Introduction
If there’s something that diabetics and overweight people can celebrate, it’s the development of GLP-1 drugs like semaglutide. They can regulate blood sugar levels and promote weight loss, too.
So effective are semaglutide brands Ozempic and Wegovy that even celebs and business tycoons swear by their pound-shedding benefits. It’s no wonder many consider them the wonder drug of the decade.
Of course, no medicine is perfect, and there’s a certain price people have to pay to gain access to it. A hefty price tag, to be exact. This begs the question, ‘Why is semaglutide so expensive?’
This article explores the factors behind its high cost and what to expect over the next decade.
What is semaglutide?
The key to understanding why semaglutide is expensive is to know what it is and how it works.
In our gut is a hormone, GLP-1, which stands for glucagon-like peptide-1. Whenever we finish eating and blood sugar levels are high, GLP-1 kicks into action. It triggers the pancreas to release the hormone insulin to bring blood glucose down.
Semaglutide acts in the same way. It’s a glucagon-like peptide-1 receptor agonist, or GLP-1 Ra. It’s also able to prompt the pancreas to secrete insulin whenever blood sugar levels are high.
At the same time, semaglutide also delays gastric emptying, when food exits the gut and enters the small intestine. Because digestion is slower, people on the drug feel fuller for longer and have fewer food cravings. As they don’t think of food as much, they end up losing weight. The drug also sends signals to the brain that they’re already full.
Eligibility
Not just anyone can take semaglutide. They first have to meet certain diagnostic criteria to be eligible to take it. Consumers also need a prescription to avail of the drug.
To take Ozempic or its sister brand Rybelsus, you must have type 2 diabetes, which they are FDA-approved to treat. Doctors may also prescribe Ozempic for heart disease patients, as it has approval for lowering the risk of cardiovascular problems. Doctors may also prescribe It for those dealing with insulin resistance.
Wegovy, on the other hand, has FDA approval to treat obesity. Wegovy users need to have a BMI of at least 27 or greater. In addition, they must also have one weight-related health condition or a BMI of 30 or greater.
Although Ozempic, Wegovy, and Rybelsus have different uses, they all share the same active ingredient, semaglutide. Additionally, they offer the same therapeutic benefits of blood sugar regulation and weight management. This is why many doctors choose to prescribe Ozempic or Rybelsus off-label for weight loss.
Oral and subcutaneous semaglutide
Before you acquire the drug, you’ll need to decide between its two formats: oral or subcutaneous semaglutide. Rybelsus, meanwhile, is referred to as oral semaglutide as it comes in tablet format and is taken orally.
Ozempic and Wegovy, meanwhile, are called subcutaneous semaglutide as they come in injectable pens and you must inject them under the skin.
Cost of semaglutide
There are several ways you can get a prescription for the medication. You can get it from a doctor, online from state-licensed pharmacies, FDA-registered outsourcing facilities registered, or telemedicine companies.
According to a November 2024 report, semaglutide brands had the following pharmacy retail prices for one month’s supply:
- Ozempic: $830-870 (list price at $968.52)*
- Wegovy: $1,237-$1,340 (list price at $1,349.02)*
- Rybelsus: $848-$917 (list price at $968.52)*
With insurance
With insurance, Ozempic can cost $25 for one to three months’ supply, while Wegovy can cost $0 per dose with insurance. Patients can also use Wegovy’s savings card, where people with insurance can save up to $225 for every 28-day supply. Those without insurance, meanwhile, can save up to $500, also for a 28-day supply.
Rybelsus’ cost, on the other hand, will vary depending on the insurance plan, treatment plan, and the pharmacy. Patients with insurance eligible for savings and support may pay as low as $10 for one to three months’ supply.
If you have insurance, you might need to secure prior authorization first before your rovider covers Rybelsus.
*Prices subject to change
Why semaglutide is so expensive
Currently, only Novo Nordisk produces semaglutide, and it will be a while before a generic version becomes available. That’s because Novo Nordisk’s patent for it will be in effect until December 5, 2031.
Because they hold this patent, they can charge how much they want for semaglutide. This also allows them to recover the hundreds of millions they spent on clinical trials, among other similar expenditures.
When Novo Nordisk’s patent lapses in 2031, other drug-making companies can start manufacturing their generic versions of it. You can expect these to have more competitive prices.
Until then, only those who can afford to buy semaglutide out-of-pocket or those with insurance can avail of it.
In a statement to Fortune.com, a Novo Nordisk representative shared that “the most effective way for the millions of Americans who need anti-obesity medicines to be able to access and afford [semaglutide] is to ensure these medicines are covered by government and commercial insurance plans.”
