Opinion | Ozempic and Wegovy Have Health Benefits Beyond Weight Loss

Americans love to dream of miracle drugs, but hardly anything ever seems to fill the bill. True, semaglutide has arrived with real questions trailing like bunting: Much of the weight loss is from lean muscle mass, which isn’t ideal, and there are reasons to worry over the possibility of thyroid problems, loss of bone density and sarcopenia, a weakness disorder associated with aging. There are potentially other serious long-term side effects, though millions of Americans have been taking Ozempic for Type 2 diabetes for years without serious issues. (Some of them do report more familiar side effects, like nausea.) The GLP-1 drugs aren’t a permanent fix in a single shot — whether the thing being addressed is body mass index or cardiac risk or the progression of Alzheimer’s — but a permanent disease-management program. They also haven’t exactly cured cancer, although more than a dozen cancers are linked to obesity, and in at least one case, colorectal cancer, there is reason to believe GLP-1 drugs may directly cut the chances of developing the disease.

All that means that semaglutide isn’t exactly a cure-all, in the vernacular sense. But it seems to be about as close as we’ve gotten, even in a time of racing biomedical progress, to that old science-fiction proposition — one pill for almost everything and almost everyone forever.

And pretty soon, it won’t be just one. Technically, Ozempic hasn’t even been approved yet for weight loss, though Wegovy and Mounjaro (under the new brand name Zepbound) have, and there are almost 100 new GLP-1 obesity drugs in various stages of development. Roughly 70 percent of American adults are obese or overweight, and while not everyone who might benefit from GLP-1 drugs is likely to take them, it’s also hard to have confidence in projections that the market will grow only 26 percent annually over the next five years, when over the past five alone, semaglutide use has grown fortyfold. When we talk about GLP-1 drugs as a major breakthrough or even potential solution to obesity, it raises questions about health care access, the social determinants of health and the political determinants of health inequality, the pathologies of the United States and the modern world. (Not to mention the unpredictability of putting so many people on what may need to be lifelong drug regimens.) But it also means, very simply and straightforwardly, that the drug could help a couple of hundred million Americans right now.

At the moment, getting those drugs to those people would be remarkably expensive. A single month’s worth of Ozempic or Wegovy is today priced at around $1,000 or more, which is more than private companies currently pay per employee into employer-based insurance in total, and at present few private insurers cover these drugs for weight loss. A group of researchers recently calculated that at current prices, the cost of providing GLP-1 drugs to all Americans who could benefit from them could grow past $1 trillion annually: more than the full annual cost of Medicare or even than that of the U.S. military.

But miracles don’t have to be this expensive, and in fact, they aren’t elsewhere in the world, where Ozempic costs one-fifth as much as it does here or even less. A month of doses can be manufactured for less than $5, which means that American customers are paying a 200-fold markup or more, with many of them paying it out of pocket. That suggests one additional way that semaglutide could reshape American health and health care: The price of marginal production has never determined American medication costs, but the sheer magnitude of Ozempic demand may force a belated reckoning with the mess of U.S. drug pricing. Perhaps it will also refocus our approach to health care away from crisis treatments and toward underlying conditions and preventive care, as reformers have advocated for decades.