The steep prices — and popularity — of Ozempic and similar weight-loss and diabetes drugs could soon make them a priority for Medicare drug price negotiations. List prices for a month’s supply of the drugs range from $936 to $1,349, according to the Peterson-KFF Health System Tracker.
The Inflation Reduction Act President Biden signed in 2022 paved the way for the federal program to negotiate prices directly with drugmakers for the first time. But for now, the high price of Ozempic, Trulicity and other drugs in the class known as GLP-1 agonists have put them out of reach for many low-income patients.
Novo Nordisk’s Ozempic and Wegovy could be eligible for negotiation as early as 2025, said Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF. Lilly’s Trulicity may follow the next year.
Medicare shelled out $5.7 billion in 2022 for three popular GLP-1 drugs, up from $57 million in 2018, according to research by KFF. The “outrageously high” prices have “the potential to bankrupt Medicare, Medicaid, and our entire health care system,” Sen. Bernie Sanders (I-Vt.), who chairs the Senate Committee on Health, Education, Labor and Pensions, wrote in a letter to Novo Nordisk in April.
That spending will continue to skyrocket as the benefits of these drugs pile up. Medicare can’t cover the drugs for weight loss alone, but the program does cover them when prescribed to treat diabetes. Wegovy, a version of Ozempic, has also been approved to treat heart disease and the compound has shown promise in treating kidney disease.
The drugs are likely choices for Medicare haggling, according to the Congressional Budget Office.
But just how much will prices come down?
We’ll learn whether Medicare is a good bargainer in September, when the negotiated prices of the first 10 drugs selected for the process are published, Cubanski said.
While the negotiations will initially help only Medicare beneficiaries, other patients could see a benefit once prices are made public and drugmakers start feeling pressure. That’s what happened after the Inflation Reduction Act capped insulin prices for Medicare enrollees at $35 a month.
Another wild card? The winner of the November election. Biden’s been touting Medicare drug price negotiations on the campaign trail.
Trump talked a lot about driving down drug prices in his first term, but he eventually backed off letting Medicare negotiate. It’s unclear whether Trump would take on drugmakers — or his own party — during a second term.
Congressional Republicans voted against the IRA and some have put forward proposals to repeal it.
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