Ozempic, Wegovy Medicare Prices Muddled by Trump’s Dueling Deals

The Trump administration’s negotiation with Novo Nordisk A/S that slashes 71% off the list price of its blockbusters Ozempic and Wegovy for Medicare patients is running up against another government deal over the obesity and diabetes treatments.

The US government announced Tuesday the negotiated prices for the 15 drugs selected for the second round of the Medicare Drug Price Negotiation Program—a Biden-era plan that seeks to slash drug costs through back-and-forth talks between the Centers for Medicare & Medicaid Services and manufacturers. The agency touted a net savings of 44%, or $12 billion, from last year’s Medicare spending, with prices slated to go into effect in 2027.

However, the agency’s $274 deal for a month’s supply of Novo’s Ozempic, Wegovy, or Rybelsus is higher than the $245 Medicare price announced weeks earlier under President Donald Trump’s latest “most-favored nation” (MFN) deal. The CMS hasn’t clarified the relationship between the two prices, leaving drug pricing and industry experts unclear on how the prices will be applied under Medicare.

“The negotiated price for Ozempic and Wegovy merits the most attention because it is unclear how this will work in light of the deal that the Trump administration struck earlier this month with Novo Nordisk,” said Melissa Wong, a life sciences attorney at Holland & Knight LLP.

There’s also “a lot of missing information” on what this means for the insurers that administer Medicare’s prescription drug, or Part D, plans and how this will affect premiums next year, said Kristi Martin, former Medicare chief of staff under the Biden administration, now a health-care director at Camber Collective.

Trump and Novo struck a deal earlier this month that Medicare would pay $245 per month for Ozempic and Wegovy under the administration’s attempt to lower US drug costs by tying them to international prices. The prices under that deal are scheduled to launch in 2026.

A spokesperson for Novo said in an email that the maximum fair price (MFP), also known as the program’s negotiated drug price, “is a mandatory price-setting process established under the Inflation Reduction Act and for semaglutide applies specifically to Medicare Part D.” Meanwhile, the most favored nation agreement “reflects a broader effort to expand access to obesity care across Medicare and Medicaid.”

“We look forward to additional clarity from CMS on how pricing and coverage will work together to support patient access as details are finalized,” the spokesperson said.

The CMS didn’t immediately respond to a request for comment.

‘Real’ Price Unclear

Clarity over the different drug prices matters because they will both be in effect in 2027.

The Medicare-negotiated drug prices for the obesity and diabetes treatments also aren’t exactly $274 due to the differences in dosage forms, according to the CMS. Ozempic and Rybelsus are priced around $276 for a month’s supply, and Wegovy is priced around $385.

“It is unclear how the two proposals will interact and which would be the ‘real’ price when both MFN and MFP are effective in 2027,” global strategy firm Capstone said in an analysis.

How the prices are implemented is also significant because it will depend on the insurers managing health plans, drug pricing experts say.

“There is no requirement that the MFN price is necessarily picked up by payers,” said Brian Reid, a consultant at Reid Strategic who works with drugmakers on pricing. “Whereas the MFP price will be required—that has to be on the formulary.”

“You can certainly imagine a world in which a voluntary price versus a required price is going to have two different sets of input into a negotiation,” Reid said.

Because Novo isn’t bound to offer the most-favored nation price, it’s also possible the $245 price “may not stand” because the negotiated price is higher, said Sarah Emond, CEO of the Institute for Clinical and Economic Review.

Drug pricing experts are also waiting for the CMS to issue new rules for Medicare to cover obesity treatments, which the agency declined to adopt in April after being originally proposed by the Biden administration.

The Trump administration could use another policy vehicle to effectuate that, such as a Center for Medicare and Medicaid Innovation demo, said Rachel Sachs, a professor at WashU Law and former senior adviser for the US Department of Health and Human Services’ Office of the General Counsel.

New Deals

Despite the confusion over Ozempic and Wegovy costs, the Trump administration appeared to strike notable price reductions in the second round of negotiations, drug pricing experts say.

“Many of the 2027 MFP prices represent true net cost reductions, driven heavily by the high-cost specialty medications on the list that have limited rebates today, such as Xtandi and Ibrance,” said Brooks Conway, a principal at Oliver Wyman focusing the Medicare Advantage Part D market.

Other industry watchers touted the price reductions, but recognized that the eventual success of the negotiations is still uncertain.

“The proportional price reductions were impressive,” said Fred Ledley, director for the Center for Integration of Science and Industry at Bentley University.

“It is not clear the ‘deals,’ however, are as good as last year,” Ledley said. “The drugs in this year’s negotiation were generally less innovative and less impactful than those last year” and the “prices relative to the benefit they provide may not be quite as good.”