Abstract

In late 2025, the White House announced new Most Favored Nation (MFN) pricing agreements for the glucagon-like peptide-1 receptor agonist class, including 3 semaglutide products, establishing substantially lower prices for Medicare and Medicaid. Shortly after, the Centers for Medicare and Medicaid Services released Maximum Fair Prices (MFPs) for selected drugs under IPAY 2027, revealing semaglutide prices that differed from the MFN prices and from earlier assumptions used in prior economic evaluations, including our prior article. Using previously published forecasting methods, we updated our 10-year (2026-2035) Medicare spending estimates for semaglutide across all US Food and Drug Administration (FDA)-approved indications under both the newly announced MFP and MFN price structures. Incorporating revised 30-day MFPs for Ozempic, Rybelsus, and Wegovy, as well as patient cost-sharing assumptions and future generic entry, we now estimate Medicare savings of $463 million under base-case MFP conditions, with alternative uptake scenarios producing $328 to $599 million in savings and up to $1.78 billion with loss-of-exclusivity assumptions. Using the lower MFN price of $245 per month and a $600 annual patient copay, estimated Medicare savings increase substantially to $1.76 billion, ranging from $1.03 to $2.50 billion across uptake scenarios and reaching $2.63 billion with generic entry. These findings highlight the significant fiscal impact of recent price negotiations and underscore uncertainties regarding the durability and future scope of MFN-based drug pricing arrangements.