Key takeaways
- $274 Medicare Maximum Fair Price for a 30-day semaglutide supply from January 1 2027, a 71% cut off the roughly $959 list
- 71% IRA-negotiated discount off list price, applying across Ozempic, Rybelsus, and Wegovy under the semaglutide MFP
- $1,060–$1,349 current WAC range across Zepbound (tirzepatide) and Wegovy (semaglutide), the two branded obesity indications on label
- $9.1K–$16.1K ICER's December 2025 annual health-benefit price benchmark range across semaglutide and tirzepatide, both rated high value
Semaglutide's Medicare price falls 71% in 2027. Tirzepatide's does not move at all, because it is not on the negotiation list, and that asymmetry is the pricing question this model is built to answer.
Obesity pricing in the US runs on two separate tracks depending on the molecule. List WAC today sits at roughly $1,349 a month for Wegovy (semaglutide), $1,060 a month for Zepbound (tirzepatide), and $959 a month for Ozempic (semaglutide, labeled for type 2 diabetes but widely used off-label and increasingly on-label adjacent for weight management). Those three numbers already show that WAC is not a single obesity price, it is a molecule-and-brand-specific number set by two manufacturers competing on a class with no generic entrant yet.
The Inflation Reduction Act changes one of those tracks and not the other. CMS's second negotiation cycle (IPAY 2027, effective January 1 2027) set a Maximum Fair Price of $274 for a 30-day semaglutide supply, a 71% reduction off list, and that price applies across the full semaglutide franchise: Ozempic, Rybelsus, and Wegovy. Tirzepatide is absent from every CMS selected-drug list published to date. A pricing strategy that treats 'GLP-1 pricing' as one number is already wrong; the negotiated track and the un-negotiated track diverge by roughly $800 to $1,000 a month, and that gap is the commercial opening the model is built to quantify.
ICER's December 2025 reassessment gives both classes a value-based ceiling independent of what CMS or a manufacturer sets. Health-benefit price benchmarks came in at $9,100 to $12,500 a year for injectable semaglutide and $11,700 to $16,100 a year for tirzepatide, with ICER rating both 'high value' at those levels. Measured monthly, ICER's own benchmark ceiling for semaglutide (roughly $760 to $1,040) already sits above the $274 MFP CMS negotiated, meaning the IRA price undercuts even ICER's cost-effectiveness ceiling. Tirzepatide's ICER ceiling, by contrast, sits close to its current list price with no negotiated floor beneath it yet.
US obesity pricing — list price, IRA-negotiated price, and ICER benchmark compared
| Agent | List WAC (monthly) | IRA-Negotiated Price (2027) | ICER Health-Benefit Benchmark (annualized monthly) |
|---|---|---|---|
| Wegovy (semaglutide) | ~$1,349 | $274 (30-day supply, effective Jan 1 2027) | ~$760–$1,040 |
| Ozempic (semaglutide) | ~$959 | $274 (30-day supply, effective Jan 1 2027) | ~$760–$1,040 |
| Zepbound (tirzepatide) | ~$1,060 | Not on CMS selected-drug list | ~$975–$1,340 |
Sources: CMS Medicare Drug Price Negotiation Program, IPAY 2027 selected-drug list and Maximum Fair Price announcement; published manufacturer WAC pricing; ICER Institute for Clinical and Economic Review, obesity management therapies reassessment, December 2025.
What this model answers
Every section answers a named commercial question your team is asking, scoped to your asset.
