As Zepbound Launches, Will Access to Obesity Meds Improve?

The Zepbound brand of tirzepatide is now available in U.S. pharmacies. This is a big deal because this launch marks the emergence of serious competition for advanced obesity medicines. Even (or perhaps especially) in healthcare, money indeed makes the world go around and one of the best checks on greed is competition. So as Zepbound launches to compete with Wegovy (semaglutide), will we see some improvement in the abysmal state of access to obesity meds?

We see reasons for guarded optimism.

Low Supply and High Prices

One of the subplots of this launch is that Novo Nordisk has handed Eli Lilly and Company a huge opportunity to take leadership on the market for obesity medicines. All because Novo has done such a poor job of meeting demand for medicines in this market that they so methodically built.

After 50 years of working in pharmacy, we have seen situations where, at launch, a drug was in short supply. Motrin (launched in 1974) comes to mind. But never have we seen a situation where patients could not get a new drug two years after launch for a new indication and six years after its first launch.

We see that scarcity in the midst of great medical need generates plenty of profit anyway and thus we have heard Novo Nordisk executives saying that they did not expect a rapid improvement in the company’s ability to meet demand. Their plan was to increase the supply gradually.

A constrained supply plus strong demand equals high prices.

Tools for Access

So we are heartened to see Lilly offering discounts for patients with prescription drug plans. For patients with a prescription drug plan, Lilly has discounts that can lower their out of pocket costs substantially. Those arrangements can lower the copay to $25 for a three month prescription if a drug plan covers Zepbound or cut the price to $550 if a patient’s plan excludes it and they have to pay 100% out of pocket. That’s about half of the list price.

Yes, Novo has offered on-again, off-again discounts that are similar. But when supplies were tight, the discount programs disappeared. Now that competition is here, the discounts are on.

A Messed-Up System

So let’s face the fact that access to care for obesity is seriously messed up. Even with the pressure of competition from Zepbound, any improvement in access to obesity meds will be incremental, starting from a very bad place.

It is nice that Lilly is talking up a lower list price for their drug. A duopoly in advanced obesity medicines is better than a monopoly. But neither Lilly nor Novo offers patient assistance for people who have no health insurance. Medicaid coverage is spotty. People on are left out in the cold when they move onto Medicare because of an archaic restriction built into the program.

And thus gaps in access to care persist for now and some of the patients who need these drugs the most are least able to get them. We can only hope that better days for access to care lie ahead. Obesity medicine physician Fatima Cody Stanford expresses a guarded optimism that we share:

“I am hopeful that access for anti-obesity medications will improve. We have demonstrated that these agents can play a role in helping to treat this pervasive disease in our society. However, time will only tell. Until now, demand has far exceeded supply.”

Click here, here, and here for more on the launch of Zepbound. For more on the abysmal state of access to advanced obesity medicines, click here and here.

Woman’s Head and Hand, painting by Pablo Picasso / WikiArt

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December 6, 2023