Eli Lilly is selling Zepbound in vials (rather than injector pens) for a discount.
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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, Eli Lilly’s CEO. 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 started selling vials 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 company is adding the 7.5 mg and 10 mg vials.
The drug usually comes in an autoinjector pen — like an EpiPen. But the LillyDirect 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 $349 and $699 a month for the vials compared to a list price of $1,086.37 per monthly injector pen.
Customers can’t get their health insurance to pay for the vials, though.
That’s because a lot of health insurers don’t cover Zepbound — 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 if the patient also has heart disease risk, but not for obesity alone.)
In fact, coverage is getting worse, according to a new report by GoodRx, 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.
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 decided not to cover 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 recent company data.
“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 health policy researcher 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.
According to the Centers for Disease Control and Prevention, 2 out of every 5 American adults have obesity.
In the coverage void, many patients have turned to telehealth 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 – and their prices tend to be well below list price.
But not all businesses selling those alternatives are licensed and following rules to keep their products safe.
And now that the Zepbound shortage 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 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.
