The High Authority of Health has classified Wegovy as an “important” medical service, allowing for 65% reimbursement through Social Security due to its cardiovascular benefits. This decision raises concerns about the financial impact on the healthcare system, as the treatment costs around 300 euros monthly for potentially over a million patients. Negotiations on pricing are set to begin, with hopes for significant reductions to alleviate costs amidst a growing Social Security deficit.
Exciting news! The High Authority of Health (HAS) has updated its stance on Wegovy, the leading weight-loss medication from Novo Nordisk, due to its newfound cardiovascular advantages. On December 4, they categorized the medical service it offers as “important,” which opens the door for Social Security reimbursement at a rate of 65%. This decision brings hope to millions suffering from severe obesity who are eagerly anticipating access to this groundbreaking treatment. However, it also raises eyebrows among those managing public finances.
With the healthcare system already under financial strain, the question arises: can it shoulder this additional financial load? Currently, the treatment costs approximately 300 euros monthly per patient. Authorities estimate that between 1,050,000 and 2,100,000 individuals could benefit from this medication. If prescribed widely, the total annual expense could soar into the billions! Thankfully, the Economic Committee for Health Products (CEPS) is prepared to monitor the situation closely.
Negotiations on Drug Pricing: A New Chapter
The CEPS is set to initiate discussions with Novo Nordisk regarding the pricing of Wegovy now that it has been deemed reimbursable. It’s worth noting that when the drug first receives marketing approval, the manufacturer has the liberty to set its price independently. Yet, following its inclusion in the Social Security reimbursement framework, the price will be negotiated with the state, and the VAT will decrease to 2.1%.
The CEPS’s goal is to negotiate the most favorable price possible for the drug. Could there be a price reduction of 20%? 50%? Or even more? According to a negotiator from another pharmaceutical company, “What we can be sure of is that the price will be lower than what it currently is; everything else remains uncertain.” The existing price of 300 euros will serve as a starting point for these discussions, with the CEPS poised to leverage two key arguments for a potential price decrease.
Projected Annual Costs for Social Security
Firstly, Wegovy is sold at nearly half the price in China, despite being manufactured in the same French facility owned by Novo Nordisk. Secondly, the company has previously negotiated a reimbursement for Ozempic, a diabetes medication sharing the same active ingredient as Wegovy, which is now priced at 76.58 euros per month since it became reimbursable. If the CEPS could secure a similar discount, the annual expense for Social Security could be as low as 600 million euros.
However, Novo Nordisk counters this perspective, stating that Ozempic does not offer the same “medical service” as Wegovy, as per the HAS’s assessment, nor does it have the same dosage. Maintaining the current price of 300 euros would lead to an annual bill of nearly 2.5 billion euros, with a substantial share going directly to the manufacturer. To strengthen their negotiation position, Novo Nordisk has enlisted the Asterès firm to conduct a study on the obesity crisis in France, revealing concerning statistics.
As the Social Security deficit is projected to hit 13.4 billion by 2025, achieving a balanced budget seems increasingly unattainable. It’s clear that these negotiations will be intricate and could extend over a lengthy period—even up to three years without a resolution. If they extend past January 2025, approximately 7,000 French patients currently enrolled in an early access program, funded by Novo Nordisk, may find themselves in a precarious situation. Their treatments may cease to be covered by the company while still lacking reimbursement from Social Security. This potential gap is a scenario no patient wishes to encounter, nor do the negotiating parties, as their reputations hang in the balance.