Insurance coverage for semaglutide
Health insurance plans typically cover Ozempic or Rybelsus if they’re prescribed for type 2 diabetes. But you may need to pay a copay (co-payment). A copay is a standard fee for a healthcare service under some insurance plans.
If for weight loss, on the other hand, there’s a chance your insurance may not cover Ozempic or Rybelsus. This is the case unless you’re taking them for a weight problem.
Meanwhile, health insurance doesn’t always cover Wegovy and other weight loss drugs as many consider them “lifestyle/vanity drugs.” Some providers cover it, others if you meet certain requirements, and others not at all.
Despite weight loss proving to improve overall health outcomes, many insurance companies still do not cover GLP-1 medications.
The most affordable semaglutide
Based on the aforementioned prices, a month’s supply of Ozempic is the cheapest semaglutide without insurance, at $830*. This is compared to the cost of a month’s supply of Wegovy and Rybelsus (without insurance), at $1,237* and $848*, respectively. The cost of the pens used in Ozempic and Wegovy is also a factor as to why they’re more expensive.
It’s important to note that factors like the dosage and pharmacy where you source the drug can impact its price.
Non-coverage of semaglutide
Insurance companies don’t typically cover weight loss drugs as they perceive obesity as a cosmetic issue than a chronic disease. Weight loss medications also have hefty price tags, with a month’s supply easily going beyond $1,000 a month.
In 2023, only one in every four employers covered GLP-1 weight loss drugs. These employers, however, are tightening the criteria for their eligibility.
Another hindrance to the coverage of semaglutide injections is a 2023 law that prevents Medicare from covering weight loss medications. Medicare is the US federal health insurance for citizens aged 65 or older.
Ironically, those who had successful treatments were suddenly denied coverage for the medication.
Weight loss drugs may still be covered
There’s still a chance that semaglutide may be fully covered by insurance, even for weight loss purposes.
Novo Nordisk, and weight loss drug Mounjaro’s manufacturer, Eli Lilly, are fast-tracking certain trials. These trials aim to prove their benefits beyond type 2 diabetes and obesity. In this way, it will be easier for patients to get access to the expensive medicine that they need.
Additionally, clinical trials are in progress to see whether the drugs can lower the risk of certain diseases. These include heart attack, kidney disease, stroke, and other chronic diseases typically afflicting those suffering from obesity.
The supply problem
Because many can prescribe Ozempic or Rybelsus off-label for weight loss instead of Wegovy, demand has skyrocketed for the drugs. Hence, non-diabetic patients can avail of the medicine, affecting the supply for type 2 diabetes patients. Some countries have even banned semaglutide exports to maintain a local supply for type 2 diabetics.
The demand has led to a massive shortage issue, which will likely persist for several more years. However, Wall Street predicts the demand will slow down in 2024 with more treatments becoming available in the market.
As consumers grapple with the shortage, healthcare providers have been turning to alternatives for type 2 diabetes and obesity. These includeTrulicity (dulaglutide), Victoza (liraglutide), Bydureon (exenatide), Rybelsus (semaglutide), Adlyxin (lixisenatide), and Byetta (exenatide).
The problem with compounded semaglutide
Amid the clamor for weight loss drugs have been a massive supply issue. Consumers are turning to compounded semaglutide, a version of the drug which contains other ingredients such as vitamins.
While the FDA has approved some drugstores to custom-mix semaglutide, some reports have cited adverse effects. Novo Nordisk and Eli Lilly have also reported impurities in the compounded medications.
Other reports have noted that salt forms like semaglutide sodium and semaglutide acetate, were being used by compounders.
Although these offer a cheaper alternative, people must ensure they’re getting it from an outsourcing facility or state-licensed pharmacy. If you are buying online, make sure you are purchasing from a valid and reputable online pharmacy.
Conclusion
Because Novo Nordisk holds a patent on semaglutide, it can dictate its price. While a generic version is unavailable, they can use it to recover the cost of developing it and running clinical trials.
Rybelsus appears to be the most affordable semaglutide brand. The cost of Ozempic and Wegovy’s auto-injector pens are a factor as to why they are more expensive than Rybelsus.
Generally, insurance companies will cover Ozempic or Rybelsus if prescribed for treating type 2 diabetes. However, most providers still consider weight loss drugs as “lifestyle drugs” and only used for cosmetic purposes. Hence, Wegovy is typically not covered.
Amid the demand for GLP-1 drugs, the market has been turning to alternatives such as compounded semaglutide. Although the FDA has approved some custom-mix variations of the drug, it warns the public to avoid its salted forms.
Glossary of terms:
- GLP-1: Glucagon-like peptide-1 is a gut-based hormone involved in the secretion of insulin to lower blood sugar levels typically elevated after meals.
- GLP-1 Ra: Glucagon-like peptide-1 receptor agonist. It mimics the actions of GLP-1.