- How much does the IRA's $274 semaglutide MFP actually undercut current WAC, and what does that do to gross-to-net once IPAY 2027 takes effect? • The full WAC ladder across Wegovy, Zepbound, and Ozempic • The 71% MFP discount mechanics and January 1 2027 effective date • A gross-to-net waterfall showing where the negotiated price lands relative to existing commercial rebates
- Why is tirzepatide absent from the CMS selected-drug list, and what pricing exposure does that create relative to semaglutide? • CMS selected-drug list eligibility mechanics and tirzepatide's current status • The pricing-parity gap this creates between the two classes • Scenario modeling for when/if tirzepatide enters a future negotiation cycle
- Where do ICER's health-benefit price benchmarks sit relative to both the negotiated and un-negotiated price, and what does that imply for commercial contracting? • ICER's December 2025 benchmark range for both molecules • Comparison against the $274 MFP and current WAC • Commercial PA/step-edit criteria (BMI thresholds) as the access lever payers still control
What's inside
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1 · The Binding Constraint 2 pp
- Why the IRA-negotiated vs un-negotiated split, not list price, is the number that decides obesity pricing strategy
- Pressure-tested against the $274 MFP before the rest of the model is built out
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2 · WAC Price Ladder 2 pp
- Wegovy, Zepbound, and Ozempic list pricing compared
- Where the two manufacturers already diverge on branded obesity pricing
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3 · IRA Negotiation — IPAY 2027 Semaglutide MFP 3 pp
- The $274 Maximum Fair Price mechanics and January 1 2027 effective date
- Why the MFP applies across Ozempic, Rybelsus, and Wegovy as one franchise
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4 · Tirzepatide's Un-Negotiated Exposure 2 pp
- Tirzepatide's absence from every CMS selected-drug list to date
- The pricing-parity gap this opens against semaglutide
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5 · ICER Value-Based Benchmarks 3 pp
- December 2025 health-benefit price benchmarks for both molecules
- Where the negotiated and un-negotiated prices sit against ICER's ceiling
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6 · GTN Waterfall & Commercial PA Criteria 3 pp
- Gross-to-net build from WAC to net, factoring commercial rebates and the IRA MFP
- Commercial prior authorization/step-edit criteria (BMI ≥30 with comorbidity, or ≥35) as the remaining access lever
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7 · Pricing Scenarios & Sensitivity 3 pp
- Conservative, base, and aggressive pricing scenarios tied to a future tirzepatide negotiation cycle
- Sensitivity ranking of MFP timing, PA criteria loosening, and list price movement
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8 · Client Alignment Questions 2 pp
- The open pricing questions your team must close before a commercial contracting position is locked
Appendix and source ledger included · 45-minute analyst readout included with delivery
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Commission this model
AXLRx delivers obesity pricing strategy models built for market access and pricing teams navigating the IRA negotiation split between semaglutide and tirzepatide. Custom model in 72 hours.
- 1. Submit your requestSpecify your target payer channel, plan mix, and comparator agents.
- 2. Scoping callAXLRx analyst confirms pricing mechanism assumptions and negotiation-cycle scope before building.
- 3. DeliveryResearch-verified pricing model in 72 hours with optional analyst readout.
How AXLRx builds this model
Prepared by MoatRx analysts on the AXLRx commercial consulting engine.
Every AXLRx pricing model separates negotiated price from list price explicitly, since the two track different mechanisms (CMS Maximum Fair Price negotiation versus manufacturer-set WAC) and conflating them misstates the actual net pricing position.
Obesity US pricing sources: CMS Medicare Drug Price Negotiation Program IPAY 2027 announcement, published manufacturer WAC pricing for Wegovy, Ozempic, and Zepbound, and the ICER obesity management therapies value assessment, December 2025.
- The $274 Maximum Fair Price and 71% discount verified against the CMS IPAY 2027 selected-drug list and negotiated price announcement
- Tirzepatide's absence from the CMS selected-drug list verified against the same IPAY 2027 published list
- ICER's $9,100–$12,500 and $11,700–$16,100 annual benchmark ranges verified against ICER's December 2025 obesity management therapies reassessment
Frequently asked questions
Deliverables What formats are included with every model?
Every commissioned Pricing Strategy Model includes an editable 8-sheet Excel model (WAC Ladder, IRA Negotiation, Tirzepatide Exposure, ICER Benchmarks, GTN Waterfall, PA Criteria, Scenarios, QC & Sources) and a PDF methodology brief, no PowerPoint deck, since a pricing model is built to be worked in directly rather than presented from. An optional 45-minute analyst readout call is included.
Sources How is the pricing evidence verified?
AXLRx builds from primary sources: CMS's own Medicare Drug Price Negotiation Program publications, manufacturer-published WAC pricing, and ICER's formal value assessments. Every negotiated price, discount percentage, and benchmark range is independently verified before inclusion.
Customisation Can I model a specific payer channel or plan type?
Yes. The intake form captures your target payer channel, plan mix, and comparator set. A scoping call confirms scope before research starts. Commission via the intake form to start.