
Obesity drug prices are dropping, but getting a steady supply remains a challenge
The medications still amount to around $500 per month for those without insurance — out of reach for many patients. And even for people with insurance, coverage remains uneven.
'The medications should be available, the question is at what price and can people sustain that,' said Matt Maciejewski, a Duke University professor who studies obesity treatment coverage.
Doctors say the situation forces them to get creative in treating patients, but there's hope that prices may fall more in the future.
The drugs are still in high demand
Wegovy and Zepbound are part of a wave of obesity medications known as GLP-1 receptor agonists that have soared in popularity.
Zepbound brought in $2.3 billion in U.S. sales during this year's first quarter, making it one of drugmaker Eli Lilly's best sellers.
Novo Nordisk says Wegovy has about 200,000 weekly prescriptions in the U.S., where it brought in nearly $1.9 billion in first-quarter sales.
Insurance coverage is increasing — for some
The benefits consultant Mercer says more businesses with 500 or more employees are adding coverage of the injected drugs for their workers and family members.
And Novo says 85% of its patients who have coverage in the U.S. pay $25 or less per month.
Plus some patients with diabetes can get coverage of the GLP-1 drugs Ozempic and Mounjaro from Novo and Lilly that are approved to treat that condition.
But most state and federally funded Medicaid programs don't cover the drugs for obesity and neither does Medicare, the federal program mainly for people age 65 and older.
Even the plans that cover the drugs often pay only a portion of the bill, exposing patients to hundreds of dollars in monthly costs, said Dr. Beverly Tchang.
Drugmakers offer help with these out-of-pocket costs, but that assistance can be limited.
'Coverage is not the same as access,' said Tchang, a New York-based doctor who serves as a paid advisor to both Novo and Lilly.
But coverage remains inconsistent
Bill-payers like employers are nervous about drugs that might be used by a lot of people indefinitely.
Some big employers have dropped coverage of the drugs due to the expense. Pharmacy benefit managers, or PBMs, also are starting to pick one brand over the other as they negotiate deals with the drugmakers.
One of the nation's largest PBMs, run by CVS Health, dropped Zepbound from its national formulary, or list of covered drugs, on July 1 in favor of Wegovy.
That forced Tchang to figure out another treatment plan for several patients, many of whom took Zepbound because it made them less nauseous.
Dr. Courtney Younglove's office sends prospective patients a video link showing them how to check their insurer's website for coverage of the drugs before they visit.
'Then some of them just cancel their appointment because they don't have coverage,' the Overland Park, Kansas, doctor said.
Cheaper compounded drugs are still being sold
Compounding pharmacies and other entities were allowed to make off-brand, cheaper copies of Wegovy and Zepbound when there was a shortage of the drugs. But the U.S. Food and Drug Administration determined earlier this year that the shortage had ended.
That should have ended the compounded versions, but there is an exception: Some compounding is permitted when a drug is personalized for the patient.
The health care company Hims & Hers Health offers compounded doses of semaglutide, the drug behind Wegovy, that adjust dose levels to help patients manage side effects. Hims says these plans start at $165 a month for 12 months, with customers paying in full upfront.
It's a contentious issue. Eli Lilly has sued pharmacies and telehealth companies trying to stop them from selling compounded versions of its products.
Novo recently ended a short-lived partnership with Hims to sell Wegovy because the telehealth company continued compounding. Novo says the compounded versions of its drug put patient safety at risk because ingredients are made by foreign suppliers not monitored by US regulators.
Hims says it checks all ingredients to make sure they meet U.S. quality and safety standards. It also uses a third-party lab to verify that a drug's strength is accurately labeled.
Prices have dropped
Both drugmakers are selling most of their doses for around $500 a month to people without insurance, a few hundred dollars less than some initial prices.
Even so, that expense would eat up about 14% of the average annual per person income in the U.S., which is around $43,000.
