Lilly starts selling $399 Zepbound vials to cash-paying patients

Eli Lilly began selling single-dose vials of Zepbound (tirzepatide) directly to self-paying patients on Aug. 27, 2024, pricing a four-week supply at $399 for the 2.5 mg starter dose and $549 for the 5 mg dose ^[1][4]. The vials went on sale through LillyDirect, the company's direct-to-consumer service, and are the first form of Zepbound Lilly has offered outside insurance at a cash price ^[1][2][4].

The vials contain tirzepatide, the same active ingredient as Zepbound's autoinjector pens, which are sold in six strengths from 2.5 mg to 15 mg ^[1][4]. Patients must have a valid, on-label prescription from their own health care provider, and Lilly said a multi-step verification process is meant to keep the vials from being dispensed for cosmetic weight loss ^[1][4]. The vials are drawn and injected with a needle and syringe rather than a pen; Lilly sells syringes and needles separately and provides instructional materials ^[1][4].

Lilly described the vial prices as at least 50% below the list price of all other incretin medicines for obesity and in line with its savings program for people whose insurance does not cover Zepbound ^[1][4]. Reuters reported that the $399 starter dose is $250, or 40%, less than the $650 Lilly charges self-paying patients for the pen version on its website — a price that rose from $550 earlier in 2024 ^[2]. BioPharma Dive put the pen's list price at $1,060 a month ^[5]. Sen. Bernie Sanders framed the change differently, saying Lilly lowered the list price for the starter dose from more than $1,000 a month to $399 ^[3].

Sanders called the move a "modest step forward" but said it was not enough. "The bad news is that Eli Lilly raised the cost that Americans have been paying for Zepbound under its patient assistance program from $550 to $650," he said ^[3]. He also said Lilly had not lowered the price of Mounjaro, the same molecule sold for type 2 diabetes, which he said costs $1,069 a month in the United States, $485 in the United Kingdom and $94 in Japan ^[3].

BMO analyst Evan Seigerman said $399 a month is likely a new low price for Lilly, even after the discounts the company gives large health plans, which he estimated pay between $300 and $400 below the drug's more than $1,000 monthly list price ^[2]. Citi analyst Daniel Grosslight said the vials should ease a bottleneck in making autoinjector pens and take market share from compounding pharmacies, which are allowed to sell copies while branded drugs are in shortage ^[2]. Shares of telehealth company Hims & Hers fell 7% to $14.91 on the news ^[2]. Evercore ISI analyst Umer Raffat noted that the discounted vials are the two lowest doses, which were not as potent at lowering weight as the 10 mg and 15 mg pens ^[5].

Lilly said vials are easier to manufacture and fill, which lets the company get the drug to patients faster ^[2]. Zepbound was listed as available by the FDA but had not been removed from the agency's shortage list as of the announcement ^[2]. The lowest starter dose of Novo Nordisk's Wegovy, a competing GLP-1 medicine for obesity, remained listed as in shortage ^[2]. Lilly's Patrik Jonsson said the company is "very confident" it can supply the U.S. market with both pens and vials, adding that many patients do not move past the 5 mg dose ^[2]. Lilly has already launched vials in Australia, Canada and Poland ^[2].

In a clinical study, tirzepatide 5 mg plus a reduced-calorie diet and increased physical activity produced average weight loss of 15% over 72 weeks, compared with 3.1% for placebo ^[1][4].

Why it matters for patients

Cash-paying patients now have a lower-priced, Lilly-made version of the two starting doses, an option aimed at people without employer coverage and those who do not qualify for the Zepbound savings card ^[1][4]. It also gives patients a way to buy tirzepatide that the manufacturer says is genuine rather than a compounded version; BioPharma Dive reported that telehealth companies have offered compounded tirzepatide at much lower prices than Lilly's list price ^[5].

The trade-offs are specific. The discounted pricing covers only 2.5 mg and 5 mg; higher maintenance doses are sold in pens, which cost more on LillyDirect ^[2][5]. The vials require a needle and syringe, and those supplies are an extra purchase ^[1][4]. Analysts differ on how much the move changes real-world affordability: Seigerman called the price a likely new low, while Raffat said it is close to the net price insurers already pay after rebates and discounts ^[2][5]. Lilly has not said whether the vial prices will change or how long they will last.

What happens next

Sanders, who chairs the Senate Health, Education, Labor and Pensions Committee, said he looks forward to discussing drug prices with the CEO of Novo Nordisk at a committee hearing on Sept. 24, 2024, and to engaging with Lilly about lowering the list prices of Zepbound and Mounjaro ^[3]. Lilly said it will keep advocating for insurance coverage of obesity medicines ^[1]. No additional vial strengths or further price changes had been announced at the time of the launch ^[1][2][4].