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Novo Nordisk’s Ozempic previously carried a list price of about $1,000 for a four-week supply, while Wegovy listed at $1,349.02 per month. Under the new TrumpRx direct-to-consumer program, both drugs would launch at $350 per month. Separately, Novo Nordisk is offering many cash-pay patients Ozempic and Wegovy at $349 per month (down from $499, a 30% cut), with new patients getting the first two months at low doses for $199. For Medicare and Medicaid, the government-negotiated price for a month’s supply of Ozempic, Wegovy and other GLP-1 drugs drops to $245 for eligible patients.
A second phase for the GLP-1 market
In recent guidance, Novo Nordisk said the combined effect of U.S. price negotiations and new discount programs should have only a “low single digit” negative impact on its global sales growth in 2026. In other words, the company is telling investors that GLP-1 volumes and new indications could more than offset sharply lower U.S. prices.
Based on Drug Discovery & Development‘s Pharma 50 data and Novo’s own guidance, we estimate that the company’s semaglutide franchise could reach roughly $36 billion in 2026, up from about $33 billion in 2025. That projection starts with first half 2025 semaglutide sales of about $16.4 billion (Ozempic about $9.4 billion, Wegovy roughly $5.4 billion, Rybelsus about $1.7 billion), annualizes that run rate to approximately $33 billion for full-year 2025, and incorporates Novo’s statement that recent U.S. pricing changes will have only a “low single digit” negative impact on its 2026 global sales growth.
Economic models suggest GLP-1s behave with unusually high price sensitivity for a chronic medication. Unlike insulin or other non discretionary drugs, there is a wide gap between the eligible population and the number of people actually on therapy. One KFF analysis estimates that roughly 36 million non-elderly Americans with employer coverage alone meet BMI criteria for a GLP-1, while only a small fraction are taking one today, which points to large latent demand constrained by cost. Health economists at the Institute for Clinical and Economic Review estimate that current net prices of about $7,000 to $9,000 per year, or roughly $600 to $750 per month, already sit in the usual U.S. cost-effectiveness range for obesity treatment, which is roughly half to two thirds of the original list prices. The boom in compounded semaglutide when brand prices were higher and Eli Lilly’s push to offer Zepbound vials through lower priced self-pay channels both point in the same direction: when GLP-1 prices fall in cash-pay settings, demand responds quickly. The volume bet baked into Novo’s guidance is that cutting effective monthly out-of-pocket costs from roughly $1,000 to the $245 to $350 range for Medicare, Medicaid, and TrumpRx buyers could unlock more than a proportional spike in filled prescriptions.
The case for aggressive pricing may also reflect underlying market dynamics. Novo Nordisk has cut its full-year forecast three times in 2025 as GLP-1 growth rates decelerated sharply. Wegovy sales rose 18% year-over-year in Q3, down from 67% growth in Q2, while Ozempic slowed to 3% growth from 15% in the prior quarter. Part of that reflects intensifying competition from Eli Lilly, which now commands 58% of total U.S. GLP-1 prescriptions compared to Novo’s 42%. But the slowdown also suggests that at current price points—roughly $1,000 to $1,350 per month at list—Novo may be nearing saturation among patients who can afford the drugs or whose insurers cover them. If the addressable market at premium pricing is plateauing, a deliberate reset to mass-market price bands could be about unlocking an entirely new customer base that has been priced out.
Based on the most recent data, the price-elasticity story mostly appears to change the shape of the uncertainty range around that $36.5 central estimate, rather than flipping it on its head.
There are, of course, wildcards. Manufacturing, prior-authorizations and clinical capacity mean you will not see the full volume response in a single year. If you assume that only about half of that long-run demand response shows up in 2026, the lower U.S. prices would cut two to three percentage points off what Novo might have earned in 2026 with no Trump deal at all, but higher volumes would claw back roughly one to two points of that hit. That is consistent with Novo’s own “low single digit negative” guidance for 2026 global sales growth.
Pre-deal path from analyst models were about $37.5 billion for semaglutide in 2026, off a roughly $33 billion 2025 base. The central case after price cuts and a modest volume response translates to about $36.5 billion. But the upside case if Medicare and self-pay uptake snap back faster than expected is high $37 billions to roughly $38 billion.
Factors that could spike more growth include GLP-1s’ pivot from premium injectables to high-volume chronic disease drugs, and that shift raises the bar for follow-on molecules. Next-generation candidates like Novo’s CagriSema or Amgen’s MariTide will need to demonstrate meaningful advantages in cardiovascular outcomes, NASH or metabolic disease to command better pricing. Weight loss alone may no longer justify premium positioning in a market where semaglutide costs $245 per month.
For now, it is still early for Wall Street to fully bake TrumpRx into detailed 2026 models. The deal was announced in early November, and most analyst notes so far focus on pricing, eligibility, and timelines rather than revised line-item revenue forecasts. The closest thing to a consensus datapoint remains Novo’s own guidance that the combined pricing impact will be “low single digit negative” for 2026 growth.
Filed Under: Metabolic disease/endicrinology
