Peterson-KFF publishes the US-versus-peer-country price gap for semaglutide

A August 2023 analysis from the Peterson-KFF Health System Tracker compared list prices for semaglutide and tirzepatide drugs in the US against prices in other large, wealthy countries. The report found that a one-month supply of Ozempic cost $936 in the US, more than five times the $169 price in Japan, and about ten times the price in Sweden, the United Kingdom, Australia, and France ^[1].

The gap was similar for other GLP-1 drugs. Wegovy, which contains the same active ingredient as Ozempic but is approved for weight loss, listed at $1,349 a month in the US compared with $328 in Germany and $296 in the Netherlands ^[1]. Rybelsus, the oral tablet form of semaglutide, was priced at $936 in the US, more than four times the $203 price found in the Netherlands ^[1]. Mounjaro, tirzepatide made by Eli Lilly, listed at $1,023 in the US versus $444 in the Netherlands and $319 in Japan ^[1].

The researchers pulled these figures from list prices posted online as of mid-August 2023, using the manufacturer's own pricing pages in the US and government or pharmacy pricing sources abroad, converted to US dollars using June 2023 exchange rates ^[1]. List prices are not what most patients or insurers actually pay, since manufacturers offer rebates to insurers and coupons to patients. The report noted that privately insured US patients could get Wegovy coupons worth $225 per 28-day supply for up to a year if their plan covers the drug, or $500 per supply if it does not ^[1].

The analysis also pointed to a demand-side factor that could magnify the US price gap's effect on total spending: the US has by far the highest rate of obesity among the countries studied. About a third of US adults, 33.5%, have obesity, compared with an average of 17.1% across the peer nations in the comparison, and Canada, Australia, and the UK all report lower rates ^[1]. KFF polling cited in the report found roughly half of US adults said they would be interested in taking prescription weight-loss drugs, though interest fell when a drug was not covered by insurance or when people heard weight might return after stopping ^[1].

Why it matters for patients

The price gap documented in this report has become one of the most frequently cited data points in the US debate over how insurers, employers, and government programs should handle GLP-1 drugs. Because Medicare is not currently allowed to cover weight-loss drugs under federal law and Medicaid coverage varies by state, what a patient pays out of pocket in the US can depend heavily on their specific insurance plan and whether that plan negotiates rebates or offers manufacturer coupons ^[1]. The report also flagged unresolved questions that affect how these price gaps translate into real costs for patients: research on long-term health effects was still emerging as of the report's publication, and it remained unclear whether patients would need to take these drugs indefinitely or alongside other treatments ^[1]. Supply shortages tied to rising off-label weight-loss use were also affecting availability in some countries; Wegovy was not available in Australia or in most European Union markets at the time of the report ^[1].

What happens next

The report's authors noted that the overall effect of these drugs on US health spending will depend not only on list prices but on net prices actually paid after rebates and coupons, and on how many people ultimately use the drugs ^[1]. The report did not include a timeline for when net pricing data or long-term coverage decisions would become available, and it is not yet known from this source how insurer and Medicaid coverage policies have evolved since publication.