| I had never seen a more crowded hearing in my time covering Capitol Hill. More than 100 lawmakers, lobbyists and pharmaceutical executives squeezed into a fifth-floor room at the Dirksen Senate Office Building Tuesday to witness a long-anticipated face-off. Those who didn't arrive early enough to score a seat were redirected to an overflow room. Many lingered in the hallway, hoping to be let in. Sitting at the witness table was the CEO of Novo Nordisk, Lars Fruergaard Jorgensen. Across from him was Senator Bernie Sanders of Vermont, a longtime champion of lowering health care costs in the US and the chair of the Senate's Health, Education, Labor and Pensions Committee. Sanders asked Jorgensen one question again and again. Why does Novo's GLP-1 weight-loss drug, Wegovy, cost so much more in the US than it does elsewhere in the world? The CEO said the US health care system is complex, blaming drug industry middlemen for leaving patients with high out-of-pocket costs. He also said that the list prices they set are needed to cover the steep investments required to bring critical drugs to market. But this oft-repeated argument is falling flat for Novo. On Monday, my colleague Bob reported that its GLP-1 drugs are making so much money that their cumulative sales will soon surpass the drugmaker's entire research budget for the past three decades. Sanders repeated his question to Jorgensen: "You haven't give me an answer as to why." "It's a simple question." "What I am asking you is, if you don't act, 40,000 people a year could die," Sanders added. "Is this acceptable to you?" Behind Sanders was a poster showing that a monthly dose of Wegovy costs $92 in the UK, $137 in Germany, $186 in Denmark, $265 in Canada and $1,349 in the US.  Senator Bernie Sanders during the hearing in Washington. Photographer: Al Drago/Bloomberg Jorgensen said that cutting drug prices could also have unintended consequences. When insulin prices were reduced, for example, pharmacy benefit managers, those US drug middlemen, took some off their preferred drug lists, since they made less money on them. "We don't control the price set for the patients — that's set by the insurance schemes," he said. But Sanders had a surprise: "I am delighted to announce today that I have received commitments in writing from all the major PBMs that if Novo Nordisk substantially reduces the list price for Ozempic and Wegovy, they would not limit coverage," he said. "That's new information for me," Jorgensen said. "Anything that will help patients get access to affordable medicine we'll be happy to look into." Among the sea of suits in the audience sat Kim and John Carlos and their son. The trio, who traveled to Washington from Georgia for the hearing, wore matching shirts proclaiming, "Make GLP-1 Affordable."  Kim Carlos and John Carlos. Photographer: Riley Griffin/Bloomberg Kim and John have tried them all. Between insurance roadblocks and ongoing shortages, they've both had to jockey between Ozempic and Wegovy, Eli Lilly & Co.'s Mounjaro and Zepbound and other weight-loss drugs. Having paid the high costs, Jorgensen's comments didn't resonate with them. "If they lowered the list price, I think the out-of-pocket cost for people with and without insurance would drop drastically," John told me after the hearing ended. That doesn't mean PBMs aren't a part of the problem, Kim said. But she wished Jorgensen had been more direct about Novo's contribution to the challenges patients face. "There's no way he's going to come here and say, 'I charge you this much because I can,'" Kim said. But if Novo won't act to lower prices and improve access, then "we have got to start to recognize that in this country with legislation." — Riley Griffin | 
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