There are some factors that may suppress prices over time. Both companies are developing pill versions of their treatments. Those could hit the market in the next year or so, which might drive down prices for the older, injectable doses.
Younglove said some of her patients save as much as 15% by getting their doses shipped from a pharmacy in Canada. They used to get them from an Israeli pharmacy until the Canadians dropped their prices.
She says competition like this, plus the introduction of pill versions, will pressure U.S. prices.
'I think price wars are going to drive it down,' she said. 'I think we are in the early stages. I have hope.'
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Demand for obesity drugs shoots up in India as Lilly, Novo jostle for market share
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2 hours ago
- Business Insider
Eli Lilly's 3-step strategy to dominate the $95 billion obesity market
In sports, the best athletes compete against themselves. In the world of weight loss drugs, Eli Lilly is quickly becoming that all-star player that bests the competition every time. "Lilly is the king. They're the king of the mountain," Deutsche Bank's James Shin, director of biopharma equity research, told Business Insider. Investors are increasingly buzzing about the world's most valuable healthcare company, the one that they say has left its rivals in the dust. Danish drugmaker Novo Nordisk, the company that developed Ozempic, initially seemed unbeatable in the new market for injectable diabetes and weight loss medications. But ever since 2022, when Eli Lilly's tirzepatide was first approved for use in the US, Lilly's been steadily gaining ground. Now, the company is developing a menu of other obesity drugs that could cater to anyone. There's a pill for weight loss instead of an injection. There are drugs that tap into new appetite-regulating hormones; an antibody injection to protect muscles while burning up excess fat. "Investors are starting to talk about Lilly on their own cue, rather than in the context of Novo," Asad Haider, Goldman Sachs's lead analyst for US pharmaceuticals, told BI. "They are at the forefront of almost every existing as well as emerging mechanism across anti-obesity, and it's going to be really hard, in our view, to leapfrog them." So, we caught up with Eli Lilly Executive Vice President Ken Custer, the man overseeing it all. Custer is the new president of Lilly's cardiometabolic health division, and in a recent one-on-one with BI, he shared the strategy behind the company's success so far and how they plan to maintain their big lead in the long run. Eli Lilly is set to dominate the market by 2030 Eli Lilly's tirzepatide, the drug currently leading the charge, is the strongest weight loss drug available so far. 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Case in point: It took about two decades to get Trulicity, Eli Lilly's first GLP-1 drug, on the market. Tirzepatide? About eight years — "blistering speed," Custer said. 2. Convenience: a cheap(er) pill to rival Ozempic Eli Lilly is in the late stages of developing the first Ozempic-like pill, designed to be just as strong as Novo's injectable drug. The drug, orforglipron, could be available as early as 2026. There are only about 8 million people currently on Mounjaro, Ozempic, Wegovy, and Zepbound in the US, which speaks to both the high cost of the injectable drugs and the supply bottlenecks. "The injectable GLP-1s are wonderful medicines, but manufacturing those medicines is hard," Custer said. "The factories that you have to use to do the sterile filling of the vials, the syringes, the devices, the cartridges are extraordinarily hard to build and operate." 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Indianapolis Star
2 hours ago
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CVS dropped Zepbound in standard coverage. What that means for Zepbound users
When Zepbound, Eli Lilly's highly anticipated weight loss drug, hit the market a year and a half ago, it marked a turning point for the accessibility of weight loss drugs. Since then, Zepbound, the brand name for tirzepatide, has nearly become a household drug brand. Lilly estimates 4.5 million people take one of the Indianapolis drugmaker's GLP-1 medicines to lose weight or curb other health concerns like sleep apnea. But a recent coverage change by a major pharmacy benefit manager may force many to decide how much they're willing to pay for the drug or whether they want to try another weight loss option. As of July 1, CVS dropped Zepbound from preferred coverage for those covered by its pharmacy benefit manager, Caremark. Novo Nordisk A/S's Wegovy, a semiglutide injectable medicine, is now the primary