Financial Implications of Ozempic, Wegovy and Mounjaro

By: Eric Bricker, MD

The newer diabetes and weight loss medications have profound implications for patient health, patient out-of-pocket costs and employee health plan costs.

Ozempic is a popular diabetes medication that also helps with weight-loss. Another name for Ozempic is Semaglutide. At higher doses of 1 mg per week it suppresses appetite and can lower weight by 10-13lbs.

Ozempic is only approved for Type 2 Diabetes, NOT weight-loss. Ozempic costs about $995 per 8 mg pen, which could potentially last you almost 2 months.

Wegovy is the same medication as Ozempic–i.e. Semaglutide–just at a higher dose of 2.4 mg per week. It suppresses appetite even more and can lead to 35lbs of weight loss.

Wegovy is approved for weight-loss. Wegovy costs about $1,432 per month.

Mounjaro is a different medication. It is Tirzepatide. It is also approved for Type 2 Diabetes and may soon be approved for weight-loss. Mounjaro can lead to 52lbs of weight-loss.

Mounjaro has a similar mechanism of action to Semaglutide–it suppresses appetite.

Mounjaro costs about $1,087 per month.

An employer group with 1,000 members on its plan could expect to see a $1.9M increase in pharmacy costs if 50% of the plan members with obesity take these medications.

Cost mitigation strategies include:

  • Moving from a traditional PBM to a transparent/pass-through PBM
  • Prior-authorization requirements
  • Specialty Rx carve-out vendors
  • Greater use of 8mg Ozempic pen
  • Inventory control so people do not lose their $1,000 pens

Where the prescription is filled can impact the price as well. For Ozempic, some pharmacies are as low as $905 for a 2mg pen and other pharmacies are as high as $1,041, approximately a 10% difference in price. For Wegovy, some pharmacies are as low as $1,302 for a pack of 4 pens and other pharmacies are as high as $1,619, approximately a 20% difference in price. Finally, for Mounjaro, some pharmacies are as low as $989 for a pack of 4 pens and other pharmacies are as high as $1,227, approximately a 19% difference in price.

SimplePay Health financially incentivizes members to fill their prescriptions at lower cost pharmacies. The copay for the exact same medication will be lower at a lower cost pharmacy and higher at a higher cost pharmacy.

Being good stewards of an employee health plan’s resources requires alignment…alignment that SimplePay Health provides with easy-to-understand, up-front-copays on prescriptions and medical services.

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