The blockbuster drug could be manufactured for 89 cents to $4.73 for a month’s supply, figures that include a profit margin, researchers at Yale University, King’s College Hospital in London and the nonprofit Doctors Without Borders reported in the journal JAMA Network Open.

The study extends research showing how steep US markups are for GLP-1 drugs like Ozempic and Wegovy and underlines longstanding criticism of prices for diabetes therapies, especially insulin.

By some estimates, however, the reductions made those products more profitable because they eliminated rebates paid to pharmacy benefit managers, the middlemen who negotiate prices for payers and employers.

State health plans and Medicaid offices are seeing growing bills for Ozempic and its sister drug Wegovy, raising questions about whether the increases in cost are sustainable.

In January, North Carolina cut off coverage of anti-obesity medicines for state employees, citing soaring costs and lack of agreement on pricing from drugmakers.

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