weight loss drug offered on CVS's standard formulary, a list of medications an insurance plan covers. The news was not only a blow to Lilly but also a surprise to millions using Zepbound on Caremark plans, who are now questioning how to move forward. Here's what to know if you are affected by the CVS Caremark formulary change. First, check your mailbox. Those affected should have received a letter with additional information and next steps that could vary person to person. Generally speaking, under the formulary change, CVS Caremark will now cover Wegovy for patients prescribed GLP-1 drugs, and patients on Caremark insurance plans should be able to switch easily. Those who currently use Zepbound on an insurance plan negotiated by Caremark should have received a letter stating the date their transition goes into effect. Some transitions may happen later than July 1, depending on the plan's sponsor. The coverage change only applies to employer and union insurance plans that choose the standard formulary template, about one-third of the population Caremark covers. Those using weight loss drugs on coverage plans different from the standard formulary are not impacted. Talk to your doctor if you have concerns about switching. Caremark offers a medical exceptions process for patients to gain access to off-formulary medications if the preferred alternative is ineffective. Or, talk to your employer. Some employers negotiate their own coverage plans so they may be able to switch to a non-standard formulary. Lilly also offers resources online to those on Zepbound. The list price for Zepbound sits at $1,086 for a 28-day supply, for those without insurance. Lilly estimates patients who have insurance that covers Zepbound pay as little as $25 for a one or three-month supply. Those with commercial insurance plans that do not cover Zepbound may be eligible for a 1-month supply that runs $650. One month equates to 28 days, or four injectable pens. Yes. Lilly sells vials of Zepbound to consumers through its online sales portal, LillyDirect. The lowest dose of 2.5 milligrams starts at $349 for four single doses that will last four weeks. Higher dose packs start at $499. The Indianapolis drugmaker expanded access through LillyDirect, and providers will be able to prescribe 12.5 and 15 milligram doses starting July 7. CVS Caremark estimates between 25 to 30 million people use its standard formulary template, comprising about 30% of its entire membership base. However, not all of those members take weight loss drugs. Weight loss drugs represent about 10% of what Caremark clients spend, up from 1% just a couple of years ago, a CVS executive said. Wegovy and Zepbound use is pretty evenly split for those on weight loss drugs through Caremark plans. Not entirely. Zepbound and Wegovy come from the same class of GLP-1 drugs and deliver significant weight loss through a once-weekly injection. But the two medications have different main active ingredients. Zepbound's main ingredient is tirzepatide and is approved for weight loss and obstructive sleep apnea. Wegovy is a semiglutide medication and helps manage weight loss and cardiovascular health. Though the two drugs are both approved for weight loss, a study published in May funded by Eli Lilly found that patients on Zepbound were more likely to experience weight loss. It was the first time the drugs were compared head-to-head. Caremark says it is dropping Zepbound from preferred coverage to ultimately lower the cost of the drug for its clients. Since Wegovy and Zepbound are clinically similar products approved for weight loss, Caremark encourages the drug manufacturers to compete against each other for preferred insurance coverage for millions of patients. Doing so, Caremark says, can significantly lower prices for employers and unions. "Our decision to prefer Wegovy over Zepbound will deliver significant cost savings for our clients in this therapy class, and the lower net price we were able to negotiate for Wegovy will enable more employers to provide coverage for the weight loss category," CVS Health Vice President of External Affairs David Whitrap told IndyStar in a written statement. Caremark expects employers and unions to expand access to Wegovy as a result of the change in policy. Two other GLP-1 injectables exist on the market, though each varies slightly from Zepbound and Wegovy. Ozempic, the original blockbuster semaglutide injection developed by Novo Nordisk, is used to treat type 2 diabetes. Mounjaro, a Lilly tirzepatide drug, is approved to treat type 2 diabetes when combined with diet and exercise. Eli Lilly is also well into clinical trials for the development of orforglipron, an oral GLP-1 drug for type 2 diabetes and weight management.