Zepbound reaches US pharmacies with a savings card and early insurer coverage

Zepbound (tirzepatide) arrived in U.S. pharmacies on Dec. 5, 2023, Eli Lilly said, about four weeks after the Food and Drug Administration cleared the obesity drug on Nov. 8 ^[1][2]. Prescriptions can be filled at retail and mail-order pharmacies in six strengths: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg and 15 mg ^[1].

Lilly said the drug is cleared for adults with a body mass index of 30 or higher, or 27 or higher along with at least one weight-related condition such as high blood pressure, abnormal cholesterol, type 2 diabetes, obstructive sleep apnea or cardiovascular disease. It is meant to be taken with a reduced-calorie diet and more physical activity ^[1].

What patients would pay

Zepbound's list price is $1,059.87 a month, Reuters reported, against $1,349 per package for Novo Nordisk's Wegovy ^[2]. Lilly's commercial savings card is now accepted at pharmacies, with two different floors ^[1][2]:

• Commercially insured patients whose plans cover Zepbound: as low as $25 for a one-month or three-month prescription ^[1].
• Commercially insured patients whose plans do not cover it: as low as $550 for one month, which Lilly described as roughly half of list price ^[1][2].

Lilly did not describe terms for people without commercial insurance, and no price for that group was announced ^[1].

Coverage is shifting at the same time. Zepbound joined the National Preferred Formulary used by Express Scripts and Cigna Healthcare on Dec. 1, 2023, and is scheduled to be added to Cigna Healthcare's commercial formularies on Dec. 15, 2023 ^[1][2]. CVS Health's Caremark said it was still reviewing whether the drug is clinically appropriate and cost-effective, and UnitedHealth's Optum Rx did not immediately respond to a request for comment, according to Reuters ^[2].

How it compares with Wegovy

Tirzepatide is also the active ingredient in Lilly's diabetes drug Mounjaro, which has been prescribed off-label for weight loss since its 2022 launch ^[2]. Lilly describes Zepbound as the first FDA-approved obesity treatment that acts on both the GIP and GLP-1 hormone receptors ^[1].

In late-stage trials, Zepbound helped patients lose an average of 20% of their weight, Reuters reported, compared with 15% for Wegovy in separate Novo trials ^[2]. Wall Street analysts expect Zepbound sales of about $2 billion in 2024 and Wegovy sales of about $7.5 billion, in a weight-loss drug market projected to reach roughly $100 billion by the end of the decade ^[2]. Pfizer said last week it would not move its oral obesity drug danuglipron into late-stage trials after most patients dropped out of a midstage study amid high rates of side effects such as nausea and vomiting ^[2].

Safety information in the label

The label says Zepbound should not be used with other tirzepatide products or with any GLP-1 receptor agonist medicine. It has not been studied in people with a history of pancreatitis or with severe gastrointestinal disease, including severe gastroparesis, and its safety and effectiveness in children under 18 is unknown ^[1].

Warnings cover thyroid tumors, including thyroid cancer. People with a personal or family history of medullary thyroid carcinoma, people with Multiple Endocrine Neoplasia syndrome type 2, and anyone who has had a serious allergic reaction to tirzepatide or the drug's ingredients should not use it ^[1]. Other listed risks include severe stomach problems, kidney problems from dehydration, gallbladder problems, pancreatitis, serious allergic reactions, low blood sugar when taken with insulin or sulfonylureas, vision changes in people with type 2 diabetes, and depression or thoughts of suicide. Common side effects include nausea, diarrhea, vomiting, constipation, stomach pain, indigestion, injection-site reactions, tiredness, allergic reactions, belching, hair loss and heartburn ^[1].

Why it matters for patients

Adults who qualify for Zepbound now have a second brand-name injected obesity medicine to discuss with a prescriber, alongside Wegovy ^[1][2]. The two contain different molecules and are not interchangeable, and the Zepbound label says it should not be combined with a GLP-1 receptor agonist medicine ^[1].

The out-of-pocket number varies widely by plan, and some pharmacy benefit managers that build covered-drug lists had not finished their reviews on the day of the launch ^[2]. Lilly said it is expanding manufacturing to meet expected demand but gave no timeline for that work, and Lilly's announcement did not address Wegovy's supply situation ^[1].

What happens next

Zepbound is due to be added to Cigna Healthcare's commercial formularies on Dec. 15, 2023 ^[1][2]. Reviews by CVS Caremark and other pharmacy benefit managers were still pending as of Dec. 5 ^[2].