Evidence-graded answer
Why do GLP-1 medications cost so much in the US?
List prices ($1,100-$1,350/mo) reflect manufacturer pricing, US-specific lack of price negotiation (until IRA implementation), and high R&D recovery on patent. Cash and PAP programs now bring effective prices to $349-$499/mo (NovoCare Pharmacy, Lilly Direct).
List price vs net price gap is enormous in the US system — manufacturer rebates to PBMs typically take 40-60% off list. Patients face list when uninsured or when insurance imposes coinsurance.
IRA (Inflation Reduction Act) Medicare price negotiation begins applying to GLP-1 in 2027, which is expected to lower prices broadly.
Direct-to-patient cash channels (NovoCare Pharmacy, Lilly Direct) launched in 2024-2025 specifically to undercut compounded GLP-1 demand. They now offer the most predictable pricing for cash-pay patients.