Novo Nordisk CEO Lars Fruergaard Jørgensen testifies during a Senate Committee on Health, Education, Labor and Pensions hearing to examine high prices for weight loss drugs Ozempic and Wegovy on Tuesday in Washington. Mariam Zuhaib/Associated Press

The CEO of Novo Nordisk testified Tuesday that the pharmaceutical company has little control over what patients pay for its blockbuster diabetes and weight loss drugs, even as skeptical senators criticized the Danish company for charging Americans exorbitant prices.

Sen. Bernie Sanders, I-Vt., chair of the Senate health committee, accused Novo Nordisk of greed in the months leading up to the hearing. On Tuesday, he pointed to a chart listing the prices of the two drugs in France, Canada, Germany and the United Kingdom, where they sell for hundreds of dollars less per month than in the United States.

“Treat the American people the same way that you treat people all over the world,” Sanders said. “Stop ripping us off.”

Lars Fruergaard Jørgensen, Novo Nordisk’s CEO, began his testimony by describing the company’s decadeslong work developing semaglutide, the active ingredient in Ozempic and Wegovy, while highlighting how it is controlled by a charitable foundation that “ensures our time and resources are focused on unlocking cures for chronic diseases – not on daily stock fluctuations.”

Jørgensen said that more than 80% of U.S. patients with insurance pay less than $25 per prescription. But he stressed that the price Novo Nordisk itself receives from selling Ozempic and Wegovy had declined about 40% in recent years as a result of rebates it pays to industry middlemen that negotiate prices on behalf of insurance companies, blaming the vagaries of American health care for patients paying high prices.

“We pay 75 cents of every dollar of medicine we sell back into this complex system in rebates, discounts and fees,” Jørgensen said in written testimony.

Jørgensen faced bipartisan criticism on why other countries pay so much less than the United States for Ozempic and Wegovy. He responded by blaming unique features of the U.S. prescription drug supply system. Reciting a common pharmaceutical industry argument, he said prices in the U.S. were set as starting points for negotiation with industry middlemen known as pharmacy-benefit managers, or PBMs.

Sen. Susan Collins, R-Maine, noted that a bill to regulate PBMs has so far failed to get a vote on the Senate floor and asked Jørgensen whether that legislation, if passed, would have helped control prices for the weight loss drugs.

Sen. Susan Collins, R-Maine, asks a question during Tuesday’s Senate Committee on Health, Education, Labor, and Pensions hearing. Mariam Zuhaib/Associated Press

“The question remains, how do we get relief to patients at the pharmacy counter?” the senator asked.

Jorgensen, while not directly answering Collins’ question, said PBMs are incentivized to have a high list price for medications, so that patients who do not have insurance or have high-deductible plans often end up paying the list price. In the case of weight loss medications like Ozempic and Wegovy, that could be thousands of dollars per month.

“It is not our intention that anyone should pay the list price,” he said.

Jørgensen also said that simply lowering the list price wouldn’t necessarily save patients money. He blamed PBMs for curbing access to prescription drugs with lower list prices because they make less money from them – a claim that the Federal Trade Commission made last week in suing three large PBMs.

Sen. Roger Marshall, R-Kan., a physician, voiced sympathy for Novo Nordisk’s position, saying the company “is not the villain in this story, they’re a hero.”

While Marshall and several other senators from both parties railed against PBM practices, Sanders and Sen. Maggie Hassan, D-N.H., cited commitments from large PBMs to preserve patient access to Ozempic if Novo Nordisk lowered the list price and pressed Jørgensen to do so.

“Anything that can help patients get access, I’m supportive of,” Jørgensen said.

Sen. Bernie Sanders, I-Vt., asks a question during Tuesday’s Senate Committee on Health, Education, Labor, and Pensions hearing to examine high prices for Ozempic and Wegovy. Mariam Zuhaib/Associated Press

“If in fact they keep their commitment, are you prepared to lower (U.S.) list prices?” Sanders asked.

Jørgensen signaled openness to discussing the issue with PBMs, saying the company would be positively disposed “if it works in a way that patients get access to more affordable medicine, and we have certainty that it happens.”

Ozempic and Wegovy, known as GLP-1 drugs for the gut hormone they mimic, work by slowing the stomach from emptying, latching on to brain cells and communicating a sense of fullness. They’ve been enormously successful at helping patients control their blood-sugar levels and lose weight, while also reducing cardiovascular risk – though they can have unpleasant side effects.

Soaring sales of GLP-1 drugs have made Novo Nordisk and its chief rival, Eli Lilly, among the most valuable publicly traded pharmaceutical companies in the world – and spawned a global gold rush across multiple industries to cash in on the demand for appetite-suppressing drugs.

While Novo Nordisk’s Ozempic and Eli Lilly’s Mounjaro are widely covered by insurance to treat diabetes, coverage for weight loss drugs is considerably spottier, leaving many patients to pay out of pocket. The list price of Wegovy is $1,349 a month.

Critics of Novo Nordisk’s pricing point to a Yale University study published earlier this year that found that injectable semaglutide could be profitably made for less than $5 a month, compared with Ozempic’s list price of $969 for a month’s supply.

Jørgensen said the study doesn’t take into account the expensive work of research and development, or of building the manufacturing facilities necessary to churn out the drugs. He added that the company has invested “well over $10 billion” to develop its GLP-1 drugs, and that many products fail commercially. Ozempic and Wegovy, he said, “bear a heavy burden” – recouping the costs of their own development, as well as those of others that fail, while providing funds for ongoing research.

It is well documented that many prescription drugs cost more in the United States than in other countries that regulate prices. The United States has taken a step in that direction with the Inflation Reduction Act, which for the first time empowers Medicare to set a maximum price for certain drugs subject to negotiation.

Press Herald Staff Writer Joe Lawlor contributed to this report.