I want to thank Mr. Lars Jørgensen, the CEO of Novo Nordisk for being with us today for this very important hearing.

The issue that we are discussing today is not complicated.  It has everything to do with the chart behind me which shows that Novo Nordisk’s diabetes drug Ozempic is sold in Canada for $155, in Denmark for $122, in France for $71 and in Germany for $59.

In the United States Novo Nordisk charges us $969 – over 15 times more than they sell it for in Germany.

Wegovy, Novo Nordisk’s weight loss drug is even more expensive.  As this chart shows, Wegovy is sold for $265 in Canada, $186 in Denmark, $137 in Germany and $92 in the United Kingdom.

In the U.S., the list price for Wegovy is $1,349 a month – nearly 15 times as much as it costs in the United Kingdom.

What we are dealing with today, is not just an issue of economics, it is not just an issue of corporate greed.  It is a profound moral issue.

Novo Nordisk has developed game-changing drugs which, if made affordable, can save the lives of tens of thousands of Americans every year and significantly improve the quality of life of millions more. If made affordable.  If not made affordable Americans throughout this country will needlessly die and suffer. 

As representatives of the American people, we cannot allow that to happen.

And let’s be clear.  The outrageously high cost of Ozempic, Wegovy, and other prescription drugs is directly related to the broken, dysfunctional and cruel healthcare system in our country.

While the current system makes huge profits for large drug companies like Novo Nordisk, huge profits for insurance companies, and huge profits for PBM’s, it is failing the needs of ordinary Americans. 

In the United States today we spend almost twice as much, per capita, on health care as the people of any other country – nearly $13,500 for every man, woman and child – over 17% of our GDP.  

Yet, despite this huge and unsustainable expenditure, we are the only major nation not to guarantee health care to all as a human right.

Further, despite all of that spending, our healthcare outcomes are not particularly good.

Today, over 85 million Americans are uninsured or under-insured, over 60,000 die every year because they don’t get to a doctor when they should, and our life expectancy, which is actually declining in many parts of this country, is far below most other wealthy countries. 

So. What does all this have to do with Mr. Jørgensen, Novo Nordisk and our hearing today? A lot.

The simple truth is that we pay, by far, the highest prices in the world for prescription drugs and that is a major factor in the healthcare crisis we are experiencing. How does that happen? What’s the connection?

First, one out of four Americans are unable to afford the prescription drugs that their doctors prescribe.  

Insanely, that means that millions of Americans go without the treatment their doctors prescribe.  The result: some will actually die and others will become much sicker than they should.  And millions will unnecessarily end up in emergency rooms or in hospitals at great expense to our health care system.  How crazy is that?

Second, one of the reasons that hospital costs in this country are rapidly increasing has to do with the very high cost of prescription drugs. My local hospital in Burlington, a moderate sized hospital, told me that 20% of their budget is now devoted to the cost of prescription drugs – some of which now cost hundreds of thousands a year for the treatment of their patients.

Third, a significant reason for the high cost of insurance policies in this country, and why insurance rates are going up, is due to the high cost of prescription drugs.  

Yes.  Millions of Americans with decent health insurance pay minimal amounts for their prescription drugs.  That’s the good news.  

The bad news is that they are paying a fortune in premiums, deductibles and co-payments for the insurance that covers those drugs.

I should also add that if you’re a taxpayer in this country you’re paying higher taxes than you should because of the inflated costs that Medicare, Medicaid and other public health programs pay for prescription drugs.   

That is the overview and why the issue that we’re discussing today is so very important. Now, let’s go to the particulars with regard to Novo Nordisk, Ozempic and Wegovy.

Ozempic and Wegovy are different brand names for the same drug: semaglutide.  These drugs are transformative new treatments for diabetes and obesity that help people control their blood sugar and lose weight.

Both are manufactured by Novo Nordisk and both are on track to be some of the best-selling and most profitable drugs in the history of the pharmaceutical industry.

In fact, since 2018, Novo Nordisk has made nearly $50 billion in sales off of these two drugs. Importantly, 72% of that revenue coming from sales in the United States.

In other words, the United States is Novo Nordisk’s cash cow for Ozempic and Wegovy.

And given that these drugs will need to be taken over the course of a lifetime – Novo Nordisk can expect to receive tens of billions in sales and huge profits from these drugs year after year.  

Now why does Novo Nordisk charge the American people such outrageously high prices for Ozempic and Wegovy?  Are they acting illegally by charging us such high prices?  Are they violating the law? 

No.  They are not. What they are doing is perfectly lawful.  They are simply taking advantage of the fact that, until very recently, the United States has been the only major country not to negotiate the cost of prescription drugs.  In other words, Novo Nordisk and other drug companies can charge us as much as the market will bear – and that is exactly what they are doing.

Now, in a few minutes when Mr. Jorgenson makes his presentation, I suspect that he will tell us that the healthcare system here is complex and that there is a difference between the list price and the net price as a result of the rebates that PBMs receive.

And he’s right.

But even factoring in all of the rebates that PBM’s receive, the net price for Ozempic is still nearly $600 – over 9 times as much as it costs in Germany.

And the estimated net price of Wegovy is over $800 – nearly four and a half times as much as it costs in Denmark.

What must also be understood is that not everybody can take advantage of the net price of these drugs.

If you are uninsured you pay the full list price. 

If you have a large deductible, you pay the full list price. 

If you have co-insurance, the percentage of the price you pay at the pharmacy counter is based on the list price.

And let’s be clear.  75% of Americans, over 190 million people, with insurance are unable to access Wegovy through their policies.

Mr. Jorgensen may also tell us that Novo Nordisk is afraid that if it substantially reduced the list price for Ozempic and Wegovy, PBM’s may limit coverage for these drugs.

