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WASHINGTON — Sen. Bernie Sanders said on Tuesday he had commitments from the nation's top pharmacy benefit managers that they would expand coverage of Novo Nordisk's popular diabetes and weight-loss medicines if the company lowered the list prices.
Sanders said in opening remarks at a hearing of the Senate Committee on Health, Education, Labor and Pensions, which he chairs, that he received the commitments from UnitedHealth Group's Optum, CVS Health's Caremark and Cigna's Express Scripts.
"I have received commitments in writing from all of the major PBMs (pharmacy benefit managers) that if Novo Nordisk substantially reduced the list price for Ozempic and Wegovy, they would not limit coverage. In fact, all of them told me they would be able to expand coverage for these drugs if the list price was reduced," he said.
The announcement preempts an argument pharmaceutical companies often make against reducing their list prices. They have said such cuts would lead to narrower coverage because pharmacy middlemen are incentivized to include expensive drugs on formularies because they lead to larger rebates.
Sanders criticized Novo Nordisk CEO Lars Jorgensen, the hearing's sole witness, on why his company charges Americans more than any other country for Ozempic and Wegovy, which can cost more than $1,000 a month in the U.S.
Semaglutide, a drug in the GLP-1 class that is marketed as Wegovy for weight loss and Ozempic for Type 2 diabetes, has been shown to help patients lose an average of 15% of their weight.
Sanders and other lawmakers have also been critical of the cost of Eli Lilly's rival drugs Mounjaro and Zepbound.
Ozempic and Wegovy carry U.S. list prices of $935.77 and $1,349, respectively, for a month's supply, far higher than the respective $59 and $92 price tags they carry in some European countries, Sanders noted.
Ozempic costs have decreased about 40% since launch while those for Wegovy have similarly declined for people who receive discounts, Jorgensen said.
The Danish drugmaker's CEO did not commit to cutting prices for either medicine when Sanders asked him if he would given the PBM commitments.
"I don't know under which conditions such a promise comes. I haven't seen any of that," said Jorgensen. He said he would collaborate with the PBMs and would be "happy to do anything that helps patients" but expressed skepticism over PBMs making the drugs more affordable.
He said 99% of U.S. commercial insurance plans now cover Ozempic and around half cover Wegovy. More than 80% of U.S. patients with insurance coverage for the drugs pay less than $25 for a month's supply and 90% pay less than $50, he added.
"It is not our intention that anyone should pay the list price," which he called merely the starting point for negotiations with pharmacy benefit managers and insurance companies.
Sanders said the net prices were still too high.
"Under your best case scenario, the price you are charging Americans for Ozempic is still nearly $600, that's with all of the rebates and all of the discounts, that's over nine times as much as people in Germany pay for the product," he said.
Contributing: Manas Mishra
