preventable deaths of tens of thousands of Americans?” Sanders, chairman of the US Senate Health, Education, Labour and Pensions Committee, asked the Danish drugmaker’s CEO, Lars Fruergaard Jorgensen.
“We are very committed to making sure that Americans have access at an affordable price point for our medicines,” Jorgensen replied. “There’s no thing we would rather see happen.”
He added that Novo Nordisk pays back about 75% of its medicine sales in rebates, discounts and fees, so the net price it receives is far lower than the list price.
And he argued that when Novo Nordisk has lowered list prices in the past, it has been penalised by PBMs that profit from discounts, or rebates, on higher prices, in the form of reduced access for patients to its medicines.
The Pharmaceutical Care Management Association, the PBMs’ industry group, accused Jorgensen, in a statement, of trying to shift attention from drugmakers’ moves that keep costs high.
During the hearing, Sanders announced that the committee had obtained written pledges from the largest PBMs to maintain access to Ozempic and Wegovy if Novo Nordisk lowered list prices. The committee simultaneously issued a report about Novo Nordisk’s pricing titled in part: “Greed, greed, greed.”
“That’s new information for me,” Jorgensen told Sanders of the PBMs’ pledges during the hearing. “Anything that will help patients get access to affordable medicine we’ll be happy to look into.”
He said, though, that when his company had lowered the price of some insulins in the past, “we had our products dropped from formulary coverage, so less patients got access to those insulins”.
“So I have a bit of concern over how this could play out.”
PBMs themselves have been under fire for their role in drug pricing, specifically over the cost of insulin; last week, the Federal Trade Commission sued the three largest – CVS Health’s Caremark, Cigna’s Express Scripts and UnitedHealth Group’s Optum Rx – alleging that they excluded available insulin products with lower prices from coverage in favour of higher-priced insulins that provided higher rebates.
Concerns over insulin
But while access to insulin is bringing heat to PBMs, it was also the subject of a line of questioning to Jorgensen on Tuesday; Novo Nordisk is one of the three largest manufacturers of the lifesaving drug in the world, along with Eli Lilly, which also makes Ozempic and Wegovy’s biggest competitor drugs, Mounjaro and Zepbound.
Multiple senators questioned Jorgensen over Novo Nordisk’s recent announcement that it would stop manufacturing a specific insulin, Levemir, which patients have argued is a critical product they continue to need.
“Any decision to take a product off the market is a very, very difficult decision, and I have to explain why we had to do that,” Jorgensen said.
“Last year, we reduced the price for Levemir; we dropped the price, yet to find that PBMs dropped access to Levemir, so fewer patients have access to it. … The reality is that the market is disappearing for Levemir because of how it’s contracted.”
Jorgensen said Novo Nordisk has “followed up with” other potential manufacturers of the medicine, “but we have not found anyone interested in manufacturing it.”
Asked whether Novo Nordisk was shifting manufacturing capacity to the more profitable Ozempic and Wegovy from older insulin products, Jorgensen responded, “we are as committed to insulin as we have always been”.
CNN article – ‘Greed, greed, greed’: Sanders demands Ozempic maker lower prices (Open access)
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