[WaPo] ‘Ozempic For All’ is starting to make economic sense

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https://wapo.st/4lBU652

‘Ozempic For All’ is starting to make economic sense
As prices come down and new benefits emerge, universal access to GLP-1s could become sound fiscal policy.
August 21, 2025 at 7:30 a.m. EDT 28 minutes ago
By Gary Winslett

Gary Winslett is an associate professor at Middlebury College in Vermont.

By now, you’ve probably heard about the weight-loss benefits of GLP-1 drugs like Ozempic (semaglutide) and Mounjaro (tirzepatide), but scientists are still discovering that they have all kinds of other benefits too: They help prevent strokes and heart attacks, fight kidney disease and Parkinson’s, curb addiction, and lower risks for several particularly nasty cancers.

At this rate, just about every American will have some condition or risk factor that makes these drugs look appealing in their lifetime. And when that day comes, they should be able to get it. Universal access to GLP-1s should be the explicit goal of our federal government.

This is not some left-wing fantasy; it’s a smart economic policy.

Obesity-related health care costs the U.S. about $173 billion annually, and that doesn’t include all those other medical problems that GLP-1s may be able to address. It also does not include costs outside of direct medical expenses like lost productivity, disability payments and early mortality. Medicare and Medicaid together spend about $1.9 trillion a year. That’s the proper baseline to be thinking from, not zero.

If spending on GLP-1s lowers these costs by more than the drugs cost, then they pay for themselves — and getting to that point is more attainable than most people realize.

When someone has a heart attack, for example, the initial hospitalization (not including any follow-on care) costs, on average, $30,000.

Preventing those heart attacks is obviously great on a human level, but it would also save the system a great deal of money.

Enter GLP-1s. Medical researchers recently estimated that for every 100,000 Americans treated with these drugs, we’d see 32,000 to 45,000 fewer cases of obesity, 20,000 fewer diabetes cases, and up to 10,000 fewer cases of heart disease. These preventive effects would save upward of $21,000 to $28,000 in medical care for each patient, depending on the GLP-1 used — and that doesn’t include potential savings from addiction, Parkinson’s, kidney disease or other ailments. That means the overall savings is likely well higher.

The authors of that estimate do not find these GLP-1s to be cost-effective investments overall right now, though, based on a combined measure of savings and expected increase in quality of life. To get there, they’d need to drop in price to about $1,522 a year. There are two reasons to be optimistic that we can get there. First, while some patients may need to stay on GLP-1s long-term, many may not need to. Most people who come off of GLP-1s do not gain all the weight back and more than one-third continue to lose significant weight even after discontinuing them. And prices are already dropping from their early highs: The net price the study used for semaglutide after rebates and discounts was more than $8,400 a year. It now runs about $6,000 per year for customers who pay out of pocket.

The key policy question is how to push prices down even further.

Denmark has been able to negotiate a price of $130 per month for Ozempic to treat diabetes, or $1,560 a year, if patients first try a less expensive treatment. If the U.S. government (which would have much greater purchasing power than Denmark’s) can match that or, even better, get down to a cost of $1,000 a year (about $83 a month), the benefits easily surpass the costs.

There are ways to speed up that process. The smartest place to start is with bulk purchasing agreements, essentially scaling up what we did so successfully with coronavirus vaccines. The federal government would negotiate directly with manufacturers to purchase millions of doses annually in exchange for significantly reduced per-unit pricing. These aren’t price controls. They’re better thought of as volume discount negotiation — the same thing Costco does, just bigger.

These bulk purchase agreements would supply multiple programs simultaneously. Instead of Medicare negotiating separately from Medicaid, and everyone competing against each other, we create one massive purchasing pool that maximizes taxpayers’ bargaining power. The manufacturers get the scale they want, taxpayers get better deals, and we avoid the administrative headache of managing multiple separate negotiations.

Medicare could expand its coverage of GLP-1s for a variety of conditions including but not limited to diabetes and weight loss, an idea the Trump administration is exploring. A Medicaid buy-in option would allow working-class Americans, i.e. people who earn too much for traditional Medicaid but can’t afford premium private insurance, to purchase GLP-1 coverage. That’s especially important because Medicaid populations are more likely to suffer from weight-related conditions. Ensuring that the new GLP-1s can come onto the market (and there are dozens in the pipeline) will ensure competition and further reduce prices.

Universal access to GLP-1s isn’t a radical anti-capitalist concept or a pie-in-the-sky dream. It’s a policy choice that builds on health care systems and preventive medicine thinking that already work. It deserves to be our next great public health project.


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