| Wegovy, the weight-loss drug that’s taken the world by storm, is finally in China. Initial online listings suggest a month’s supply will cost Chinese patients 1,400 yuan ($193) — about one-seventh of its US price tag. To be sure, that’s just the price put up by private clinics. Public hospitals, the dominant healthcare providers in China, will be negotiating their own prices with Novo Nordisk, the Danish pharmaceutical company that makes Wegovy. But it likely won’t deviate much from that figure. What’s remarkable about the price difference is ... how unremarkable it is. Having covered China’s pharmaceutical market for years, I’ve come to expect blockbuster treatments to have lower prices when they enter the mainland market. The list price in China for Merck’s flagship cancer drug, Keytruda, is about half of the US list price. The anti-inflammatory drug Humira costs about $7,000 per month in the US, but only the equivalent of $357 in China. Ozempic, Wegovy’s sister drug sold for diabetes management, costs just $67 per month in China compared with $969 in America. I could go on. So why will Chinese looking to lose weight be paying so much less for Wegovy than their counterparts in the US, where health-care costs can be notoriously sky-high?
Let’s start with the obvious: As many as 95% of China’s 1.4 billion people get basic health insurance through a government agency that controls which drugs get reimbursed. Every year, domestic and foreign drugmakers gather in a nondescript building in Beijing to meet with authorities from this agency to negotiate prices of their drugs. It’s a grueling exercise that ultimately determines whether they earn a spot on the coveted National Reimbursement Drug List, or NRDL. The agency is known to drive a hard bargain. In 2023, drug companies slashed prices by an average of nearly 62% to get their medications on the NRDL, in a bet that the sales volume it unlocked would be worth the price cut. It’s common for foreign drugmakers to cut prices in the lead-up to the negotiations, in anticipation of further cuts. Even those who choose not to engage would need to face competitors, including local companies who are increasingly capable of developing me-too versions of their drugs.
And unlike the US, China doesn't have complicated systems for rebates, meaning drug companies don't have to bake in as big of a cut for middlemen. Wegovy’s $193 price tag in China is likely to fuel more complaints about high drug costs in the US, where Senator Bernie Sanders has accused Novo’s chief executive officer of prioritizing profits over American lives. Chinese authorities have made clear they don’t intend to reimburse for Wegovy use, meaning most patients will pay out of pocket unless they have commercial insurance. Still, keeping the treatment affordable will likely help Novo make inroads among the 140 million Chinese adults estimated to live with obesity by 2030. The clock is ticking: Wegovy’s patent in China will expire in 2026, after which cheap generics could flood the market. In the meantime, I’m wondering whether I paid for all those sessions with my personal trainer too soon. — Amber Tong Another day, another former TV personality is tasked to lead a massive US federal agency. In another against-the-grain move, President-elect Donald Trump said Tuesday that he would appoint celebrity doctor Mehmet Oz to run the massive Centers for Medicare and Medicaid Services. This followed Trump’s nominations of Fox News weekend host Pete Hegseth as defense secretary and Fox Business host Sean Duffy to head the Department of Transportation. You may not have heard of CMS, but it administers health programs that accounts for $1.7 trillion in federal spending. That includes the enormous federal Medicare program that provides coverage for the elderly, as well as the state and federal Medicaid insurance program for lower income Americans. It also administers key parts of the Affordable Care Act, known informally as Obamacare. In prior administrations, an experienced technocrat or health policy wonk would often get the CMS role, which involves leading a massive bureaucracy and understanding mind-numbing intricacies of various federal health programs. This time, as Trump noted in his announcement, it will be led by a nine-time Daytime Emmy award winner. Oz has a medical degree from the University of Pennsylvania, and is a former surgeon and surgical professor at Columbia University’s medical school. But he is best known for “The Dr. Oz Show,” a syndicated daytime talk show that ran from 2009 to the beginning of 2022. The popular program was criticized for promoting various unproven alternative treatments. And early during the pandemic he promoted hydroxychloroquine, a malaria drug, as a potential Covid treatment in a Fox News appearance. After he left the show, Oz ran for Senate in Pennsylvania and lost to John Fetterman in 2022.  Mehmet Oz while he was running for the Senate in 2022. Photographer: Ryan Collerd/Bloomberg “I’m stunned and don’t really know what to say. This nomination process is like a carnival,” Spencer Perlman, director of health-care research at consultancy firm Veda Partners, said in an email. He says he had assumed that after Trump nominated Robert F. Kennedy Jr, to lead the Department of Health and Human Services, he would in turn tap someone for CMS with deep government experience. “I guess not,” he said.
In his announcement, Trump promised that Oz would work closely with RFK Jr. to “take on the illness industrial complex, and all the horrible chronic diseases left in its wake.” It wasn’t at all clear what that would mean in practice. If he is confirmed by the Senate, Oz would be in charge of its upcoming pharmaceutical price negotiations with drug companies as part of the Inflation Reduction Act. He’s previously come out in favor of expanding Medicare Advantage, an alternative to traditional Medicare that is run by private managed care companies. While a famous TV personality leading CMS might excite Trump’s supporters, putting someone with so little health coverage expertise in charge of the agency won't necessarily help get things done in the end, Perlman said. “I think it is going to make it exceedingly difficult for the new administration to effectuate promised policy reforms.” — Robert Langreth | 
