The global market for semaglutide, the active ingredient in Ozempic, has become a stark illustration of pharmaceutical pricing disparities. A recent report reveals that Canada pays a fraction of the US price for this diabetes and weight loss drug, while the British National Health Service (NHS) negotiates some of the lowest costs in the developed world. This divergence is not merely a financial footnote; it is a symptom of a broader systemic failure in how the United States approaches drug pricing.
Consider the numbers. A month’s supply of Ozempic in Canada costs approximately 150 Canadian dollars, roughly 110 US dollars. Across the border, the same prescription in the United States can range from 800 to 1,200 dollars, depending on insurance coverage. In the United Kingdom, the NHS pays around 70 pounds per month (about 89 dollars) after negotiations that leverage the country’s single-payer system. The differences are not marginal; they are multiples.
The physics of pricing is simple: monopolies extract maximum value from fragmented buyers. The US market, with its patchwork of private insurers and pharmacy benefit managers, lacks the collective bargaining power that single-payer systems like Canada’s or the UK’s possess. Even with rebates and discounts, US list prices remain astronomically high. This is not a failure of capitalism but a failure of regulation. The US government, unlike its counterparts in Canada and the UK, is prohibited by law from negotiating drug prices for Medicare, the largest drug buyer in the world. A single policy change could shift the entire equilibrium.
The implications extend beyond national budgets. High drug prices force patients into rationing, skipping doses to stretch supplies. This leads to poorer health outcomes and higher downstream costs. In diabetes care, consistent medication adherence reduces complications like kidney failure and amputations. The US, for all its technological prowess, lags behind many developed nations in diabetes-related mortality. When drugs are priced out of reach, the biosphere of public health collapses.
The NHS model is often criticised for limiting access to new drugs, but the data show a different story. The UK’s National Institute for Health and Care Excellence (NICE) evaluates cost-effectiveness rigorously, ensuring that value is obtained for every pound spent. Ozempic was approved for use on the NHS after negotiations brought the price down. In contrast, the US pays more for the same molecule, subsidising global research and development through inflated margins.
There is a calm urgency here. The climate crisis has taught us that incremental change is insufficient. Similarly, the drug pricing crisis demands systemic reform. Canada’s example shows that lower prices are possible without sacrificing innovation. The UK’s approach demonstrates that value-based pricing can work. The US retains the choice to follow or persist with a system that drains household budgets and exacerbates health inequalities.
For the energy transition, we have learned that subsidies and mandates can accelerate adoption. For healthcare, the lesson is analogous: policy levers exist. The question is whether the political will to pull them will materialise before the system collapses under its own weight.
