The Hidden Costs of Wegovy: How Big Pharma and Insurers Profit While You Pay More
At Truemed, we believe that true health starts with addressing the root causes of disease, not just treating symptoms. That’s why we’re excited to highlight the work of our partner, Commune, a platform dedicated to holistic wellness and lifestyle transformation. Commune empowers individuals to take charge of their health with video courses on integrative medicine, nutrition, mindfulness, and fitness. Today, we’re sharing insights from Commune on how the pharmaceutical industry, Pharmacy Benefit Managers (PBMs), and health insurers operate in ways that drive up costs for consumers—and how a different approach to health can change the game.
The High Price of Wegovy and the Pharmaceutical Monopoly
Wegovy is a weight-loss drug belonging to the GLP-1 agonist class. It’s a derivative of Ozempic, a diabetes medication produced by Novo Nordisk. The list price for a 28-day supply of Wegovy is $1,350, even though it costs only a fraction of that to manufacture.
In the United States, pharmaceutical companies have the power to set their own drug prices without government intervention. Patents further protect these drugs from competition, keeping prices high. But what makes Wegovy particularly lucrative is its long-term dependency—patients must continue using it indefinitely for sustained weight loss.
How Insurers Justify Covering Expensive Drugs
It may seem counterintuitive for health insurers to cover such a costly drug, but the secret lies in rebates and hidden financial incentives.
Pharmacy Benefit Managers, or PBMs, act as intermediaries between pharmaceutical companies and insurers, negotiating deals that maximize profit for both. For example, Wegovy’s manufacturer might offer insurers a $500 rebate per prescription to ensure the drug remains covered. However, because rebates are calculated based on the inflated list price, Big Pharma continues to make enormous profits—and PBMs take a cut as well.
Why You End Up Paying More
Health insurers don’t absorb the cost of these expensive drugs; instead, they distribute the expense across everyone’s insurance premiums. Additionally, high-deductible plans require individuals to pay thousands out-of-pocket before insurance kicks in. Co-pays, often set as a percentage of the list price, further increase what patients owe.
This cycle keeps premiums rising year after year while reinforcing a system that prioritizes expensive treatments over preventive health measures.
The Incentive to Keep Drug Prices High
The reality is that the system benefits from keeping drug prices high. The larger the list price, the bigger the rebate—and the more everyone in the chain profits. Pharmaceutical companies, PBMs, and insurers all win, but consumers are left shouldering the financial burden.
Shifting the Focus to Preventative Health
Instead of relying on costly prescriptions, we need a different approach—one that prioritizes health and wellness over pharmaceutical dependency. Transparency in drug pricing, government regulations on pricing caps, and restrictions on direct-to-consumer advertising are all steps in the right direction. But ultimately, we must shift our focus toward preventing chronic diseases rather than merely managing symptoms.
A Real Story of Transformation
At Commune, we regularly hear from members who have reclaimed their health through lifestyle changes. One such member, Casey, shared her journey with us:
"Loss of a pet, family medical issues, and personal health concerns resulted in major dips in my mental health. My Commune membership has been transformative and life-saving. I've lost more than 60 pounds through intermittent fasting and yoga, and Commune's EFT tapping meditations helped me establish a daily meditation practice for the past 2.5 years."
An Alternative to Prescription Dependency
We’ve partnered with Truemed to make holistic health more accessible. Through Truemed, qualified customers can use their Health Savings Account (HSA) or Flexible Spending Account (FSA) to purchase a Commune Lifetime Membership—saving an additional 30% or more on the already discounted price.
For context, the average co-pay for brand-name prescription medications ranges from $36 to $66 per month. That means a Lifetime Membership is equivalent to just 5 to 10 months of prescription drug co-pays. And unlike prescription drugs, the benefits of a holistic health approach last a lifetime.
Would you rather stay dependent on costly medications, or take charge of your well-being? The choice is yours.
Learn more about Commune Lifetime Membership.
The content on the Truemed blog is intended for informational and educational purposes only, and should not be considered medical advice. It is not a substitute for professional medical care, diagnosis, or treatment. Truemed is committed to expanding access to medically necessary products and services through HSA and FSA plans, though individual needs and eligibility for benefits may vary.