Lilly's Weight Loss Medication Zepbound Set to Drive Significant Health Expenditures by 2025
The anti-obesity drug Zepbound manufactured by Eli Lilly & Co. could potentially be one of the major financial burdens for health insurance providers, employers, and government healthcare programs that provide coverage for it in 2025.
At present, GLP-1 weight loss drug prescriptions such as Wegovy, Rybelsus, Saxenda, and Ozempic — alongside Ozempic — are currently the "primary contributor" to employer health costs, raising the total premium expense by 1% for 2025, as per data unveiled last autumn by benefits consultancy Aon.
These GLP-1 medications are contributing to the overall healthcare inflation projected to raise employer-sponsored health insurance coverage by 9%, reaching $16,000 per employee in 2025. The escalation in premiums, which exceeds the 6.4% increase employers faced in 2024 and 2023, transpires prior to any "cost-saving strategies" being executed, Aon indicated.
However, a recent report by GlobalData suggests that Zepbound is poised to surpass other GLP-1 medications.
"Zepbound's superior efficacy and strategic market expansion indicate that the drug will command the obesity market, surpassing Novo Nordisk's Wegovy (semaglutide)," GlobalData stated in a report released Tuesday.
"Recently, Eli Lilly disclosed the outcomes from its SURMOUNT-5 trial, comparing Zepbound and Wegovy's efficacy equitably," GlobalData's analysis reported. "As anticipated, Zepbound displayed more efficiency in stimulating weight loss. While Wegovy led to an average weight loss of 13.7% body weight, Zepbound promoted around 20.2% body weight loss in patients."
The introduction of Zepbound into a bustling field of GLP-1 medications occurs when more health insurance companies and state Medicaid programs for lower-income Americans, along with the Medicare health insurance program for senior Americans, are contemplating expanding coverage for these treatments celebrated for their capacity to aid people in shedding weight.
The Biden administration in November proposed that Medicare and Medicaid must cover weight loss drugs. The suggested new rule, requiring the incoming new Trump administration's approval, will not be effective until January 1, 2026, enabling individual market Medicare plans to adjust to the modifications and incorporate their costs within the bidding process, according to benefits experts.
Although the Aon report and other studies cite a surge in health insurance premiums due to a monthly fee ranging from about $400 per month to over $1,000 for those without coverage depending on the dosage, some argue for the long-term cost savings if obese Americans lose weight and prevent more serious and potentially expensive health issues such as hospitalizations in the future.
"The impact of Wegovy on the obesity market has been substantial," GlobalData pharmaceutical analyst Costanza Alciati stated in a statement accompanying the report. "Key opinion leaders interviewed by GlobalData referred to it as 'revolutionary.' Now with Zepbound, the revolution continues, and Eli Lilly's drug is more potent, and perhaps negotiations with national health services will also make it more cost-effective than Wegovy."
The list price of Zepbound is $1,086.37 per fill, as per a pricing plan Lilly announced last year. However, the actual cost to the consumer depends "on your prescription drug insurance plan," the drugmaker explains on its website.
"If you have commercial drug insurance with coverage for Zepbound, you may be eligible to pay as low as $25 for a one- or three-month supply of Zepbound," Eli Lilly states. "One month is defined as 28 days and 4 pens. Three months is defined as 84 days and up to 12 pens. If you have commercial drug insurance but it does not cover Zepbound, you may be eligible to pay as low as $650 for a 1-month supply of Zepbound."
- In the forecast for 2025, GLP-1 drugs like Ozempic, manufactured by Eli Lilly & Co., contribute significantly to the rising costs of employer-sponsored health insurance, according to data provided by benefits consultancy Aon.
- GlobalData's recent report predicts that Eli Lilly's upcoming GLP-1 drug, Zepbound, may surpass Novo Nordisk's Wegovy in the obesity market, citing Zepbound's superior efficacy in stimulating weight loss compared to Wegovy in clinical trials.
- Eli Lilly & Co. offers different pricing plans for Zepbound, with eligible commercial insurance plans allowing patients to pay as low as $25 for a one- or three-month supply of the drug, as indicated on Lilly's website.
