The “fat drug,” as the president is fond of labeling GLP-1s, is now the cheap fat drug. The terms of a deal between Eli Lilly, Novo Nordisk, and the administration are (according to the White House fact sheet):

• The agreement represents a historic reduction in prices for Americans on the two drugs with the highest annual expenditures in the United States, both of which help adults struggling with diabetes, heart disease (Ozempic and Wegovy only), obesity, and other conditions.
  • The prices of Ozempic and Wegovy will fall from $1,000 and $1,350 per month, respectively, to $350 when purchased through TrumpRx.
  • The price of Zepbound and Orforglipron, if approved, will fall from $1,086 per month to an average of $346 when purchased through TrumpRx.
  • In the event that the FDA later approves the Wegovy pill, or certain similar “GLP-1” drugs in each company’s pipeline intended to be taken orally rather than as a shot, the initial dose of those drugs will be priced at $150 per month through TrumpRx.

This is characterized as most-favored-nation (MFN) pricing, although there is seemingly no link between the announced prices and the prices prevailing in any foreign country’s market. And it is certainly not the case that this is “ENDING GLOBAL FREELOADING ON AMERICAN PHARMACEUTICAL INNOVATION,” as the fact sheet advertises. Instead, these are simply two more deals between the administration and drug manufacturers. With four down and 13 to go, the “policy” that guides these deals remains utterly opaque.

While the focus is on the pricing, it is important to note that this constitutes a Medicare coverage decision, negotiated in private and not via the usual Centers for Medicaid and Medicare Services channels. It is also a coverage and pricing decision for oral versions of the obesity drugs that have not yet even been approved for use by the Food and Drug Administration. The latter is a feature of the new priority review vouchers, which expedite the review timelines of new potential drugs.

Finally, it appears that the obesity drugs will be available to about six million Medicare beneficiaries, which seems like the least-likely population to benefit from the long-term better health noted by advocates of obesity drugs. Nevertheless, according to CNBC HHS Secretary  Kennedy: “’the American public will lose 125 million pounds by this time next year,” saying the expanded access will have ‘dramatic effects on human health in the U.S.’”

Lots of claims have now been made about the pricing, take-up, and impact of GLP-1s. Let’s see what the experience actually shows.