With the rising demand for weight loss drugs like Ozempic and limited availability, a new marketplace has emerged to cater to those struggling to access these medications. Numerous telehealth companies now offer online prescriptions for more affordable, compounded versions of these weight loss drugs. These alternative options come in vials with syringes for dosing and cost significantly less than brand-name versions.
On Tuesday, Eli Lilly made headlines by announcing that it would begin selling lower doses of its weight loss drug, Zepbound, in vials at a substantially reduced price compared to its pre-filled pens. These vials will be available exclusively through LillyDirect, a telehealth platform the company launched in January, connecting patients with providers who can prescribe obesity medications. Like compounded drugs offered by online startups, Zepbound vials can be delivered directly to patients’ homes.
Expanding Access to Weight Loss Drugs
The introduction of lower-cost vials could greatly expand access to weight loss drugs for those whose insurance does not cover these medications, said Lindsay Allen, a health economist at Northwestern Medicine. As the popularity of weight loss drugs has grown, many insurers have tightened restrictions or ceased covering them altogether to manage costs. This has driven millions of patients to seek cheaper alternatives from compounding pharmacies, which can produce versions of any medication the FDA lists as “in shortage,” including tripeptide, the active ingredient in Zepbound and the diabetes drug Mounjaro.
Lilly’s move also presents a direct challenge to the many telehealth companies currently offering weight loss drugs, highlighting the competition they pose to Lilly’s market share, according to Dr. Allen and other experts.
“Maybe this is a signal to that space: ‘We will get this market share back from you, even if it means lower pricing,’” said Dr. Timothy Mackey, a professor at the University of California, San Diego, who has studied the counterfeit weight loss drug market.
Pricing and Market Impact
The newly introduced vials are significantly cheaper than Zepbound pens, which cost just over $1,000 per month without insurance. A month’s supply of the 2.5-milligram dose will now cost $399, while a 5-milligram dose will be priced at $549. These vials may be particularly beneficial for people without insurance coverage for Zepbound, including Medicare recipients, said Patrik Jonsson, Executive Vice President of Eli Lilly and Company.
However, Dr. Adriane Fugh-Berman, a professor of pharmacology and physiology at Georgetown University Medical Center, expressed concern about the appeal to older Medicare recipients, given that weight loss drugs can cause muscle mass loss, increasing the risk of fractures or frailty in those over 65.
“Older people do not need to lose muscle,” she noted.
Compounded Drugs vs. Zepbound Vials
Lilly is positioning its vials as a safer alternative to compounded drugs for those who cannot afford its pens. Compounded drugs are subject to far less oversight than FDA-approved medications, and health officials have repeatedly cautioned against taking compounded weight loss drugs.
“There is no reason why any U.S. person should be on a non-FDA-approved medicine that is not controlled for safety, quality, and effectiveness,” Mr. Jonsson said. “This is a way of just safeguarding the U.S. population.”
Lilly announced this month that all doses of tripeptide are now available. The FDA will need to review the supply before removing it from its shortage list.
“When we are off the shortage list, there should be no space for mass compounders,” Mr. Jonsson said, noting that Lilly has already initiated legal actions against compounding pharmacies.
In addition to connecting patients with providers, LillyDirect will now allow patients with prescriptions from any doctor to purchase vials, needles, and syringes directly from Lilly. These patients will need to self-pay for the drugs, as Lilly will not accept insurance coverage for the vials. The company can offer “transparent pricing” for the vials by selling directly, bypassing third-party supply chains.
Lilly will initially offer vials with only the two lowest doses of Zepbound. While many patients remain on the 5-milligram dose, some gradually increase their dosage up to 15 milligrams. Patients requiring doses higher than 5 milligrams will need to transition to the pens.
For those on lower doses, however, Lilly is effectively undercutting its product by offering a cheaper alternative to its pens. Mr. Jonsson acknowledged that it is “likely” patients paying out of pocket for Zepbound pens will switch to the more affordable vials. “Is that going to be 10 percent? 60 per cent? We don’t know,” he said.
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