Dear Reader,

This is Joey Mattingly and I'll be writing about pharmacy and drug policies for Insider throughout 2026. If you haven't already, watch my January Insider event where I present on the latest drug polices

Time for a Drug Price Reporting Standard?

The recent announcement of oral semaglutide (Wegovy pill) was accompanied by unusually consistent media coverage describing a price range of $149–$299 per month for the weight-loss pill.

That figure has been widely repeated across multiple mainstream outlets, policy commentary, and amplified with partnerships with companies such as Amazon and Ro.

What's been notably absent, however, is reference to the drug’s wholesale acquisition cost (WAC) — which Novo Nordisk has publicly set at $1,349 per month, identical across tablet and injection dose strengths.

This disconnect is not merely semantic.

For decades, WAC has served as the default reference price in US drug pricing debates, particularly when the goal is to demonstrate manufacturer pricing power in the US compared to other countries or to anchor public outrage. 

Why does a drug have so many prices?

The pharmaceutical supply chain has always produced multiple legitimate prices based on the context of who is buying and who is selling.

Common drug prices referenced in lay press, academic journals, and government reports:

1. List price (aka: WAC), reflecting the manufacturer’s posted price in major drug price compendia such as Red Book or First Databank.

2.  

   Net price, reflecting confidential rebates and discounts negotiated by payers – this price is typically not known to the general public as it is determined through contracting between payers and manufacturers.

3.  

   An insured patient’s out-of-pocket price, shaped by insurance benefit design, deductibles, and formulary tiering.

4.  

   A cash price without insurance (aka: Usual & Customary price), refers to the price a retailer offers its customers without billing the patient’s insurance plan.

Historically, journalists and policymakers have relied on WAC precisely because it is observable, standardized, and comparable across products and time.

Although WAC does not reflect what most patients or payers ultimately pay, it has functioned as a common starting point for drug pricing analysis because it is publicly available, consistently defined, and stable across reporting contexts.

At the same time, reliance on WAC is known to be imperfect and, in some cases, misleading.

WAC excludes confidential rebates and discounts substantially overstating the true net price paid by an insurance company and list price increases may not impact the patient’s ultimate out-of-pocket price based on the patient’s insurance design. 

The Issue with Selective Price Reporting

The central issue raised by previous WAC-focused news headlines like the “$1,000 hepatitis C pill” and the new $149 Wegovy pill announcement is one price is being promoted while others are effectively ignored.

Selective price reporting shifts attention away from the full set of economic signals embedded in a drug’s pricing architecture and replaces them with a partial narrative that is easier to communicate but may be misleading to the reader. 

The implications of selective price reporting are not merely academic; they are increasingly visible in contemporary drug pricing debates.

During a recent Senate hearing, Sen. Bernie Sanders pressed the chief executive officer of Novo Nordisk on the affordability of Ozempic and Wegovy, repeatedly citing US list prices that far exceed prices observed in other high-income countries.

But what Sen. Sanders failed to include in his questioning were the access requirements to obtain these lower prices in Canada, Denmark, Germany, or the United Kingdom – which in several cases, reflect the same utilization management restrictions (e.g., approved for diabetes and not obesity) we observe in the US in our commercial, Medicare, and Medicaid markets.

Now, in the context of Direct-to-Consumer (DTC) prescription channels, we are seeing a completely different price selection problem – companies and news outlets are focusing on the lower promotional price and ignoring the higher list price.

This shift risks understating the drug price by treating a conditional access price as representative of the drug’s true cost.

Promotional DTC prices are often limited in scope and tied to specific distribution channels (e.g., Eli Lilly Direct, NovoCare, Ro, Amazon) established by agreements between different distribution networks and the pharmaceutical manufacturer (Sound familiar?). 

In the case of Wegovy pill, an uninsured or one with commercial insurance (not Medicare or Medicaid) can fill out some personal information online and receive a “Wegovy Savings Card” directly from Novo Nordisk and see if their usual retail pharmacy will accept the discount card.

The discount card is then processed at the pharmacy similar to a commercial insurance card. The instructions on the card also request that the pharmacist “submit the claim to the patient’s primary insurance first” – because if the insurance covers the claim, then the discount card only applies to the copayment.

But this means that if the insurance covers it…the higher WAC price is back in the conversation. 

Developing a Drug Price Reporting Standard

The Wegovy pill episode highlights the need for clearer norms, not just for journalists, but for academic journals and policy institutions as well.

A minimal set of Drug Price Reporting Standards would materially improve transparency without prescribing policy outcomes.

At a minimum, any public discussion of a drug’s price should clearly specify which price is being reported along with who the price applies to, including relevant eligibility criteria and access pathways.

These basic reporting standards would not privilege manufacturers or their critics; rather, they would restore analytical clarity to a policy debate increasingly shaped by selective framing rather than consistent price definitions.

Absent such standards, debates over drug affordability will continue to alternate between competing price narratives, obscuring rather than clarifying the underlying economics of the pharmaceutical supply chain.

Joey Mattingly, PharmD, MBA, PhD
Associate Professor and Vice Chair of Research
Department of Pharmacotherapy
University of Utah College of Pharmacy

February 17: The FDA and Its Changing Relationship to Industry

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Moderated by Rachel Sachs from Washington University in St Louis, speakers include: 

• Genevieve Kanter, USC Sol Price School of Public Policy
• Holly Fernandez Lynch, Perelman School of Medicine at the University of Pennsylvania
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Moderated by Health Affairs’ Michael Gerber, presenters include:

• Martin Cauz from Beechwood Consulting Group on the financial challenges facing skilled nursing facility operators.
• Renée Landers from Suffolk University Law School on the Health Equity Compact and its aims to embed equity in all policies and programs involving health expanding.
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