Updated March 05, 2025 at 13:33 PM ET
Every month, roughly 100,000 people buy Zepbound directly from Eli Lilly through its website.
"It's about the size of a small city," says David Ricks, . That's about 10% of the 1 million people who use the blockbuster obesity drug every month, though the numbers can vary, he says.
The customers are getting a significant discount, but there's a catch: they can't use their health insurance.
Last summer, Lilly of the 2.5 mg and 5 mg doses of Zepbound online through its LillyDirect platform. Patients either need a prescription from their doctor or can get one online through a Lilly partner. Now, the the 7.5 mg and 10 mg vials.
And on Wednesday the maker of Wegovy, a similar weight-loss drug, announced that it, too, would offer for patients paying cash.
The drugs usually come as autoinjector pens 鈥� like an EpiPen. But the LillyDirect Zepbound offer is for vials that patients inject themselves with, using an old-fashioned syringe.
"It's a cultural phenomena," Ricks says of the drug. "It's used by millions of people in the U.S. and millions more would like to use it. So I think it's incumbent on us not just to invent great new medicines, but get them to patients."
The syringe option is cheaper for consumers: It costs between for the vials compared to a list price of $1,086.37 per monthly injector pen.
Wegovy's maker, Novo Nordisk, is for its direct-to-consumer product.
Customers can't get their health insurance to pay for the either Eli Lilly's Zepbound vials or the discounted Wegovy, though.
That's because a lot of Zepbound or Wegovy 鈥� or any drug specifically used to treat obesity. It's especially difficult for people with government insurance, because Medicare, for example, isn't allowed to cover weight-loss drugs. (It can cover Wegovy but not for obesity alone.)
In fact, coverage is getting worse, according to a , a company that helps patients find discounts on drugs. The report determined that 4.9 million people whose health insurance covered Zepbound last year actually lost coverage of the drug in 2025.
While the same report found Wegovy coverage is improving, many people still don't have insurance coverage for it.
The number of people who need obesity drugs coupled with their price has made it difficult for health insurance plans to cover them. For example, in North Carolina, the state health plan the drugs because it would have to increase monthly premiums for everyone by about $50 a month to do it.
Ricks says the LillyDirect model is "not a panacea."
"We think actually a better way would be to have the normal health care system. Doctors and patients connect and then use the insurance they've already paid the premium on to reimburse them for a chronic disease like obesity. That's not working perfectly right now. Here, we'll do what we can."
Still, the company is not losing money on the discounted vials, Ricks says.
Zepbound brought in almost $5 billion in revenue last year, according to .
"This is not a question of is Eli Lilly going to make enough money to recoup investment on the drug? They absolutely will," says Dr. Ben Rome, a at Brigham and Women's Hospital in Boston.
Rome, an internist, says he talks with patients about these medicines every week. But he says most Americans won't be able to afford even the discounted Zepbound vials.
"Remember Americans are already spending thousands of dollars a year on health care. So to say, well there is this medicine available but you have to pay for it out of pocket, it really serves a small percentage of the population."
Most Americans "cannot afford $500 or $600 per month," he adds.
He says it's not surprising to see Novo Nordisk jump in with a similar direct-to-consumer discount strategy as Lilly's. "Obviously, the two companies are competing to sell their products to people in the U.S."
According to the , 2 out of every 5 American adults have obesity.
In the coverage void, many patients have and compounding pharmacies to get weight-loss drugs like Zepbound and Novo Nordisk's drug Wegovy. Compounders are allowed to make alternatives that aren't generics during drug shortages 鈥� and their prices tend to be well below list price.
But not all businesses selling those alternatives to keep their products safe.
And now that the is over, the compounding is expected to stop.
Ricks says the company is pushing to expand health insurance coverage.
One thing Eli Lilly could do, says Rome, is give insurers the option of covering the cheaper Zepbound vials, so they can be more affordable to health plans and patients don't have to pay for them out of pocket.
"We will see if Eli Lilly and Novo [Nordisk] come to the table and want to make these widely available, or if they're going to prioritize high prices and short-term profits over widespread access to the treatments," he says.
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