The Numbers That Should Make You Angry
A Yale University study published in JAMA Network Open found that GLP-1 medications cost between $0.89 and $4.73 to manufacture for a month's supply. Yet Americans pay nearly $1,000 at the pharmacy counter.
That's not a typo. The markup on these medications exceeds 20,000%.
Meanwhile, patients in Germany pay $59 for the same medication. Patients in the UK pay $95. Canadians pay $155. Americans pay $969.
Why Americans Pay 16x More
The price disparity isn't about manufacturing costs, shipping, or quality. It's about who has the power to negotiate.
1. No Government Price Negotiation
In most developed countries, governments negotiate drug prices directly with manufacturers. In the US, that's largely prohibited. The Inflation Reduction Act (2022) allowed Medicare to negotiate prices for some drugs, but GLP-1s weren't initially included.
2. Patent Monopolies
Novo Nordisk and Eli Lilly hold patents that prevent generic competition until 2031-2032 in the US. During this exclusivity period, they can charge whatever the market will bear.
3. Insurance Complexity
The US healthcare system's complexity—with PBMs, rebates, and formulary negotiations—creates opacity that allows high list prices to persist. The "list price" isn't what anyone actually pays, but it sets the baseline for the entire pricing ecosystem.
4. Demand Is Through the Roof
An estimated 48 million American adults want to start GLP-1 medications. With 42% of Americans qualifying as obese, demand far outstrips the supply of alternatives. Manufacturers have no incentive to lower prices.
Where the Money Goes
Novo Nordisk generated approximately $50 billion in GLP-1 revenue in 2024. Of that, roughly 72% came from American patients.
| Country | Ozempic Price | % of US Price |
|---|---|---|
| 🇺🇸 United States | $969 | 100% |
| 🇨🇦 Canada | $155 | 16% |
| 🇬🇧 United Kingdom | $95 | 10% |
| 🇫🇷 France | $79 | 8% |
| 🇩🇪 Germany | $59 | 6% |
| 🇦🇺 Australia | $87 | 9% |
The Human Cost
These aren't just abstract numbers. The pricing has real consequences:
- 40% of GLP-1 prescriptions go unfilled due to cost
- 54% of patients find GLP-1s difficult to afford even WITH insurance
- 41+ million Americans have no Wegovy coverage whatsoever
- 85% of denied patients never appeal—even though 65% of appeals succeed
Obesity costs the US healthcare system an estimated $9.1 trillion over the next decade. Medications that could address this are priced out of reach for millions.
What's Being Done
Medicare Negotiation (Starting 2026)
The Medicare BALANCE Model launching July 2026 will offer GLP-1s at $245/month (negotiated) with $50 copays for qualifying beneficiaries. This is a start, but only covers Medicare patients with specific conditions.
Self-Pay Programs
Facing public pressure, both Novo Nordisk and Eli Lilly have introduced self-pay discount programs (NovoCare at $349/mo, LillyDirect at $299-449/mo). These dramatically cut costs but still generate healthy profits.
Compounding (Controversial)
During drug shortages, compounding pharmacies produced semaglutide and tirzepatide at $149-299/month. The FDA has since removed these drugs from the shortage list, creating regulatory uncertainty for this lower-cost pathway.
What You Can Do
While systemic change is slow, you can find savings today:
- Check insurance coverage and always appeal denials (65% success rate)
- Use manufacturer programs (NovoCare, LillyDirect) for brand medications
- Compare telehealth providers for compounded options
- Consider HSA/FSA for additional tax savings
- Don't pay retail—almost no one should