The combined image shows an injection pen for Eli Lilly’s weight-loss drug Zepbound and a box of Wegovy, made by Novo Nordisk.
Reuters
Despite limited insurance coverage and high out-of-pocket costs, prescriptions for a blockbuster weight loss drug in the U.S. will increase by 2 in 2024, according to data released Thursday by drug savings company GoodRx. It has more than doubled.
The numbers provide further evidence of insatiable demand for topical drugs called GLP-1 and GIP agonists, which are similar to intestinal hormones that suppress appetite and regulate blood sugar levels. For that, novo nordiskWeight loss drug Wegovy and Eli Lilly‘s obesity drug Zepbound has a hefty list price of about $1,000 a month, before insurance and savings cards.
Since the beginning of 2024, prescription fills for Wegovy and Zepbound have increased by more than 100% and 300%, respectively. Zepbound’s surge reflects its first year on the market, as it was approved in the US in November 2023. Wegovy won US approval in 2023. 2021.
“This is just astronomical sales growth, so there’s a lot of focus on its affordability and accessibility,” GoodRx research director Tori Marsh said in an interview. .
This data comes from GoodRx’s new weight loss drug tracker, which examines filling trends and spending patterns for popular weight loss drugs in the United States.
This high fill rate comes despite the fact that only 9% of people with commercial insurance have Zepbound unlimited coverage and 14% have Wegovy unlimited coverage, according to GoodRx. has been realized. This refers to insurance coverage that does not require additional hoops for patients to jump through, such as prior authorization or higher BMI requirements.
A much higher proportion of patients (approximately 60% to 70%) have insurance plans with more restrictive drug coverage. But Marsh said even if a patient has insurance coverage for weight loss treatment, the out-of-pocket costs can be high.
The average insured person taking Zepbound can expect to pay more than $2,500 a year in out-of-pocket costs for the drug, she said. GoodRx research found that from January 2023 to October of this year, people paid an average of $231 out-of-pocket for their monthly Zepbound prescriptions.
“Insurance is not the stopgap it once was,” Marsh says.
Meanwhile, nearly 1 in 5 commercially insured people do not have coverage for at least one brand of GLP-1 and GIP agonist prescribed for weight loss.
According to a GoodRx study, Americans saved at least $200 million by paying the full retail price of weight loss drugs instead of taking advantage of savings options like GoodRx coupons and assistance programs offered by Eli Lilly and Novo Nordisk. It turned out to be overused. GoodRx said it calculated the number of overpayments based on the average price people would have paid for drugs with GoodRx discounts.
According to GoodRx, uninsured people can save an average of $250 a month, or $3,000 a year, with weight loss drug coupons.
GoodRx’s data is consistent with other studies showing disparities in insurance coverage for weight loss drugs in the United States. For example, a study released in October found that fewer than one-fifth of the nation’s large employers include these treatments in their health insurance plans.
Federal Medicare plans also do not cover weight loss treatments unless they are approved and prescribed for another health condition. Research shows that drug coverage can significantly increase costs for employers and state and federal governments.
But the Biden administration proposed a rule in November that would allow Medicare and Medicaid to cover weight-loss drugs for obese patients. If approved by the incoming Trump administration, this rule would significantly expand access to treatment.
