Jan 17 (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 PATIENTS
The 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.