Senators pressed the CEO of Novo Nordisk about why the Danish firm charges U.S. consumers significantly more for its popular weight-loss drug Wegovy and the diabetes treatment Ozempic compared to its charges in Europe.

Lars Fruergaard Jørgensen, the CEO of Novo Nordisk, was questioned by the Senate Committee on Health, Education, Labor and Pensions, which is led by Senator Bernie Sanders, an independent from Vermont. Sanders initiated an investigation this year focusing on Novo Nordisk’s pricing practices.

According to Sanders, Novo Nordisk has earned almost $50 billion from Ozempic and Wegovy sales since 2018, labeling the U.S. market as a “cash cow,” which makes up 72% of the company’s total sales for these two medications globally.

One of the key questions raised by Sanders was why American patients are charged so much more for these drugs than individuals in other countries.

To kick off the hearing, Sanders presented charts that highlighted the stark differences in prices between the U.S. and Europe for Novo Nordisk’s products. For instance, the monthly cost for Ozempic in the U.S. is $969, while it’s only $155 in Canada, $122 in Denmark, and $59 in Germany.

For Wegovy, the monthly cost in the U.S. is $1,349. In contrast, the same medication is priced at $186 in Denmark, $140 in Germany, and $92 in the UK based on Sanders’ displayed data.

“No one is asking Novo Nordisk to perform charitable acts toward Americans,” Sanders remarked. “We simply want, Mr. Jørgensen, for you to treat American customers the same as those elsewhere in the world. Stop overcharging us.”

In response, Jørgensen defended the pricing of the very popular medications, stating that 80% of Americans can access these drugs for $25 or less each month.

He explained that U.S. list prices cannot be simply compared to those of other countries because of the complex healthcare system in America. Pricing is heavily influenced by health insurers and pharmacy benefit managers, who act as intermediaries in drug pricing.

Jørgensen noted that the diabetes medication Ozempic is covered by most private insurance plans as well as Medicare and Medicaid, which serve low-income families and seniors. Wegovy is covered by roughly half of the private insurers, Medicaid in 20 states, and the Department of Veterans Affairs.

“You have said that our outstanding medicines can’t help patients if they’re not affordable—this is true,” stated Jørgensen. “However, patients can only gain full benefits from Ozempic and Wegovy if they have access to them. Affordability and access are crucial.”

Medicare, which provides health coverage for seniors, is legally restricted from covering medications for those with obesity unless there are serious health risks. However, patients who are obese and have diabetes or heart disease can qualify for coverage. The Kaiser Family Foundation estimates that about 25% of Medicare recipients who are obese may qualify for Wegovy to lower their risks of heart attack or stroke.

The committee also referred to a study from Yale University conducted in March, which suggested these medications could be produced for less than $5 a month, totaling around $57 yearly. Recently, Sanders stated that CEOs from major generic drug companies would be willing to sell Ozempic to Americans for under $100 a month while still making a profit. Nevertheless, these figures do not factor in the substantial expenses linked to drug research, development, and clinical trials.

Jørgensen mentioned that Novo Nordisk scientists have been working on these weight-loss medications since the early 1990s. The company has also pledged $30 billion toward increasing manufacturing capabilities to help alleviate shortages of these drugs.

Officials from the pharmaceutical industry’s trade group, PhRMA, argued that more attention should be given to health insurers and pharmacy benefit managers regarding drug pricing.

“The real question should be why insurers and PBMs aren’t held accountable for denying coverage and increasing patients’ costs?” queried Alex Schriver, PhRMA’s senior vice president for public affairs. “Senator Sanders keeps repeating the same misleading claims about drug pricing. Why doesn’t he address the record profits that insurance companies are making or the issues that PBMs are facing from investigations for their questionable practices?”