Zepbound reaches US pharmacies four weeks after approval

Eli Lilly announced on Dec. 5, 2023 that Zepbound (tirzepatide) injection is now available at US retail and mail-order pharmacies, about four weeks after the Food and Drug Administration approved it on Nov. 8, 2023 ^[1]. The company also said its commercial savings card program is live at pharmacies, which can bring the monthly cost down to as little as $25 for people whose insurance covers the drug ^[1][2].

Zepbound is approved as an addition to a reduced-calorie diet and increased physical activity for adults with obesity (BMI of 30 or higher) or adults who are overweight (BMI of 27 or higher) and also have a weight-related condition such as high blood pressure, dyslipidemia, type 2 diabetes, obstructive sleep apnea or cardiovascular disease ^[1]. It is shipping in six dose strengths: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg and 15 mg ^[1]. Lilly notes it should not be used with other tirzepatide products or with any GLP-1 receptor agonist medicine, and that it has not been studied in people with a history of pancreatitis or severe gastrointestinal disease, including severe gastroparesis ^[1].

The price and coverage picture

Zepbound carries a list price of $1,059.87 a month, compared with a list price of $1,349 per package for Novo Nordisk's Wegovy (semaglutide) ^[2]. Lilly's savings card has two tiers: people with commercial insurance that covers Zepbound may pay as low as $25 for a one-month or three-month prescription, while people with commercial insurance that does not cover Zepbound may pay as low as $550 for a one-month prescription, roughly 50% below list ^[1][2]. Terms and conditions apply, and Lilly directs patients to its website for eligibility details ^[1]. The sources do not describe eligibility rules for people on Medicare, Medicaid or other government programs, so that is not known from this announcement.

Coverage is starting to move. Zepbound was added to the National Preferred Formulary for Express Scripts and Cigna Healthcare effective Dec. 1, 2023, and was set to be added to Cigna Healthcare's commercial formularies effective Dec. 15, 2023 ^[1][2]. CVS Health's Caremark, another large pharmacy benefit manager, said it was still reviewing Zepbound to confirm it was clinically appropriate and cost-effective, and UnitedHealth's Optum Rx did not immediately comment ^[2].

On effectiveness, Reuters reported that Zepbound reduced weight by an average of 20% in late-stage trials, compared with 15% for Wegovy in separate Novo Nordisk trials ^[2]. Those were different studies, not a head-to-head comparison. Analysts expected Zepbound sales of about $2 billion in 2024 and Wegovy sales near $7.5 billion ^[2].

Why it matters for patients

Availability at the pharmacy counter and coverage on a formulary are two different hurdles. A prescription can now be filled at retail and mail-order pharmacies ^[1], but whether a plan pays is decided by the employer or insurer and its pharmacy benefit manager. At launch, Express Scripts and Cigna had made moves toward coverage while Caremark had not yet decided ^[1][2].

The savings card matters most for people with commercial insurance. Someone with coverage could see $25 for a one- or three-month fill, while someone with commercial insurance that excludes weight-loss drugs could face roughly $550 a month under the card, versus the $1,059.87 list price ^[1][2].

Lilly's own materials list the medicine's boxed warning about thyroid C-cell tumors, including medullary thyroid carcinoma, and warn against use by people with a personal or family history of MTC or with Multiple Endocrine Neoplasia syndrome type 2 ^[1]. Common side effects include nausea, diarrhea, vomiting, constipation, abdominal pain, indigestion, injection site reactions, fatigue, allergic reactions, belching, hair loss and heartburn ^[1].

One thing these sources do not address: the supply situation for Wegovy or whether Zepbound demand could strain Lilly's manufacturing. Lilly said only that it "continues to invest in the expansion of its global manufacturing footprint" to address expected demand ^[1].

What happens next

Dec. 15, 2023 was the effective date for adding Zepbound to Cigna Healthcare's commercial formularies ^[1][2]. Decisions from CVS Caremark and Optum Rx were still pending as of Dec. 5 ^[2]. Lilly said it is working with employers, government and industry partners to widen access ^[1].