Lilly says most new Zepbound prescriptions in the U.S. are now self-pay

Eli Lilly said that self-pay prescriptions — ones paid for without insurance — made up 55% of new Zepbound prescriptions and 45% of all Zepbound prescriptions in the United States during the second quarter of 2026 ^[2]. Zepbound is tirzepatide, Lilly's branded obesity medicine.

The numbers were disclosed on the company's second-quarter earnings call on Aug. 5, 2026 ^[2]. In the same quarter, U.S. Zepbound revenue rose 44% to $4.9 billion, which Lilly attributed to strong demand but said was partly offset by lower realized prices, "including previously announced reductions in cash-pay prices" ^[1]. Lilly did not put a dollar figure on those cash prices in its results, and the call materials do not state what a self-pay prescription currently costs.

Across the company, second-quarter revenue rose 48% to $23.0 billion ^[1]. U.S. revenue was $14.4 billion, up 33%, driven by a 37% increase in volume and partly offset by a 3% decline in realized prices. Lilly said that excluding adjustments to rebate and discount estimates, U.S. price would have fallen by about 9% ^[1]. The company raised its full-year 2026 revenue guidance to $85.0 billion to $87.0 billion ^[1].

The two self-pay figures measure different groups. The 55% share applies to people newly starting Zepbound, while the 45% share covers all prescriptions, new and refilled ^[2]. That gap means patients beginning treatment are more likely to be paying cash than patients already taking the drug.

The 55% figure covers the second quarter, which ended June 30. Lilly said the Medicare GLP-1 Bridge program launched on July 1, offering what the company described as coverage for obesity treatments at a $50 monthly out-of-pocket cost for 20 million Americans, and said the program increased the number of people with coverage for Lilly's obesity medicines in the United States by 35% ^[2]. Lilly has not said whether prescriptions filled through that program are counted in the self-pay segment.

Several things are not established by the company's disclosures. Lilly did not break out how many self-pay prescriptions were filled with single-dose vials versus autoinjector pens, how many self-pay buyers used a savings card or other discount, or how self-pay volumes compare with compounded versions of the drug. Those figures have not been reported.

Why it matters for patients

For a patient who is uninsured, has coverage that excludes obesity drugs, or faces a prior authorization they cannot clear, the practical question has shifted from whether insurance will pay to what the drug costs at the pharmacy counter. Lilly's own numbers suggest that is already the majority experience for people starting Zepbound ^[2].

Because Lilly reports lower realized prices on Zepbound — including the cash-pay reductions — the trend is toward cheaper cash purchases rather than more expensive ones, at least in the company's aggregate reporting ^[1]. But realized price is an average across all buyers and does not tell an individual patient what they will be quoted.

Prescription counts and revenue move differently here. New starts are tilting toward cash while total U.S. Zepbound revenue rose 44% ^[1][2], which is hard to interpret without knowing the actual cash prices paid. Lilly has not disclosed those prices in these materials.

Anyone comparing routes — insurance, cash, a savings program, or a Medicare option — still has to check current numbers directly, because none of the figures Lilly released are per-patient prices.

What happens next

Lilly said it has completed the U.S. submission of Foundayo (orforglipron) for type 2 diabetes and expects regulatory action by the end of 2026 ^[1][2]. The oral medicine is under review in more than 40 countries, and the company expects rollout across major markets by 2027 ^[2]. Foundayo recorded $98 million in its first reported quarter of revenue ^[1].

Lilly also plans to submit a Biologics License Application for retatrutide, its next-generation obesity candidate, to the U.S. Food and Drug Administration in the first quarter of 2027 ^[1]. The company said its clinical data package for retatrutide is complete for obesity, obstructive sleep apnea and knee osteoarthritis pain ^[1].