Lilly Sees More Zepbound Out-of-Pocket Payments as Obesity Pill Nears Phase III Readout

Eli Lilly World Headquarters/iStock, jetcityimage

Pictured: Eli Lilly's world headquarters in Indianapolis/iStock, jetcityimage

More patients are shelling out for the full list price of Eli Lilly’s weight-loss treatment Zepbound (tirzepatide) than they did for the sister type 2 diabetes drug Mounjaro (tirzepatide), according to Lilly Diabetes and Obesity President Patrik Jonsson.

Speaking at Monday’s Goldman Sachs 45th Annual Global Healthcare Conference, Jonsson said a mid-single-digit percentage of patients in the U.S. are having to pay out-of-pocket for Zepbound, compared with only a low-single-digit proportion that do so for Mounjaro, which shares the same active ingredient but is indicated for type 2 diabetes.

The disparity can largely be attributed to the difference in coverage for the therapies, according to Jonsson, who is also president of Lilly USA. “There is full coverage for Mounjaro,” he said, while access to Zepbound “is good, but it’s not 100% yet.”

There is also a big patient group in Medicare “that actually will have to pay for list price, but based upon how the regulations are defined, there is unfortunately no other option” for those patients, Jonsson said.

The Centers for Medicare and Medicaid Services (CMS) covers GLP-1 receptor agonists like Mounjaro for the treatment of diabetes but not for weight loss, for which Zepbound is explicitly indicated. In April 2024, following its approval to reduce the risk of heart attack and stroke in obese adults with cardiovascular disease, CMS also agreed to cover Novo Nordisk’s weight-loss therapy Wegovy (semaglutide)—but only for this specific cardiovascular indication.

During the Goldman Sachs conference, Jonsson pointed to CMS coverage of Wegovy as a promising development for its tirzepatide brands, particularly as the pharma advances the GLP-1 agonist into other indications. In April 2024, Lilly reported strong Phase III data for Zepbound in obstructive sleep apnea. The pharma is also developing tirzepatide for heart failure with preserved ejection fraction.

“I think this opens up for the Medicare population to get access to anti-obesity medications,” Jonsson said. “We expect something similar with our approval of sleep apnea. We would expect something similar for the heart failure indication that is reading out later this year.”

Beyond tirzepatide, Lilly is also looking forward to its next-generation weight-loss candidate orfoglipron, which is formulated to be an oral pill and designed to be taken once a day.

In June 2023, the pharma posted Phase II data for orfogolipron, which cut patients’ body weight by 8.6% to 12.6% at 26 weeks. This effect was maintained through 36 weeks, at which point weight-loss increased slightly to 9.4% to 14.7%.

Lilly expects a first readout for the Phase III study of orfoglipron to come in April 2025, Jonsson announced on Monday. The pharma expects to release complete data before the end of 2025, including from head-to-head trials with Farxiga (dapagliflozin) and Rybelsus (semaglutide) in type 2 diabetes.

“Based on everything we have seen so far, we have a high degree of confidence in orfoglipron,” Jonsson said.

Tristan Manalac is an independent science writer based in Metro Manila, Philippines. Reach out to him on LinkedIn or email him at tristan@tristanmanalac.com or tristan.manalac@biospace.com.

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