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    Home > Finance > Explainer-What Wegovy's inclusion in Medicare price negotiation means for patients, company
    Finance

    Explainer-What Wegovy's inclusion in Medicare price negotiation means for patients, company

    Published by Global Banking & Finance Review®

    Posted on January 17, 2025

    2 min read

    Last updated: January 27, 2026

    This image depicts Wegovy drug bottles alongside the Medicare logo, highlighting the significance of Medicare's price negotiation for patients. The article explores how Wegovy's inclusion affects accessibility and affordability for older Americans.
    Wegovy drug bottles with Medicare logo, symbolizing Medicare price negotiation impact - Global Banking & Finance Review
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    Quick Summary

    Medicare's inclusion of Wegovy in price negotiations could expand access for seniors but may not impact commercial or uninsured patients. Novo Nordisk may see a 30% discount by 2027.

    Understanding Wegovy's Role in Medicare Price Negotiations

    (Reuters) - The U.S. government on Friday announced a list of 15 prescription medicines targeted for Medicare price negotiations for 2027, which includes Novo Nordisk's blockbuster weight-loss drug Wegovy.Here's what Wall Street analysts say about the inclusion:

    WHAT IT MEANS FOR PATIENTSThe potential for more aggressive price cuts would enable wider access to GLP-1 drugs - the same class of drugs as Ozempic and Wegovy - for people over the age of 65. Medicare prescription drug plans administered by private insurers, known as Part D, currently cannot cover drugs that are approved solely for obesity. Expanding coverage of anti-obesity drugs could enable more Americans to afford the new weight-loss medications. However, inclusion does not solve access or out-of-pocket costs issues for commercial and uninsured patients, BMO Capital Markets analysts said.

    WHAT IT MEANS FOR SALES

    Given that diabetes drugs, including Ozempic, are already heavily discounted and the negotiated cuts are based on the gross price rather than the discounted price, the impact of a negotiated price is expected to be small.

    TD Cowen analysts estimate that about 45% of U.S. sales for Ozempic and Rybelsus each goes through Medicare Part D.

    Wegovy, on the other hand, is eligible for coverage under Medicare only if the eligible overweight or obese patients have pre-existing heart conditions.This group constitutes around 3.6 million overweight or obese patients with heart conditions insured under the U.S. Medicare program, according to a study published last year by Kaiser Family Foundation. However, this was still a relatively small portion of obesity population in the U.S., according to TD Cowen analysts.

    WHAT IT MEANS FOR PRICE

    Ozempic has a list price of around $935 a month while Wegovy has a list price of around $1,350 a month, regardless of dosage, not taking any coupons and rebates into account.

    The negotiated price cuts are based on the gross price and do not reflect after-market rebates or discounts the drugmakers had already been giving.

    Novo has said it retains around 60% of Ozempic's list price.

    TD Cowen expects the negotiations to result in about 30% discount relative to the current average net price in 2027, adding that there was a wide range of possibilities on what the negotiations would be like with the incoming Trump administration.

    (Reporting by Mariam Sunny and Sneha S K in Bengaluru; Editing by Shailesh Kuber)

    Key Takeaways

    • •Medicare targets 15 drugs for price negotiation by 2027.
    • •Wegovy's inclusion could expand access for seniors.
    • •Price cuts may not affect commercial or uninsured patients.
    • •Novo Nordisk retains 60% of Ozempic's list price.
    • •Negotiations could lead to a 30% discount by 2027.

    Frequently Asked Questions about Explainer-What Wegovy's inclusion in Medicare price negotiation means for patients, company

    1What is the main topic?

    The article discusses the inclusion of Wegovy in Medicare price negotiations and its implications for patients and Novo Nordisk.

    2How does this affect patients?

    It could enable wider access to weight-loss drugs for seniors but doesn't address costs for commercial or uninsured patients.

    3What are the expected price changes?

    Negotiations might lead to a 30% discount relative to the current average net price by 2027.

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