Well, let me ease his concerns.  I am delighted to announce today that I have received commitments in writing from all of the major PBM’s that if Novo Nordisk substantially reduced the list price for Ozempic and Wegovy they would not limit coverage.  In fact, all of them told me they would be able to expand coverage for these drugs if the list price was reduced.  I ask unanimous consent to insert the letters I received from the PBM’s making this commitment into the record.

Now, let me share with the Committee some other important information that we have uncovered as part of our investigation.

Last week, I received a letter from over 250 doctors urging us to do everything we can to substantially reduce the price of these drugs.

This should come as no surprise.

What these doctors are telling us is that if the price of Ozempic and Wegovy is not substantially reduced, many of their patients who have diabetes and obesity will be unable to afford them.  Some of them will unnecessarily die and others will suffer a significant decline in their quality of life.  I ask unanimous consent to enter this letter into the record.

Earlier this year, Dr. Alison Galvani, an epidemiologist at Yale university, conducted a study on Wegovy.  And what she found, and I hope Mr. Jorgensen pays attention to this, is that over 40,000 lives a year could be saved if Wegovy were made widely available at an affordable price to Americans who need this drug.  I ask unanimous consent to insert this study into the record. 

A few months ago, Dr. Melissa Barber, a health care economist at Yale University, conducted a study on the cost of manufacturing Ozempic.  And what she found is that Ozempic can be profitably manufactured for less than $5 a month.

We all know the cost of production is not the only expense for a drug company.  Pharmaceutical companies spend great sums on research and development to find new treatments with many of those products never coming to market.  We get that.  But it is important to know that this drug can be manufactured profitably for a few dollars a month.

You may hear from Mr. Jørgensen that Novo Nordisk spent $21 billion on research and development since 2018.  I take his word on that.

What he may not tell you is that Novo Nordisk spent $44 billion on stock buybacks and dividends over that same time period.

In other words, since Ozempic came onto the market in 2018, Novo Nordisk spent over twice as much on stock buybacks and dividends than it spent on research and development.

And let’s be clear.  Outrage over the high cost of Ozempic and other prescription drugs is not a partisan political issue. It’s not just Democrats.  It’s not just Republicans.  It’s not just Independents like me.  It’s the vast majority of the American people. 

For example, Dale Folwell, the Republican treasurer of the state of North Carolina has told us that if he did not discontinue covering Wegovy for some 20,000 state workers in North Carolina he would have been forced to double health insurance premiums for teachers, firefighters and police officers in his state – regardless if they needed this drug or not.  He would have had to double health insurance premiums in the State of North Carolina.

Blue Cross-Blue Shield of Michigan also announced that it would have to discontinue covering Wegovy because it was too expensive. 

Even Elon Musk, not someone who shares my political views, recently posted on Twitter and I quote: “Solving obesity greatly reduces risk of other diseases, especially diabetes, and improves quality of life. We do need to find a way to make appetite inhibitors available to anyone who wants them.”

And he’s right.

Further, not only must we be concerned about lack of access to these drugs we have also got to take a serious look at the financial implications of what happens if the prices of these drugs are not substantially reduced.

Bottom line: If just half of the adults in our country with obesity took weight loss drugs like Wegovy at current prices the cost would be astronomical and would have a devastating financial impact on our country and on federal and state budgets.

The best estimate that I have seen suggests that if half of the adults in our country took these weight loss drugs, it would cost $411 billion per year.  That is $5 billion more than what Americans spent on all prescription drugs at the pharmacy counter in 2022.

In other words, the outrageously high price of these drugs could bankrupt Medicare and radically increase insurance premiums to absolutely unaffordable rates.

This does not have to happen.

Over the last several months, I and my staff have been talking to a number of major generic pharmaceutical companies.

These are large companies that supply hundreds of millions of prescriptions to many millions of Americans.

And what these CEOs have told me is something of enormous consequence. 

They have studied the matter and they tell me that they can sell a generic version of Ozempic, the exact same drug that Novo Nordisk is manufacturing, to Americans for less than $100 per month.

Yes.  That’s right.

Novo Nordisk charges us $969 a month for Ozempic.  These generic companies can sell this same product for less than $100 a month – less than ten percent of what Americans are currently paying.

Let’s be clear.  Nobody here is asking Novo Nordisk to provide charity to the American people. Novo Nordisk has already made billions of dollars in profit off of these products and, in the coming years, will make many billions more.

All we are saying, Mr. Jørgensen, is treat the American people the same way that you treat people in countries all over the world. Stop ripping us off. 

A few months ago President Biden and I wrote an op-ed which appeared in USA today. And here is what the president and I said: 

“If Novo Nordisk and other pharmaceutical companies refuse to substantially lower prescription drug prices in our country and end their greed, we will do everything within our power to end it for them. Novo Nordisk must substantially reduce the price of Ozempic and Wegovy.  As Americans we must not rest until every person in our country can afford the prescription drugs they need to lead healthy, happy and productive lives.”

That’s what President Biden and I wrote a few months ago.  And that’s what I believe.  Prescription drugs in this country must be affordable and we must not be forced to pay far higher prices than people in other countries pay for the same exact product.

This is especially true when we face a national emergency in terms of the twin epidemics of diabetes and obesity which, if not addressed with lower cost drugs, could cost us tens of thousands of lives and an unimaginable amount of money.

And if taking the kind of action that must be taken means standing up to the 1,800 well-paid pharmaceutical lobbyists here on Capitol Hill, including more than a few from Novo Nordisk, so be it.  If it means refusing to be influenced by the massive amounts of campaign contributions that come from the pharmaceutical industry.  So be it. 

Congress and the Administration have a moral responsibility to act boldly and act now.  

Senator Cassidy, you are now recognized for an opening statement.