While the price reduction headline is significant, it is important for plan sponsors to recognize that GLP-1 market complexity as utilization increases. Competition, expanding indications beyond diabetes and obesity (including cardiovascular disease for example), and direct-to-consumer channels such as TrumpRx are accelerating utilization. (Read our recent PBIRx on TrumpRx blog here.) In this move, Novo Nordisk is targeting members with high deductibles or coinsurance, including those who may pay out of pocket. It is important to note that while the “out-of-pocket” options may still offer the lowest sticker prices, these purchases do not count towards a member’s out-of-pocket maximum.

Starting in 2027, the reduced list price may make using the pharmacy benefit more financially advantageous for members who face high deductibles or coinsurance as their cost share is based on the drug’s list price. Even if the plan price is higher than direct-to-consumer channels (*i.e. TrumpRx) price, using the plan sponsors pharmacy benefit helps these members accumulate out-of-pocket credit toward their deductible or maximum.  Additionally, Ozempic; Rybelsus; and Wegovy are on the selected drug list for the second cycle of negotiations with Centers for Medicare & Medicaid Services.