Semaglutide Accessibility and Affordability Addressed at Senate Committee Hearing

The Senate HELP Committee held a hearing to address the high cost of semaglutide drugs, finding that many patients cannot afford them despite their potential benefits. | Image Credit: Corgarashu- stock.adobe.com

Today the US Senate Committee on Health, Education, Labor, and Pensions (HELP), held a hearing led by Sen. Bernie Sanders (I, Vermont), chairman of the committee, and ranking member Sen. Bill Cassidy, MD, (R, Louisiana), to address what they deemed the outrageously high prices of semaglutide (Wegovy, Ozempic).¹ The hearing focused heavily on the transformative weight loss drug achieved by patients with obesity and some with diabetes while explaining how most patients who receive prescriptions for the drugs are unable to access them.

Novo Nordisk, the drug manufacturer, came under scrutiny amid a BBC report that 72% of its revenue from semaglutide is from the US; Sanders cited data statistics that the company has made $50 billion in American sales since the drug hit the market in 2018. Novo Nordisk lists Wegovy at $1349 and Ozempic at $969 in the US, significantly higher than Canada ($265, $155), Denmark ($186, $122), and Germany ($137, $59), respectively.

Sanders addressed the potential Novo Nordisk has in saving the lives of thousands of Americans and improving their quality of life (QOL) if they make their drugs affordable in his opening statement.

“One out of four Americans are unable to afford the prescription drugs that their doctors prescribe,” said Sanders. “That means that millions of Americans go without the treatment that their doctors recommend.”

Sanders stated firmly that the inability to access lifesaving drugs leads to death; som patients become much sicker than they should, and many patients will unnecessarily end up in emergency department visits at the expense of our health care system.

Cassidy recognized that nearly 1 in 3 Americans lives with obesity while 1 in 10 has type 2 diabetes. While the US undoubtedly has greater health care costs compared with other countries, he added that it is important to highlight the costs of their health plans.

The senators recognized Lars Fruergaard Jørgensen, president and chief executive officer of Novo Nordisk, as the sole witness at the hearing who spoke on the prescription drug prices of semaglutide across each region. Jørgensen agreed that the development of medications like Wegovy and Ozempic are useless when the patients in need of the drugs the most are unable to access them.

He argued, “Ozempic is covered by 99% of all commercial plans, by Medicare and Medicaid in 50 states.” However, this statement is only true for patients diagnosed with type 2 diabetes depending on the insurance plan benefits, deductibles, and co-insurance or copays the consumer has.²

The senators stressed the high prices for semaglutide drugs were significantly greater for patients in the United States and focused on the various factors contributing to this issue.¹ It was evident the panel found the accessibility and affordability of these drugs has lifesaving impacts on various patient populations.

Low Income, Minority Families

The Senate committee heavily emphasized the high costs that directly impact low income households, especially patients who identify as Black or Hispanic. Sen. Ben Ray Luján (D, New Mexico) referenced a study published in JAMA Network Open that found 45.6% of the adult Hispanic population in the US had obesity incidence. Luján continued to argue that both the Black and Hispanic populations across the US have a greater risk of developing type 2 diabetes caused by obesity.

Luján went on to explain the median household income in New Mexico is around $62,268 annually and across the country, Hispanic households make an estimated $65,540 annually. Jørgensen pointed out a 40% reduction in list prices when patients are financially eligible, but Luján countered this after explaining the cost of the drugs represents a large portion of the households’ monthly income of most New Mexicans and Hispanic Americans.

Sen. Susan Collins (R, Maine) made an effort to address Novo Nordisk’s recent decision to remove levemir, a popular insulin drug from their shelves.³ Collins argued the abrupt switch for patients is alarming due to its effectiveness and affordability.¹

Despite Novo Nordisk’s claims of widespread coverage for formulations of semaglutide, many patients, especially those from low income and minority communities, are unable to afford these drugs. The committee’s focus on the disproportionate impact on marginalized populations underscores the critical importance of addressing health care disparities and ensuring that essential treatments are accessible to all.

PBMs

The panelists recognized the role of pharmacy benefit managers (PBMs) and referred to a prior Senate hearing that brought attention to rising prescription drug costs. Sen. Ted Budd (R, North Carolina) stated that PBMs favor drugs with higher list prices because it allows them to make more profit due to higher rebates. However, depending on how a health plan is structured, this can mean higher out-of-pocket costs for patients.

“PBMs are reimbursed based on a percentage of the drugs list price,” Budd stated. “That means, PBMs are going to make more money if they cover the higher price drugs.”

Jørgensen debated this statement and explained that Novo Nordisk has negotiated against PBMs to ensure their products were accessible to patients but says the company has no control over insurance coverage or the out-of-pocket costs. Jørgensen also stated the disinterest Novo Nordisk has in decreasing list prices for fear of PBMs removing them from formularies.

Sen. Maggie Hassan (D, New Hampshire) presented the hearing with evidence that challenged Jørgensen’s claims. Hassan found major PBMs such as Cigna Express Scripts, Optum Rx, and CVS Caremark, all agreed they would not harm formulary placements for semaglutide drugs if the net costs decreased or stayed the same.

The committee's ultimate focus remained on the exorbitant drug costs that create significant barriers to access medications for many Americans, especially among low income and minority communities. As the pharmaceutical industry continues to evolve, it is essential that policymakers and industry leaders work together to ensure that essential medications are affordable and accessible to all.

References

1. Hearing Before the US Senate Committee on Health, Education, Labor & Pensions; Why is Novo Nordisk Charging Americans with Diabetes and Obesity Outrageously High Prices for Ozempic and Wegovy? September 24, 2024. Accessed September 24, 2024. https://www.help.senate.gov/hearings/why-is-novo-nordisk-charging-americans-with-diabetes-and-obesity-outrageously-high-prices-for-ozempic-and-wegovy

2. Anderson LA. Will my insurance cover Ozempic? Drugs.com. April 11, 2024. Accessed September 24, 2024. https://www.drugs.com/medical-answers/insurance-cover-ozempic-3575100/

3. Aungst C. Levemir long-acting insulin discontinued: 5 questions answered. GoodRx. February 6, 2024. Accessed September 24, 2024. https://www.goodrx.com/levemir/insulin-discontinued