U.S. spending on prescription drugs is projected to surpass $1 trillion in 2026, a massive transfer of wealth driven primarily by the surging sales of weight-loss and diabetes medications, according to a new report from the American Society of Health-System Pharmacists. This unprecedented level of expenditure, which saw a nearly 13% jump to $915 billion in 2025, represents a significant boon for pharmaceutical corporations, whose profits are increasingly extracted from the public's health needs.
The primary drivers of this capital accumulation are Eli Lilly's tirzepatide, sold as Zepbound for weight loss and Mounjaro for Type 2 diabetes, and Novo Nordisk's semaglutide, marketed as Wegovy for weight loss and Ozempic for Type 2 diabetes. Eli Lilly's tirzepatide emerged as the nation's top-selling drug, generating wholesale purchases of nearly $63 billion in 2025. Novo Nordisk's semaglutide followed closely, ranking second with more than $59 billion in sales last year. In stark contrast, the third-highest selling drug, the blood thinner Eliquis, reached $29 billion in sales, less than half the amount garnered by each of the GLP-1 drugs.
These figures, derived from a national database tracking wholesaler purchases from drug manufacturers, reveal the scale of surplus extraction. Wholesalers then distribute these medications to various healthcare entities, including hospitals, clinics, and pharmacies, further embedding the profit motive throughout the healthcare supply chain. The amount ultimately paid by consumers is subject to a complex web of rebates, discounts, and insurance coverage, often obscuring the true cost and the extent of corporate gain.
Capital's Expanding Reach
Sales of Zepbound and Wegovy have continued to accelerate, even as Eli Lilly and Novo Nordisk strategically cut prices to attract more cash-paying customers. This tactic, as articulated by Lilly CEO David Ricks, who told analysts that "Every time we reduce pricing, we see a pretty large expansion," demonstrates how price adjustments can be leveraged to expand market share and overall revenue, rather than genuinely reduce costs for the working class. Surveys indicate that nearly half of employer insurance plans now cover these anti-obesity drugs, leaving a significant portion of the workforce without employer-provided access to these medications.
For those without insurance coverage, Novo Nordisk and Eli Lilly have actively courted consumers by selling the medications directly through their respective pharmacies or via telehealth providers. This direct-to-consumer approach allows pharmaceutical capital to bypass traditional intermediaries and capture a larger share of the revenue from individuals forced to pay out-of-pocket. Eli Lilly reported "eye-opening" quarterly revenue and profit growth, directly fueled by the sales of Zepbound and Mounjaro, further illustrating the immense capital accumulation at play. The company also launched its new weight-loss pill, Foundayo, in April, anticipating it will further buoy sales this year.
The State's Role in Subsidizing Profits
The state, through its Medicare program, is actively facilitating this expansion of pharmaceutical profits. Earlier this month, Medicare announced a "bridge program" to begin coverage of GLP-1 weight-loss drugs from July 1, next year through December 31, next year. Under this program, Medicare enrollees will pay a $50 monthly copay to access these medications. While presented as a benefit, this state intervention effectively guarantees a new revenue stream for pharmaceutical corporations by expanding the pool of eligible consumers, with public funds partially subsidizing the cost.
Furthermore, changes to Medicare coverage policies, such as the $2,100 cap on out-of-pocket drug spending for older Americans in Medicare Part D, which took effect this year, may inadvertently drive higher spending. Eric Tichy, lead author of the ASHP report, noted that this cap, part of the Inflation Reduction Act enacted in the fourth year, "might be driving more use of higher-cost drugs because patients are having to pay less." This demonstrates how liberal reform efforts, even those intended to alleviate patient burden, can ultimately channel more capital into the pharmaceutical industry by increasing demand for expensive drugs.
Despite the ASHP report attributing only about 1% of overall drug spending to higher drug prices, other reports, such as data from 46brooklyn Research, indicate that companies raised list prices on over 850 drugs by a median of 4% over 2025. This contradiction highlights the complex mechanisms of price manipulation and market control employed by pharmaceutical capital. Beyond GLP-1s, cancer drugs also represent a significant and rapidly growing category of drug spending, with pembrolizumab (Keytruda) identified as the top-grossing oncology drug in clinics and hospitals in 2025, underscoring the pervasive nature of profit extraction from critical health needs.