When Ruth Gonzalez decided to start taking the weight-loss medicine Zepbound last year, she first had to find a way to afford its roughly $350 (£260) monthly cost. Gonzalez switched her mobile phone plan, dropped all but one of her streaming subscriptions, limited her grocery spending, and cut out Starbucks. The 56-year-old, who is self-employed and pays out of her own pocket because her health insurance does not cover weight-loss drugs, says the financial sacrifices have been worth it. The spike in her blood pressure, which had scared her into seeking a prescription, was back to normal within six weeks. She has also lost more than 40 lb (18 kg), dropping her weight to 175 lb (79 kg), which she is hoping will help her with subsequent diagnoses of sleep apnea and incipient fatty liver disease.
In December, Zepbound-maker Eli Lilly lowered the price of its vials by $50-$100 (£37.50-£75), allowing her to start taking a more powerful and expensive dose. Now she is eyeing new options, including an even lower-cost weight-loss pill the company is expected to launch in the coming months. For someone on a fixed budget, it is absolutely helpful, she says.
The price cuts helping Gonzalez have caught attention in the U.S., where prescription medications are notoriously expensive. They reflect a cutthroat competition occurring between weight-loss drugmakers in the U.S., as they look to capitalize on a potential sales bonanza in the country, where the obesity rate among adults is roughly 40%.
Normally, such battles would occur behind closed doors, as manufacturers, insurance companies, employers, and other firms furiously negotiate coverage, rebates, and other factors before presenting the final bill to patients. But in the case of weight-loss drugs, known as GLP-1s, many private and government insurers have balked at the potential costs and refused to cover the medicines solely to treat weight.
This has left millions of people in the U.S., like Gonzalez, paying for them on their own and pushed pharmaceutical firms to seek and compete for customers like a regular retailer. They have launched direct-to-consumer sales websites, struck distribution deals with retail giants such as Walmart and Costco, and launched court battles against off-label rivals. Perhaps most importantly, the firms have slashed their prices. A starting dose of Wegovy is now available to self-pay patients for just $149 a month, compared with a list price of more than $1,600 a month when it first launched in the U.S. in 2021. Vials of Lilly's Zepbound start at $299 a month, down from more than $1,000 when it launched in 2023.
Though prices remain higher than in many other parts of the world, they are expected to continue to fall in the years ahead, as patents expire and new offerings enter the market, including lower-priced alternatives like pills. The price drops have stirred interest in whether the direct-to-consumer model might help bring down the country's high drug costs, as it makes pricing less opaque and squeezes out pharmacy benefit managers, or PBMs, who negotiate drug prices between manufacturers and health insurance plans.
Even with price cuts, weight-loss drugs remain out of reach for many. Shekinah Samayah-Thomas, a 62-year-old who had bariatric surgery in 2017 after topping 330 lb (150 kg), says the medicine has been critical to helping her keep off the weight, which had started creeping back up since the surgery. However, she has been trying to stretch out her remaining supply of Wegovy since California's Medicaid program stopped covering it for weight loss. Her requests for coverage have been denied, despite a diagnosis of sleep apnea.
Health advocates remain focused on pushing insurers to expand coverage, maintaining that the rough-and-tumble of the free market is not the best way to get medicine into the hands of those who need it - just those who can afford to pay. The Trump administration's decision to have Medicare start covering the drugs on a trial basis in July could end up being much more meaningful, potentially influencing private insurers to follow suit. Advocates emphasize the need for general, standard coverage of treatments for obesity.
In December, Zepbound-maker Eli Lilly lowered the price of its vials by $50-$100 (£37.50-£75), allowing her to start taking a more powerful and expensive dose. Now she is eyeing new options, including an even lower-cost weight-loss pill the company is expected to launch in the coming months. For someone on a fixed budget, it is absolutely helpful, she says.
The price cuts helping Gonzalez have caught attention in the U.S., where prescription medications are notoriously expensive. They reflect a cutthroat competition occurring between weight-loss drugmakers in the U.S., as they look to capitalize on a potential sales bonanza in the country, where the obesity rate among adults is roughly 40%.
Normally, such battles would occur behind closed doors, as manufacturers, insurance companies, employers, and other firms furiously negotiate coverage, rebates, and other factors before presenting the final bill to patients. But in the case of weight-loss drugs, known as GLP-1s, many private and government insurers have balked at the potential costs and refused to cover the medicines solely to treat weight.
This has left millions of people in the U.S., like Gonzalez, paying for them on their own and pushed pharmaceutical firms to seek and compete for customers like a regular retailer. They have launched direct-to-consumer sales websites, struck distribution deals with retail giants such as Walmart and Costco, and launched court battles against off-label rivals. Perhaps most importantly, the firms have slashed their prices. A starting dose of Wegovy is now available to self-pay patients for just $149 a month, compared with a list price of more than $1,600 a month when it first launched in the U.S. in 2021. Vials of Lilly's Zepbound start at $299 a month, down from more than $1,000 when it launched in 2023.
Though prices remain higher than in many other parts of the world, they are expected to continue to fall in the years ahead, as patents expire and new offerings enter the market, including lower-priced alternatives like pills. The price drops have stirred interest in whether the direct-to-consumer model might help bring down the country's high drug costs, as it makes pricing less opaque and squeezes out pharmacy benefit managers, or PBMs, who negotiate drug prices between manufacturers and health insurance plans.
Even with price cuts, weight-loss drugs remain out of reach for many. Shekinah Samayah-Thomas, a 62-year-old who had bariatric surgery in 2017 after topping 330 lb (150 kg), says the medicine has been critical to helping her keep off the weight, which had started creeping back up since the surgery. However, she has been trying to stretch out her remaining supply of Wegovy since California's Medicaid program stopped covering it for weight loss. Her requests for coverage have been denied, despite a diagnosis of sleep apnea.
Health advocates remain focused on pushing insurers to expand coverage, maintaining that the rough-and-tumble of the free market is not the best way to get medicine into the hands of those who need it - just those who can afford to pay. The Trump administration's decision to have Medicare start covering the drugs on a trial basis in July could end up being much more meaningful, potentially influencing private insurers to follow suit. Advocates emphasize the need for general, standard coverage of treatments for obesity.
