New Zepbound direct prices represent a net increase

September 6, 2024

Last week, Eli Lilly announced a new direct-to-consumer pricing schedule for Zepbound, which is tirzepatide labeled for the treatment of obesity. Previously, Eli Lilly had been selling Zepbound in pens for administration to those without insurance for $549 a month. Lilly announced that the two starting doses of the drug, 2.5 mg and 5 mg, would now be available in vials for $399 a month (2.5 mg) and $549 a month (5 mg). These require patients to use an insulin syringe to give themselves an injection weekly. At the same time, Lilly increased the prices of Zepbound 7.5 mg and higher to $649 a month, although this was not stated in the press release. The price changes apply to consumers who purchase Zepbound through Lilly Direct and does not affect prices adjudicated through insurance.

Zepbound is generally started at 2.5 mg a week, and the dose is increased monthly until side effects are not tolerated or the desired cadence of weight loss is achieved. Therefore, most people will be on the 2.5mg dose for the first month, the 5 mg dose for the second month and will be on a dose of 7.5 mg or more each week starting in the third month.

Here is what the change in price means:

The second graphic (below) shows what this price change means in terms of cumulative cost if the patient continues on Zepbound for a year and progresses normally to the target dose. List price is $1060 per month, the same for all doses of this medication.

Many press outlets heralded this as a challenge to telemedicine firms using compounded GLP-1 medications, even though this actually represents an increase in cost. Here are some examples:  (1) (2) (3) (4). Some quoted the Obesity Action Coalition, an advocacy group that obtains much of its funding from pharmaceutical companies.

Implications for employers:

-        Direct purchase from a pharmaceutical company of GLP-1 medications effective in obesity treatment at this point remains cost-prohibitive for most plan members with obesity who do not have coverage in their employer-sponsored plans.

-        Beware of press releases that use only the list price for context, since very few pay the list price. The “direct” prices are similar to prices paid by employer-sponsored plans after discounts and rebates.

-        This drug, sold directly to patients without insurance coverage, is now less affordable than it was previously after the first few months of treatment.

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