GLP-1 Patents and Prices: MCPS’s Bill Tops $100 Million Before Rebates

GLP-1 drugs such as Ozempic and Wegovy now cost the Montgomery County Public Schools employee health plan “over $100 million,” MCPS’s chief financial officer told a school board committee in September, and MCPS later told Moderately MOCO that the figure is before drug-maker rebates.

In a Novo Nordisk-funded trial of 17,604 adults 45 or older with heart disease and overweight or obesity but no diabetes, 6.5% of those given weekly 2.4 mg semaglutide, the dose used in Wegovy, had a heart attack, stroke or cardiovascular death over an average of about 3.3 years, compared with 8.0% on placebo, according to the study in the New England Journal of Medicine.

In the United States, the FDA’s Orange Book lists a patent on semaglutide itself as expiring Dec. 5, 2031, and lists other patents on the drugs that run later.

On election night, Moderately MOCO asked Rep. Jamie Raskin, the top Democrat on the House Judiciary Committee, whether patent reform could be on the agenda for GLP-1 drugs. “Intellectual property patents and trademarks and copyright are all under the jurisdiction of the Judiciary Committee. And we’re going to be looking at all of that,” Raskin said in the interview.

MCPS Chief Financial Officer Ivon Alfonso-Windsor gave the MCPS figures aloud at the Board of Education’s Fiscal Management Committee meeting on Sept. 15. “I think in FY 24, our GLP one cost was about 34 million,” Alfonso-Windsor said, and fiscal 2026 costs were “like 80 million.” “Now we’re over $100 million in total expenses for GLP one drugs,” she said, according to Moderately MOCO’s transcription of the official meeting video (at 57:04).

Montgomery Perspective first reported the CFO’s GLP-1 figures, in an Oct. 12 column by Adam Pagnucco.

Moderately MOCO’s series on what GLP-1 drugs cost, who pays and what sets the price starts with this story.

What MCPS told us

MCPS answered three questions from Moderately MOCO about the CFO’s figures in an email on Oct. 30:

• The GLP-1 spending figures are before drug-maker rebates, “as the provider does not report rebates by drug type,” MCPS said.
• The GLP-1 spending figures include “all members, with the exception of Post-65 Medicare retirees,” MCPS said.
• “Approximately 5,600 members” of the MCPS health plan used a GLP-1 drug last year, MCPS said.

MCPS did not give a GLP-1 cost after rebates, and the MCPS email did not say which 12-month period “last year” covers.

GLP-1 drugs make up about one third of all prescription spending in the MCPS employee health plan, according to the slides MCPS staff presented on Sept. 15 (page 6). MCPS’s Sept. 15 slides project that the MCPS employee health fund ended fiscal 2026 about $97 million in the red, and list prescription drug costs among four factors affecting the fund.

The price and the patents

GLP-1 costs average close to $1,000 per patient per month, the County Council’s Office of Legislative Oversight wrote in an October report on group health insurance costs, citing National Insurance Services (page 8).

Seven applications to sell generic versions of Ozempic, each challenging Ozempic’s patents, were submitted to the FDA on Dec. 6, 2021, according to the FDA’s list of patent challenges. Novo Nordisk, which makes Ozempic and Wegovy, settled U.S. patent litigation over Ozempic with seven generic companies, and “all terms of the agreements are confidential,” Novo said in its 2025 annual report to the SEC.

The FDA tentatively approved Apotex’s generic semaglutide injection on April 7, 2026, and the FDA’s drug approvals database still listed the approval as tentative in its Nov. 6 update. Under a tentative approval, the FDA delays final approval until patent or exclusivity issues are resolved, and the generic cannot be marketed, according to the FDA’s glossary.

Canada’s patent office lists a Novo Nordisk patent on “acylated GLP-1 compounds,” the Canadian patent covering semaglutide, as expired; the last maintenance fee it records was received in October 2018, according to an April 2026 archived copy of the record. Canada approved its first generic semaglutide on April 28, 2026, Harvard researchers Daniel Eisenkraft Klein and Aaron Kesselheim wrote in the journal Health Policy.

Health Canada’s Drug Product Database lists Dr. Reddy’s generic semaglutide as marketed in Canada from May 6, 2026, and Apotex’s from May 14. Apotex said its generic would be “approximately one-third the price” of brand-name Ozempic in Canada, The Canadian Press reported in a story published by BNN Bloomberg.

In Maryland, the Prescription Drug Affordability Board voted May 18 to propose a limit of $274 per 30-day supply on what eligible government payers pay for Ozempic, according to the board’s Ozempic page. The board’s agenda for its Nov. 16 meeting lists a vote on approving the Ozempic limit as final.

How MCPS’s plan covers GLP-1 drugs now

Under MCPS’s employee health plan, two GLP-1 drugs may be used for obesity, and each must be preapproved, a rule that came out of negotiations, Alfonso-Windsor told the committee. For 2026, MCPS added programs “to prevent coverage of off-label use of GLP-1 diabetes drugs for weight management while minimizing member disruption,” according to its Oct. 3, 2025 open enrollment memo (page 2).

Moderately MOCO’s series will follow the patent question in Congress and the Prescription Drug Affordability Board’s Nov. 16 meeting.

Still unanswered

• Would Maryland’s proposed $274 Ozempic limit apply to the MCPS employee health plan?
• Which 12-month period does the “over $100 million” figure cover, and is it actual or projected spending?

MCPS answered three of our questions by email on Oct. 30. We have not yet put these questions to MCPS or the Prescription Drug Affordability Board; this story will be updated with any response.

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