By: Peter Sullivan, Axios

Sen. Bernie Sanders is trying to use the bully pulpit to lower the price of wildly popular anti-obesity drugs the same way he helped pushed drugmakers to limit inhaler and insulin costs. But this bid could be much more of an uphill climb.

Why it matters: Surging demand for drugs like Novo Nordisk’s Ozempic and Wegovy could severely strain Medicare and patients’ wallets. Despite that, drug manufacturers are loath to budge on list prices.

Driving the news: Sanders recently announced he’ll grill Novo CEO Lars Fruergaard Jørgensen later this summer during a hearing of the Senate health committee he chairs.

• Sanders acknowledged in an interview it won’t be easy to get the company to agree to lower prices, but he said the “spotlight” can make a difference.
• “The people who run Novo Nordisk are not stupid,” Sanders said. “They are in a very good position. They’re charging 10 to 15 times more for the product than they charge people in Germany and elsewhere.”
• “But they’re also, I think, cognizant of public relations and to the degree that we can put a spotlight on them, I think the pressure will build for them to finally say, ‘OK, we’re not going to rip off the American people,'” he added.

Between the lines: Sanders has been able to claim some important drug cost victories after taking the chairmanship of the Senate HELP Committee last year.

• Public pressure from him and the Biden administration likely played at least a role in makers of insulin and asthma inhalers limiting monthly out-of-pocket costs to $35.
• Eli Lilly CEO Dave Ricks also pledged not to raise the price of insulin at a hearing Sanders held last year.

Yes, but: Those efforts mostly capped patient costs, rather than reduce list prices that are a starting point for negotiations with insurers — though that did occur to some degree. Drug manufacturers tend to support caps since they mean more people can buy their products.

• Anti-obesity drugs are also a new breakthrough, not decades old like inhalers or insulin.
• Novo says the net prices have already declined 40% since their launch after accounting for rebates.
• And the drugs in the next few years may be subject to new Medicare negotiations, which are among the drug pricing provisions from the Inflation Reduction Act that Sanders called “modest progress” and said should be expanded.

The other side: Novo has pointed to the billions of dollars it had already invested in research and in ramping up production capacity for the drugs.

• In a letter to Sanders’ committee last month, Novo said 80% of U.S. patients with insurance are paying $25 or less per prescription of Ozempic or Wegovy.

• “Novo Nordisk takes patient access and affordability very seriously and we are committed to working with policymakers to develop meaningful solutions within the complex U.S. healthcare system,” Novo spokesperson Allison Schneider said in a statement to Axios.

Sanders said even with rebates, the price of Ozempic is much higher than in other countries — about $600 per month compared with $59 in Germany.

• And even if many patients are shielded from high direct costs by insurance, Sanders warns private insurance premiums will have to rise or Medicare will have to spend exorbitant amounts to cover the drugs.

What’s next: Sanders also left the door open to calling in Novo’s rival Eli Lilly to testify about its anti-obesity drug Zepbound and medications in the same class.

• “One at a time,” he said. “Eli Lilly is also very big, but I think we focus on Novo Nordisk first and then we’ll go to the others.”
• Sanders said his committee may also advance additional legislation targeting pharmacy benefit managers, who’ve faced increased scrutiny for their role in driving up drug prices.

The bottom line: There are limits to what “shaming” can do to drug prices, said Gerard Anderson, professor of health policy and management at Johns Hopkins.

• “Changing the laws is absolutely the right answer,” he said.