Eli Lilly letter criticizes insurers over dropped obesity drug coverage

Eli Lilly published an open letter on May 21, 2025 saying that recent changes to insurance coverage for obesity medicines are forcing patients into a choice between stopping a medicine they and their doctors selected or paying out of pocket to stay on it ^[1].

The letter, posted on Lilly's investor news site, describes the situation in direct terms: "Recent changes to insurance coverage for obesity management medications have forced thousands of Americans living with obesity into a choice they shouldn't ever have to face: stop taking a safe and effective medicine they and their health care providers chose, or pay out of pocket to continue on their preferred medication" ^[1].

Lilly did not name the insurers, pharmacy benefit managers or specific medicines involved, and the letter does not describe any single formulary decision ^[1]. The company writes that payer-driven treatment decisions "often undermine a health care provider's ability to choose the most appropriate treatments, disrupt ongoing care for current patients, and leave those with other conditions, such as obstructive sleep apnea, without any viable medicine or facing high out-of-pocket costs to stay on treatment" ^[1].

The letter places those changes in a wider coverage picture. According to Lilly, Medicare does not cover any obesity management medications, and only a handful of states provide coverage for Medicaid patients. Even when a pharmacy benefit manager adds an obesity medicine to its formulary, the letter says, employers "must – but often don't – take the additional step of opting in to coverage" ^[1].

Lilly lists four positions: open access to obesity medicines according to their labeled indications; coverage decisions based on clinical evidence, with treatment decisions left to health care providers and their patients; offering what it calls creative solutions and innovative pricing to insurers, pharmacy benefit managers and employers; and covering obesity medicines the way treatments for other chronic diseases are covered ^[1]. The letter says the issue is not about "just one medicine, formulary, or insurance plan" but about a system that limits those choices ^[1].

Lilly also directs people affected by coverage changes to a Zepbound access website for help navigating options, and says it urges health care organizations, government and others in the industry to act, adding that "we cannot do it alone" ^[1]. Zepbound is Lilly's tirzepatide product for obesity.

Why it matters for patients

The letter points to a practical problem with insurance: continuity. A patient whose plan drops an obesity medicine may need to switch to a different drug, pay the full price themselves, or stop treatment ^[1]. Lilly argues that switching for reasons other than clinical evidence can disrupt ongoing care ^[1].

The coverage gaps the letter describes go beyond employer plans. Medicare covers no obesity management medications, and few state Medicaid programs cover them ^[1]. Lilly also says that adding a medicine to a formulary is not the same as covering it, because employers often do not opt in ^[1].

The letter does not say which plans have made changes, which drugs patients were moved to, how much patients typically pay out of pocket, or what clinical data support its argument. Those details have not been disclosed in the letter ^[1].

It is also a manufacturer's position. Lilly sells Zepbound (tirzepatide), one of the medicines in this category, and the letter links to that product's access page ^[1].

What happens next

The letter sets no deadline and announces no commitments from insurers, pharmacy benefit managers or government programs ^[1]. Lilly says it offers pricing approaches to insurers, pharmacy benefit managers and employers, but the letter does not describe those offers or say whether any have been accepted ^[1]. Whether insurers or pharmacy benefit managers respond to the letter has not been reported.