“We do not control what patients pay for their medications,” Novo Nordisk CEO Lars Fruergaard Jorgensen said in written testimony submitted to the Senate Health, Education, Labor and Pensions (HELP) panel ahead of the hearing.

“Overall, we pay 75 cents of every dollar of medicine we sell back into this complex system in rebates, discounts, and fees—meaning the ‘net’ price Novo Nordisk ultimately receives for the medicines it sells is far below the published ‘list’ price,” he added. 

Jorgensen said Novo spent hundreds of billions of dollars to develop the drugs, but because of the money paid to pharmacy benefit managers (PBMs), the price that Novo is actually paid for Ozempic has declined by about 40 percent.

“While the rebates we pay to PBMs and insurers as a share of each dollar earned have increased dramatically over the last decade, this has not resulted in a proportionate reduction in out-of-pocket costs for patients at the pharmacy counter,” he said. 

Blaming the PBMs is a familiar argument from drug companies, while the intermediaries point the finger at pharmaceutical companies.

“PBMs are the only entities in the health care system working to mitigate the impact on patients, employers, and taxpayers of Big Pharma’s outrageous prices on blockbuster GLP-1s facing minimal competition,” said the PBM trade group Pharmaceutical Care Management Association (PCMA). 

The Senate HELP Committee, led by Sen. Bernie Sanders (I-Vt.), opened an investigation into the “outrageously high prices” of the diabetes and weight loss drugs in April.

Jorgensen agreed in June to testify, after Sanders had threatened him with a subpoena.  

“The American people are sick and tired of paying, by far, the highest prices in the world for prescription drugs. They deserve to hear from Mr. Jorgensen,” Sanders said in a statement ahead of the hearing.

Sanders said Novo Nordisk charges Americans with diabetes far more for Ozempic than people in other countries. Ozempic in the U.S. costs $969 a month, while this same drug can be purchased for $155 in Canada, $122 in Denmark and $59 in Germany.  

Americans with obesity pay $1,349 a month for Wegovy, while Sanders said the same product can be purchased for just $186 in Denmark, $140 in Germany and $92 in the United Kingdom. 

Novo Nordisk has made nearly $50 billion in sales from these two products alone, he noted.