A larger share of Medicare patients are having to pay the full list price for Lilly’s obesity drug Zepbound than for Mounjaro, a top executive said at a recent banking conference.
Patrik Jonsson, president of Lilly USA, said Monday at the Goldman Sachs 45th Annual Global Healthcare Conference that while access to Zepbound has been good, “it’s not 100 percent.” He added that because of a Medicare provision excluding coverage of anti-obesity medications, more patients have had to pay the full list price than patients receiving type 2 diabetes treatment Mounjaro.
Patrik Jonsson“I would say we have the mid-single digit of patients paying full list price out-of-pocket in the US, which compares to low-single digit for Mounjaro for type 2 diabetes,” Jonsson said, describing first-quarter data. Outside of the US, Jonsson said Lilly expects to see “different archetypes of markets.”
A spokesperson for Novo Nordisk did not respond to a request for comment when asked if it was seeing similar out-of-pocket dynamics for its own portfolio of metabolic medications, namely Wegovy and Ozempic.
The regulation cited by Jonsson stems from the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which restricted Medicare from covering prescription drugs to treat obesity. A bill introduced last year by Rep. Brad Wenstrup (R-OH) would expand benefits to patients who are overweight or obese. Part D currently covers patients who are prescribed the new class of GLP-1 agonists to treat type 2 diabetes.
No progress has been made on the bill since it was introduced to the House. A presentation from the CBO in March underscored that “at their current prices, [anti-obesity medications] would cost the federal government more than it would save,” and that the federal deficit would grow over the next 10 years.
The office also described the future price of anti-obesity meds as “highly uncertain,” writing that it believes they’ll likely be subject to federal price negotiations “within the next few years,” and that new market entrants could be more expensive.