Imagine shelling out $500 a month for a life-changing drug, only to find your insurance won’t cover it.
According to AP News, prices for obesity drugs Wegovy and Zepbound are declining, yet access remains a frustrating maze for many, with uneven insurance coverage, high out-of-pocket costs, and cheaper compounded alternatives stirring debate.
Let’s start with the good news: the cost of Wegovy and Zepbound, popular GLP-1 receptor agonist drugs for obesity, has dropped to about $500 monthly for uninsured patients. That’s a notable reduction from earlier prices.
Yet, $500 a month is still steep—about 14% of the average U.S. per-person annual income of $43,000. For many, this remains a barrier to treatment. Insurance offers little relief for most. Coverage for these drugs is spotty, even when plans include them, often leaving patients with hundreds in monthly costs.
Medicare and Medicaid are largely out of the picture, refusing to cover these drugs for obesity treatment. State and federal programs prioritize other uses, like diabetes, where drugs like Ozempic and Mounjaro sometimes get approved.
Even when employers step in, it’s a mixed bag. While benefits consultant Mercer notes more businesses with 500+ employees are adding coverage, some large employers have dropped it due to soaring costs.
Drugmakers like Novo Nordisk and Eli Lilly offer assistance for out-of-pocket expenses, but it’s often limited. Meanwhile, 85% of Novo Nordisk’s insured patients pay $25 or less monthly for Wegovy, a bright spot for some.
High demand fuels the problem, with Wegovy seeing 200,000 weekly U.S. prescriptions and $1.9 billion in first-quarter sales for Novo Nordisk. Zepbound isn’t far behind, raking in $2.3 billion for Eli Lilly in the same period.
Shortages of these drugs led to a workaround: compounding pharmacies producing cheaper, off-brand versions. Though the FDA declared the shortage over, some personalized compounding is still allowed.
Companies like Hims & Hers Health offer compounded semaglutide (Wegovy’s active ingredient) at $165 a month with an upfront payment for a year, adjusting doses to manage side effects. They claim rigorous safety checks, but drugmakers aren’t convinced.
Novo Nordisk cut ties with Hims & Hers over safety concerns, citing unmonitored foreign ingredients in compounded versions. Eli Lilly has also sued pharmacies and telehealth firms to halt such sales.
Pharmacy benefit managers are picking favorites, with CVS Health dropping Zepbound from its formulary on July 1 in favor of Wegovy. Such negotiations could shift costs further.
Looking ahead, both Novo Nordisk and Eli Lilly are developing pill versions of their treatments, potentially hitting the market soon and driving down prices for injectables. Some patients already save up to 15% by sourcing doses from Canadian pharmacies after price drops there.
For now, access isn’t guaranteed, even as costs ease. As Dr. Beverly Tchang, an advisor to both drugmakers, notes, “Coverage is not the same as access.” Investors and patients alike should watch this space—price wars, as Dr. Courtney Younglove predicts, may bring relief, but only if barriers crumble.