There is no semaglutide settlement yet. Nearly 4,000 lawsuits over Ozempic, Wegovy, Rybelsus, and related GLP-1 drugs are pending in federal multidistrict litigation, but no global deal has been reached, no individual cases have paid out, and the first bellwether trials are not expected until late 2026 at the earliest. Attorneys involved in the litigation have published projected payout ranges based on comparable pharmaceutical mass torts, running from roughly $50,000 for mild gastrointestinal injuries to $2.5 million or more for severe vision loss, but those are estimates, not offers.
Projected Payout Ranges by Injury
The numbers below come from legal analysts and plaintiff-side attorneys working on the cases. They are projections drawn from how similar drug injury litigation has resolved historically. No defendant has agreed to them, and no court has awarded them.1Estimates published by legal analysts and attorneys involved in the semaglutide MDL.
- NAION with significant vision loss: $500,000 to $2,500,000 or more
- Wrongful death: $1,000,000 or more
- Severe gastroparesis requiring surgery, such as gallbladder removal: $400,000 to $700,000
- Chronic gastroparesis requiring ongoing treatment: $300,000 to $500,000
- Moderate gastrointestinal injury requiring hospitalization: $150,000 to $500,000
- Mild gastrointestinal symptoms treated on an outpatient basis: $50,000 to $150,000
Some analysts have projected total industry liability could exceed $2 billion. Because the litigation is organized as multidistrict litigation rather than a class action, there is no single pot divided among plaintiffs. Each case is valued on its own facts: the strength of medical documentation, severity and permanence of the injury, lost wages, and eventually what juries do with the bellwether cases.
Why No Settlement Has Happened Yet
The cases sit in two federal MDLs, both in the Eastern District of Pennsylvania and both overseen by Judge Karen S. Marston. MDL 3094 covers gastrointestinal injuries (gastroparesis, ileus, bowel obstruction, and related conditions) and had 3,763 pending cases as of June 1, 2026. MDL 3163, created in December 2025, handles vision loss claims involving non-arteritic anterior ischemic optic neuropathy (NAION) and started with 21 actions before growing.
In an MDL, consolidation is only for pretrial efficiency: shared discovery, common motions, and consistent rulings on scientific questions. Each plaintiff keeps an individual case. Settlement in this kind of proceeding typically follows bellwether trials, which are representative cases that let both sides see how juries respond to the core evidence. Until those verdicts land, defendants have little reason to negotiate seriously and plaintiffs have little leverage to demand a specific number.
By mid-2026, expert depositions had been completed in April, Daubert motions were fully briefed, and summary judgment briefing was underway and expected to run through July 2026. Bellwether trials are expected to begin mid-to-late 2026, though no formal trial date had been set as of June 2026. Most observers anticipate settlement discussions opening in mid-to-late 2027, with final resolutions potentially not arriving until 2028 or later.
What Plaintiffs Have to Prove
The lawsuits run on a failure-to-warn theory. Plaintiffs allege that Novo Nordisk and Eli Lilly knew or should have known these drugs could cause severe, sometimes permanent harm and failed to disclose those risks to patients and doctors.
Two categories of injury drive the litigation:
- Gastrointestinal injuries, including gastroparesis (stomach paralysis), ileus, intestinal obstruction, cyclic vomiting syndrome, gallbladder disease, pancreatitis, and acute kidney injury.
- Vision loss, specifically NAION, a condition in which blood flow to the optic nerve is suddenly cut off, causing permanent and often irreversible blindness.
On the labeling side, the Ozempic prescribing information has never included the word “gastroparesis” as a risk. The label notes that the drug “delays gastric emptying,” but only in the context of how it might affect absorption of other medications. A January 2025 label update stated that Ozempic is “not recommended in patients with severe gastroparesis,” but plaintiffs argue that language still does not warn that the drug causes the condition. The FDA required one significant addition in September 2023, adding a warning for ileus under “postmarketing experience.” NAION is not listed as an adverse drug reaction on U.S. labels for Ozempic, Rybelsus, or Wegovy, though a July 2024 study in JAMA Ophthalmology found semaglutide users with type 2 diabetes had a hazard ratio of 4.28 for developing NAION, and overweight or obese users had a hazard ratio of 7.64, compared to patients on other medications.
The single most consequential evidentiary ruling so far came in August 2025, when Judge Marston held that any plaintiff claiming gastroparesis must show a diagnosis based on a properly performed gastric emptying study: scintigraphy, a breath test, or a wireless motility capsule. Plaintiffs’ own counsel estimate this requirement reaches roughly 95% of the cases in the MDL. If your gastroparesis diagnosis rests only on clinical symptoms and a doctor’s observation without objective testing, your claim faces a serious hurdle.
Who Can File a Case
The primary defendant is Novo Nordisk, which manufactures Ozempic and Rybelsus (both approved for type 2 diabetes) and Wegovy (approved for chronic weight management). All three contain semaglutide. Novo Nordisk also makes Saxenda and Victoza (liraglutide). Eli Lilly is also a defendant for its GLP-1 drugs Mounjaro and Zepbound (tirzepatide) and Trulicity (dulaglutide).
Users of compounded semaglutide are not part of this litigation. Only patients who took brand-name medications from the named manufacturers have standing in the MDL. Novo Nordisk has separately filed 111 lawsuits across 32 states against pharmacies and online sellers of compounded versions of the drug, which are not FDA-approved.
Patients prescribed the drugs off-label for weight loss may have a stronger causation argument than patients who took them for type 2 diabetes, because defendants point to diabetes itself as an alternative explanation for gastroparesis and for the vascular conditions associated with NAION. Novo Nordisk has argued that gastroparesis is a known complication of diabetes and that NAION is associated with established risk factors including diabetes, obesity, and hypertension, which are common among semaglutide users.
How Novo Nordisk Is Defending the Cases
Novo Nordisk argues its warnings were adequate and that federal law may preempt state failure-to-warn claims, essentially that the FDA-approved label sets the ceiling for what warnings were required. The company has also invoked the learned intermediary doctrine, arguing that in prescription drug cases, warnings should be measured by what was communicated to prescribing doctors, not directly to patients. On NAION, Novo Nordisk has stated that the “benefit-risk profile of semaglutide remains favorable,” citing clinical programs involving over 54,000 participants and more than 38 million patient-years of post-marketing exposure.
Regulators have not aligned on the vision-loss risk. The European Medicines Agency’s Pharmacovigilance Risk Assessment Committee concluded in June 2025 that NAION is a “very rare” side effect of semaglutide, affecting up to 1 in 10,000 users, and recommended updating European product labels. The FDA had not made a comparable determination as of mid-2026 and was still analyzing national electronic data to assess whether a safety signal exists. Separately, on March 5, 2026, the FDA issued a warning letter to Novo Nordisk citing serious violations in postmarketing adverse event reporting, including failure to report three patient deaths within the required 15-day window.
What to Watch Next
The calendar between now and any settlement runs through a specific sequence. Summary judgment briefing was expected to wrap by July 2026. Bellwether trial selections and dates should follow. Once bellwether verdicts come in, both sides will have real data on jury reactions, and that is when settlement negotiations typically become serious.
If you believe you have a claim, the two facts that most affect what happens next are the type of drug you took (brand-name from Novo Nordisk or Eli Lilly, not compounded) and the objective medical evidence in your records, particularly a gastric emptying study for gastroparesis claims or ophthalmologic documentation for NAION. The projected payout ranges above are the working numbers attorneys are using, but until a jury or a settlement agreement puts a real figure on a real case, they remain projections.