Analysis finds US list prices for semaglutide far above peer nations

On August 17, 2023, the Peterson-KFF Health System Tracker published a comparison of list prices for semaglutide and tirzepatide in the United States and other large, high-income countries. It found that a month of the same medicine costs several times more in the US than in peer nations ^[1].

The analysis put the US list price for a month of Ozempic (semaglutide injection, 1 mg) at $936, compared with $169 in Japan, $144 in Switzerland, $103 in Germany and the Netherlands, $96 in Sweden, $93 in the United Kingdom, $87 in Australia and $83 in France ^[1]. Rybelsus, the oral tablet form of semaglutide, was also listed at $936 a month in the US for the 7 mg dose, against $203 in the Netherlands, $158 in Canada, $147 in Switzerland, $103 in Sweden and $69 in Japan ^[1].

Wegovy, the same molecule approved for weight loss, had a US list price of $1,349 for a month at the 2.4 mg maintenance dose, compared with $328 in Germany and $296 in the Netherlands ^[1]. Mounjaro (tirzepatide, 15 mg) was listed at $1,023 in the US, compared with $444 in the Netherlands and $319 in Japan ^[1].

Peterson-KFF said the prices came from website searches as of August 15, 2023, and were converted to US dollars using exchange rates as of June 30, 2023 ^[1]. Some drugs were not sold in every country studied. Wegovy was available in only a few European Union markets and not in Australia at that point, and Mounjaro had not been recommended in the United Kingdom ^[1].

List prices are not net prices

The authors wrote that list prices are not necessarily the net prices paid, because manufacturers provide rebates to insurers and coupons to patients. Private insurers and employers in the US may be able to negotiate lower prices or larger rebates ^[1]. As an example, the analysis cited Wegovy coupons of $225 per 28-day supply for up to one year for privately insured patients whose plan covers the drug, or $500 per 28-day supply if their private plan does not cover it ^[1].

The brief also noted that the US has by far the highest obesity rate among the countries compared: about a third of US adults (33.5%) have obesity, against an average of 17.1% across peer nations ^[1]. KFF polling cited in the analysis found that about half of US adults would be interested in taking prescription weight-loss drugs, though interest fell if the drug was not covered by insurance or after people heard that patients might regain weight after stopping ^[1].

Why it matters for patients

The listed price is the starting point for a prescription, not the amount most patients pay. What someone actually owes depends on whether their health plan covers the drug, how the plan designs cost sharing, and whether they qualify for a manufacturer coupon or rebate ^[1]. That means two people on the same drug in the same city can face very different bills.

Coverage rules also vary widely. Under current law, Medicare is not allowed to cover drugs prescribed for weight loss, and Medicaid coverage differs by state. Private insurers and employers were still deciding whether and how to cover these drugs when the analysis was published, and Peterson-KFF said coverage and cost sharing would likely vary by health plan ^[1].

The brief said research on long-term health effects and side effects is still emerging, and it is not clear whether patients would need to take these drugs for the rest of their lives or alongside other treatments ^[1]. It also said it remains to be seen what share of the cost of weight-loss drugs will be paid by patients versus insurers ^[1].

Higher US prices combined with higher obesity rates could mean a larger effect on overall US health spending than in peer countries, the authors wrote ^[1]. Cost figures for doses other than those analyzed, and net prices after confidential rebates, have not been disclosed in this analysis ^[1].