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BOSTON, December 16, 2025 – The Institute for Clinical and Economic Review (ICER) today released a Final Evidence Report assessing the comparative clinical effectiveness and value of semaglutide (injectable Wegovy®, and a yet to be approved oral formulation) (Novo Nordisk) and tirzepatide (Zepbound®) (Eli Lilly and Company) for the treatment of obesity. The final report includes key policy recommendations to help ensure fair access.
Downloads: Final Evidence Report | Report-at-a-Glance | Policy Recommendations
“Semaglutide and tirzepatide have revolutionized the management of obesity,” said ICER’s Chief Medical Officer, David Rind, MD, MSc. “In addition to typically producing meaningful weight loss, these therapies reduce cardiovascular risk and improve multiple other aspects of the metabolic syndrome as well as additional obesity-related conditions. On average, these drugs are highly cost-effective, but the population in need of treatment is so great that even at these prices the US healthcare system will be strained to provide them to most people who need them in an affordable manner.”
ICER’s Public Meeting: Voting Results on Clinical Effectiveness and Benefits Beyond Health
ICER’s report was the subject of the November 2025 meeting of the New England CEPAC, one of ICER’s three independent evidence appraisal committees.
ICER assessed, and the independent appraisal committee voted on the evidence for the net health benefit of injectable semaglutide, oral semaglutide, and tirzepatide. Some of the voting results on clinical effectiveness and benefits beyond health include the following:
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The panelists unanimously (14-0) found that current evidence is adequate to demonstrate a net health benefit of each of the three treatments (injectable semaglutide, oral semaglutide, and tirzepatide) as an add-on therapy to lifestyle modification in comparison to lifestyle modification alone.
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The majority of panelists (13-1) found that current evidence is not adequate to distinguish the net health benefit between tirzepatide and injectable semaglutide.
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The majority of panelists (9-5) found that the current evidence is not adequate to distinguish between the net health benefit between oral semaglutide and injectable semaglutide.
Panel members also weighed potential benefits and disadvantages beyond the direct health effects and weighed special ethical priorities. Voting highlighted the following as particularly important for payers and other policymakers to note:
- There is substantial unmet need despite currently available treatments.
- All three treatments are likely to produce substantial improvement in caregivers’ quality of life and/or ability to pursue their own education, work, and family life.
- Oral semaglutide offers a substantial opportunity to improve access to effective treatment by means of its mechanism of action or method of delivery.
ICER’s Public Meeting: Voting Results on Long-Term Value for Money
Injectable semaglutide has a current estimated net price of $6,829, while tirzepatide is priced at $7,973. Oral semaglutide has not yet been approved by the FDA for obesity, and manufacturer has not yet announced a US price for the therapy if approved. For the purposes of our assessment, it was assumed that the net price is the same as injectable semaglutide.
ICER has calculated a health benefit price benchmark (HBPB) to be between $9,100 and $12,500 for injectable semaglutide, $8,300 and $11,400 for oral semaglutide, and $11,700 and $16,100 for tirzepatide.
After reviewing the clinical evidence and considering the treatments’ benefits beyond health noted above, the New England CEPAC evaluated the long-term value of injectable semaglutide, oral semaglutide, and tirzepatide at their current pricing:
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The majority of panelists (12) found that at their current pricing, both injectable semaglutide and oral semaglutide as add-on therapies to lifestyle modification represent “high” long-term value for money.
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The majority of panelists (13) found that at its current pricing, tirzepatide as an add-on therapy to lifestyle modification represents “high” long-term value for money.
Key Policy Recommendations
ICER’s independent assessment of value informs the critical decisions that stakeholders across the US health system need to make around pricing and coverage. Following the voting session, a policy roundtable of experts — including clinical experts, patients and patient advocates, manufacturers and representatives from US payers — convened to discuss the pricing implications and recommendations to ensure fair access. Key recommendations stemming from the roundtable discussion include:
- All stakeholders should take steps to promote culturally sensitive, comprehensive obesity care to all patients without stigma or bias, and ensure that direct-to-consumer platforms do not worsen health inequities or patient safety.
- Payers should ensure that cost-sharing and coverage policies do not further exacerbate treatment disparities through high out-of-pocket cost burdens or onerous clinical eligibility criteria, and in light of access and affordability concerns, should work with other stakeholders (e.g., manufacturers, plan sponsors, clinicians, patient groups) to find innovative ways to increase affordable access to comprehensive obesity care.
- Policymakers, payers, and clinical specialty societies should work together to support primary care physicians in providing comprehensive management of obesity.
- Existing GLP-1 RA manufacturers, and those with products in the pipeline, should consider steep discounts to prices in exchange for higher volume.
- Researchers should put a high priority on understudied aspects of obesity, including increasing the precision of diagnosis, characterizing caregiver burden, studying the feasibility of treatment de-escalation and withdrawal, and assessing the effectiveness of drugs compared with each other, as well as long-term efficacy and safety of the GLP-1 RAs and GLP-1/GIP RAs.
ICER’s detailed set of policy recommendations is available in the Final Evidence Report and in the standalone Policy Recommendations document.
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