By Cheryl Winokur Munk

Continuing high prices and demand for GLP-1 weight-loss drugs is creating lots of questions about the affordability of these drugs for U.S. healthcare consumers.

For more than two years, drugs administered under the brand names Ozempic, which treats diabetes, and Wegovy, sold for obesity, were on the Food and Drug Administration's list of drugs in short supply in the U.S. The FDA in recent months has declared shortages over in the U.S., but prices remain high.

Without insurance, consumers can easily pay in the range of $1,000 to $1,300 a month for these drugs, though there are programs and potential alternatives that can reduce the cost.

The Centers for Medicare and Medicaid Services, meanwhile, recently announced it wouldn't extend Medicare coverage to weight-loss drugs, dropping a proposal made earlier by the Biden administration. The decision largely leaves people over the age of 65 who are obese but don't have other health conditions like diabetes to pay out-of-pocket for their supplies of such drugs.

What follows are answers to common questions about the prices of these drugs.

Why are these drugs so expensive?

Newer drugs tend to cost more because of the upfront research and development, as well as patent laws that limit competition and keep prices higher due to exclusivity, says Cynthia Cox, vice president at KFF, a health-policy nonprofit formerly known as the Kaiser Family Foundation and based in San Francisco. Also, the U.S., unlike some other countries that routinely negotiate drug prices, hasn't stepped in to negotiate lower prices for these drugs. Supply and demand is another factor. "There's a lot of demand for these drugs, and for a while there was a shortage too," Cox says.

Do most employers cover the drugs?

KFF estimates, based on clinical eligibility and GLP-1 drug-use data, that around 57.4 million adults under 65 with private insurance -- more than 2 in 5 Americans -- could be eligible for coverage under the clinical criteria for GLP-1 drugs used to treat Type 2 diabetes, obesity or excess weight and weight-related health issues. It's hard to pinpoint precise figures in part because employers and insurers may have more restrictive eligibility standards for coverage.

But only 36% of employers in the U.S. provide their workers with coverage for GLP-1 drugs to treat weight loss, according to a survey from the International Foundation of Employee Benefit Plans of employer coverage in 2025. Some 55% provide coverage for the treatment of diabetes only.

Even when weight-loss treatment is covered, there are often restrictions. For instance, some employers require trying less-expensive alternative weight-loss drugs first, and some limit coverage to employees with higher body mass indexes. Some employers also require workers to participate in a weight-management program or to get nutrition counseling before approval.

How much might I expect to pay?

For people without insurance, several drugmakers have recently started direct sales of lower-priced versions of their products that are delivered using a vial and syringe, as opposed to an injectable pen. For cash-paying patients, in March, Danish drugmaker Novo Nordisk lowered the cost of Wegovy in this form to $499 a month from $650. And in February, Eli Lilly dropped the price of a similar form of anti-obesity drug Zepbound to between $349 and $499 a month from $399 to $699, depending on the dose.

For patients with insurance that covers these drugs, meanwhile, two-thirds have copays of $100 or less a month, and 40% pay $50 or less, according to Ro, a direct-to-patient healthcare company that has conducted tens of thousands of benefits verifications for patients nationwide. The company offers a free online tool to help consumers determine their insurance coverage costs.

KFF research found that insurance fully covered the cost of GLP-1 drugs for less than a quarter of insured adults in a survey it conducted. More than half had to cover part of the cost themselves, and 19% had to fully pay for the drug themselves.

Are prices expected to come down further?

It will be years before patents on the drugs in the U.S. expire, the point at which, typically, less-expensive generic versions get introduced. Novo Nordisk's patent for Ozempic in the U.S., for example, is set to expire in 2032, though its Ozempic patents in other markets are set to expire sooner. Still, drugmakers can often extend the life of their patents by filing additional patents related to the original patent, a process called evergreening, says Alan Sager, professor of health law, policy and management at the Boston University School of Public Health.

As more employers opt to cover these drugs, prices should drop somewhat, says David Risinger, senior managing director and senior research analyst at Leerink Partners, an investment bank in the healthcare industry. But even then, not all employees will automatically benefit. In many cases, employers and insurers restrict access to those with Type 2 diabetes and other weight-related medical conditions, or to those who meet other criteria.

The period of short supply for GLP-1 drugs fueled rapid growth of companies called compounders, that make and sell less expensive versions of the original drugs -- often for $100 to $300 a month -- for customers whose doctors said they needed different dosages from the original drugs. Now that the shortages have ended, the FDA is attempting to halt the compounding companies from making such drugs, but the effectiveness of that effort remains unclear. Many compounders continue to sell their versions, often tweaking the formulations so they can't be considered copies.

Meanwhile, new GLP-1 drugs could hit the market that cost less than currently available options. Risinger says one such drug might be Eli Lilly's experimental once-daily obesity pill, orforglipron, which could receive U.S. regulatory approval as soon as early 2026. The oral form of the drug is much cheaper to manufacture and distribute than injectable GLP-1s currently on the market and doesn't require refrigeration, says Risinger.

A spokesperson for Lilly says it is premature to speculate on the cost or reimbursement for orforglipron since it is still an "investigational medicine."

President Trump, meanwhile, signed a sweeping executive order this month with the goal of cutting prescription drug costs in the U.S. GLP-1s haven't been singled out, but they are likely to be among those targeted for price cuts.

What's the outlook for people on Medicare?

Medicare has said that Part D plans -- the part of Medicare used to cover prescription drugs -- have options to cover weight-loss drugs like Wegovy if used for cardiovascular conditions. People over the age of 65 who are obese but not diabetic have the option to pay out-of-pocket for supplies directly from the companies or from a pharmacy, likely at a higher cost than from the manufacturers directly. Under the Biden administration proposal, coverage of weight-loss drugs would have been available to about 3.4 million Medicare beneficiaries who are obese, according to a report from the U.S. Department of Health and Human Services.

If Medicare plans cover these drugs more widely in the future, which proponents are hoping for, the monthly cost could drop by as much as 95% for some enrollees, according to the report. So instead of paying $400 or $500, like some patients do, there might be a copay of $25 to $50 a month, Risinger says.

Cheryl Winokur Munk is a writer in New Jersey. She can be reached at reports@wsj.com.

(END) Dow Jones Newswires

May 27, 2025 10:00 ET (14:00 GMT)

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