Novo Nordisk
Insulin, Ozempic and Wegovy pricing, a Victoza settlement and a US–EU safety gap
Danish drugmaker Novo Nordisk leads the world in diabetes care and helped create the modern obesity drug market with Ozempic and Wegovy. In the US it has been a defendant in insulin pricing litigation, the subject of a Senate hearing over the price of its GLP-1 drugs, and a party to a federal settlement over how its sales representatives communicated cancer risk information for Victoza. More recently, a European safety finding on its semaglutide medicines has not yet been mirrored on US labels.
Questions
Why is Novo Nordisk considered controversial in the United States?
Novo is one of three companies supplying most of the world's insulin, and a Senate investigation found evidence of lockstep price increases; its GLP-1 drugs cost many times more in the US than in Europe; and it settled a case over downplaying a mandated cancer warning.
Novo Nordisk's controversies centre on price. It is one of three companies supplying the vast majority of US insulin, and a 2021 Senate investigation found evidence that it and Sanofi raised insulin prices within hours or days of each other. The same investigation reported that Novo's board voted down a proposed insulin price decrease because of concerns about PBM revenue.
Q2What did the Senate find about Novo Nordisk and insulin prices?
The Senate Finance Committee found Novo and Sanofi raised insulin list prices sometimes within hours of each other — and that Novo's board voted down a price decrease specifically because lower prices would reduce the rebates PBMs expected.
The Senate Finance Committee's bipartisan 2021 report found that insulin makers engaged in "shadow pricing," raising list prices in close succession, and that Novo Nordisk and Sanofi in particular increased prices sometimes within hours or days of each other. PBM rebates rose from single digits in 2013 to 60% or more for large accounts.
Q3How did Minnesota's lawsuit against Novo Nordisk end?
In January 2025 Novo became the last of the three insulin makers to settle, agreeing to cap insulin at $35 a month for all Minnesotans for five years — reducing annual insulin costs from roughly $6,000 to about $600.
Minnesota's attorney general sued Novo Nordisk, Eli Lilly and Sanofi in 2018, alleging they deceptively priced insulin so that uninsured and underinsured residents paid out-of-pocket costs based on inflated list prices. In January 2025 Novo became the last of the three to settle, agreeing that all Minnesotans could buy its insulin for $35 a month for five years, with or without insurance, and committing to continue free insulin for households below 400% of the federal poverty level.
Q4Why has Ozempic's US price drawn so much criticism?
In September 2024 the Senate cited Novo charging $969 a month for Ozempic in the US versus $59 in Germany, and $1,349 for Wegovy versus $92 in the UK — while a Yale study suggested the drugs could be profitably made for less than $5 a month.
In September 2024 Novo Nordisk CEO Lars Fruergaard Jørgensen testified before the Senate HELP Committee, chaired by Senator Bernie Sanders. The committee highlighted that Novo charged $969 a month for Ozempic in the US versus $155 in Canada and $59 in Germany, and $1,349 a month for Wegovy versus $137 in Germany and $92 in the UK.
Q5What was the Victoza settlement about?
Novo paid $58.65 million after allegedly instructing its sales force to downplay a required medullary thyroid cancer warning — even after an FDA survey found half of primary care doctors were unaware of the risk.
In September 2017 Novo Nordisk agreed to pay $58.65 million to resolve allegations concerning its diabetes drug Victoza. The FDA had required Novo to communicate a potential risk of medullary thyroid carcinoma, a rare cancer, under a Risk Evaluation and Mitigation Strategy. After a 2011 survey found half of primary care doctors were unaware of the risk, the FDA required stronger messaging.
Q6What is the NAION safety issue with semaglutide?
In June 2025 the EMA concluded that NAION — an eye condition causing sudden vision loss — is a very rare semaglutide side effect with a roughly two-fold increased risk; US labels still did not include a warning as of August 2026.
NAION (non-arteritic anterior ischaemic optic neuropathy) is an eye condition that can cause sudden, usually irreversible vision loss. In June 2025 the European Medicines Agency's safety committee concluded that NAION is a very rare side effect of semaglutide, affecting up to 1 in 10,000 users, and that large studies suggested roughly a two-fold increased risk in adults with type 2 diabetes.
Q7How has Novo Nordisk responded to competition from compounded GLP-1s?
After the FDA declared the semaglutide shortage over in February 2025, Novo sued compounders it accused of misrepresenting their products as equivalent to Ozempic and Wegovy — while compounders challenged the FDA's shortage declaration in court.
When the FDA listed semaglutide in shortage from 2022, compounding pharmacies were permitted to make copies, and at the 2024 peak nearly one in three Americans taking a GLP-1 said they got it from a compounder at roughly $150 to $300 a month. The FDA declared the semaglutide shortage over in February 2025, triggering enforcement deadlines.
Q8What access deals has Novo Nordisk made?
In November 2025 Novo and Lilly agreed deals with the Trump administration setting a $245 monthly Medicare price and opening direct-to-consumer sales via TrumpRx — a sharp shift from the confrontational Senate hearing a year earlier.
In November 2025 Novo and Eli Lilly announced agreements with the Trump administration under which Medicare and Medicaid prices for Ozempic, Wegovy, Mounjaro and Zepbound would be $245 a month, Medicare would cover Wegovy and Zepbound for obesity with related conditions for the first time, and beneficiaries would pay a $50 copay.
Q9How did Novo Nordisk defend its GLP-1 prices?
Novo's CEO argued at the 2024 Senate hearing that the company had spent billions developing and manufacturing GLP-1 therapies — and that net prices after rebates are much lower than list prices — though he acknowledged PBM dynamics as new information.
At the September 2024 Senate hearing, Novo's CEO Lars Fruergaard Jørgensen argued that the company had spent billions to research, develop and expand manufacturing for the treatments and was funding research into other obesity-related conditions. His written testimony said the drugs extend and improve lives, which could reduce the health costs associated with obesity and diabetes. He said the company had fought for public and private insurance coverage, and that net prices after rebates are much lower than list prices.
Q10Is Novo Nordisk losing ground to Eli Lilly?
In obesity, yes — Zepbound sold $4 billion in Q1 2026 versus Wegovy's $2.7 billion. Novo has fought back with a 7.2mg Wegovy approved in March 2026, a false advertising lawsuit against Lilly, and government pricing deals.
In obesity, yes. Novo was first to market with Wegovy but later lost the lead to Lilly's Zepbound. After replacing its CEO and issuing multiple profit warnings, Novo counterattacked with an oral version of Wegovy and a high-dose 7.2mg injection approved in March 2026, which produced average weight loss of about 18.8% in a 72-week trial. In the first quarter of 2026, Zepbound sold $4 billion compared with about $2.7 billion for Wegovy.
Q11What is the bottom line on Novo Nordisk?
Novo has produced some of the most important medicines of the century — and its US controversies are mainly about how those medicines have been priced: insulin list prices that rose in lockstep, a board decision against cuts to protect PBM revenues, and GLP-1 prices many times higher than in Europe.
Novo Nordisk has produced some of the most important medicines of the century, including drugs that have changed the treatment of diabetes and obesity. Its controversies are mainly about how those medicines have been priced and marketed in the US: insulin list prices that rose in lockstep with a rival, a board decision not to cut prices because of PBM economics, GLP-1 prices many times higher than in Europe, and a settlement over downplaying a mandated cancer warning.