Prices are falling for the popular obesity treatments Wegovy and Zepbound, but steady access to the drugs remains challenging.<\/p>\n
The medications still amount to around $500 per month for those without insurance \u2014 out of reach for many patients. And even for people with insurance, coverage<\/a> remains uneven.<\/p>\n \u201cThe medications should be available, the question is at what price and can people sustain that,\u201d said Matt Maciejewski, a Duke University professor who studies obesity treatment coverage. <\/p>\n Doctors say the situation forces them to get creative in treating patients, but there\u2019s hope that prices may fall more in the future. <\/p>\n The drugs are still in high demand<\/p>\n Wegovy and Zepbound are part of a wave of obesity medications known as GLP-1 receptor agonists that have soared in popularity.<\/p>\n Zepbound brought in $2.3 billion in U.S. sales during this year\u2019s first quarter, making it one of drugmaker Eli Lilly\u2019s best sellers.<\/p>\n Novo Nordisk says Wegovy has about 200,000 weekly prescriptions in the U.S., where it brought in nearly $1.9 billion in first-quarter sales.<\/p>\n Insurance coverage is increasing \u2014 for some<\/p>\n The benefits consultant Mercer says more businesses with 500 or more employees are adding coverage of the injected drugs for their workers and family members.<\/p>\n And Novo says 85% of its patients who have coverage in the U.S. pay $25 or less per month.<\/p>\n Plus some patients with diabetes can get coverage of the GLP-1 drugs Ozempic and Mounjaro from Novo and Lilly that are approved to treat that condition. <\/p>\n But most state and federally funded Medicaid programs<\/a> don\u2019t cover the drugs for obesity and neither does Medicare, the federal program mainly for people age 65 and older.<\/p>\n Even the plans that cover the drugs often pay only a portion of the bill, exposing patients to hundreds of dollars in monthly costs, said Dr. Beverly Tchang. <\/p>\n Drugmakers offer help with these out-of-pocket costs, but that assistance can be limited.<\/p>\n \u201cCoverage is not the same as access,\u201d said Tchang, a New York-based doctor who serves as a paid advisor to both Novo and Lilly.<\/p>\n But coverage remains inconsistent<\/p>\n Bill-payers like employers are nervous about drugs that might be used by a lot of people indefinitely.<\/p>\n Some big employers have dropped coverage<\/a> of the drugs due to the expense. Pharmacy benefit managers, or PBMs, also are starting to pick one brand over the other as they negotiate deals with the drugmakers.<\/p>\n One of the nation\u2019s largest PBMs, run by CVS Health, dropped Zepbound<\/a> from its national formulary, or list of covered drugs, on July 1 in favor of Wegovy.<\/p>\n That forced Tchang to figure out another treatment plan for several patients, many of whom took Zepbound because it made them less nauseous.<\/p>\n Dr. Courtney Younglove\u2019s office sends prospective patients a video link showing them how to check their insurer\u2019s website for coverage of the drugs before they visit.<\/p>\n \u201cThen some of them just cancel their appointment because they don\u2019t have coverage,\u201d the Overland Park, Kansas, doctor said.<\/p>\n Cheaper compounded drugs are still being sold<\/p>\n Compounding pharmacies and other entities were allowed to make off-brand, cheaper copies of Wegovy and Zepbound when there was a shortage of the drugs. But the U.S. Food and Drug Administration determined earlier this year<\/a> that the shortage had ended.<\/p>\n That should have ended the compounded versions, but there is an exception: Some compounding is permitted when a drug is personalized for the patient. <\/p>\n The health care company Hims & Hers Health offers compounded doses of semaglutide, the drug behind Wegovy, that adjust dose levels to help patients manage side effects. Hims says these plans start at $165 a month for 12 months, with customers paying in full upfront. <\/p>\n It\u2019s a contentious issue. Eli Lilly has sued pharmacies and telehealth companies trying to stop them from selling compounded versions of its products.<\/p>\n Novo recently ended a short-lived partnership with Hims to sell Wegovy because the telehealth company continued compounding. Novo says the compounded versions of its drug put patient safety at risk because ingredients are made by foreign suppliers not monitored by US regulators.<\/p>\n Hims says it checks all ingredients to make sure they meet U.S. quality and safety standards. It also uses a third-party lab to verify that a drug\u2019s strength is accurately labeled. <\/p>\n Prices have dropped<\/p>\n