Barriers to accessing GLP-1 medications are beginning to break down as drug manufacturers, insurers, and lawmakers look to expand availability, lower costs, and address continued high demand.
In December, Eli Lilly partnered with telehealth company Ro, enabling eligible patients to receive Zepbound prescriptions during telehealth visits and have the medication shipped directly to their homes. This initiative is integrated with LillyDirect, the company's direct-to-consumer platform, which offers patients the option to pay out of pocket for Zepbound. Single-dose vials of the drug are available at $399 for a 2.5-milligram vial and $549 for a 5-milligram vial, both covering a four-week supply.
The label for Zepbound also underwent a significant change this fall, broadening its accessibility. Previously, the label specified BMI thresholds of at least 30 for obesity and 27 for overweight individuals with weight-related comorbidities. The new label has removed these thresholds, instead targeting individuals with obesity or who are overweight alongside comorbid conditions. Though the change could make the drug more accessible, actual access will still depend on insurer and PBM policies.
Novo Nordisk's Ozempic could see price reductions if selected for Medicare drug price negotiations with CMS. Currently, the drug costs $968 per month in the U.S. before insurance. Competitors like Lilly have introduced discounts for their GLP-1 products to expand their market share — over 16 new weight loss drugs are expected by 2029, and financial analysts project that prices could decline by more than 10% annually by 2027 as competition intensifies.
Other developments include Teva Pharmaceuticals' launch of the first generic version of Victoza, a GLP-1 drug originally approved in 2010 for Type 2 diabetes and later for reducing cardiovascular risks in diabetes patients. The introduction of generics is expected to increase competition and bring costs down.
"[Generics] will allow a gigantic population of individuals to have some hope in weight control. Not everyone is a responder to GLP-1s, so if you can purchase something that's cheaper, you can at least try it. If it doesn't work, that box is ticked off and you can try something else. So the generic will help more people that didn't have access in the first place, but I don't think it will replace or decrease the current demand," Christine Ren-Fielding, MD, director of the NYU Langone Weight Management Program, told Becker's in July.
As demand continues to grow, insurers and self-funded employers have grappled with the high costs of weight loss drugs, with some opting to drop coverage entirely.
"The finance and the economics of these drugs are very challenging. It is also very hard clinically," Amazon Pharmacy's chief medical officer, Vin Gupta, MD, told Becker's in June. "I don't think it should be just on self-funded employers individually figuring this out. We have to figure this out as a society because this is not gonna be the last time we deal with the challenge of an amazing innovation where the list price is extremely high."
Amid growing coverage restrictions, net prices for GLP-1 drugs have dropped for individuals covered by Medicare and commercial insurance. Medicare Part D still does not cover GLP-1s for obesity alone but allows coverage when the drugs address other approved health conditions, such as cardiovascular disease. Wegovy received approval in March 2024 for reducing cardiovascular events in patients with obesity or overweight and cardiovascular disease, prompting CMS guidance for Part D plans to cover anti-obesity medications under these circumstances. The Biden administration has also proposed expanding Medicare and Medicaid coverage for weight loss drugs, with some state Medicaid programs already providing this coverage.
Currently, U.S. list prices for a one-month supply of GLP-1 drugs range from $968 for Ozempic to $1,349 for Wegovy. However, net prices are significantly lower due to payer negotiations, with Ozempic's net price falling from $531 in 2018 to $290 in 2024, and Rybelsus' price dropping from $376 in 2020 to $296 in 2024.
"In the net prices, we see evidence of the impact of competition as new drugs in the class enter the market," HHS wrote in November. "While list prices are consistently stable or increasing, for many of these drugs, including Ozempic, Rybelsus, Saxenda, and Victoza, net prices fell."
According to HHS, the future of GLP-1 prices will depend on the number of approved conditions for each drug, the outcomes of Medicare price negotiations, and the arrival of new entrants into the market.