Gross sales of Eli Lilly’s persistent weight-management drug Zepbound are rising by leaps and bounds, however the product is pricey to supply and the pharmaceutical big stays beneath strain to supply sufficient to satisfy demand. In the meantime, different corporations are taking market share with compounded variations.

Lilly has discovered a technique to attain extra sufferers with its fast-growing product whereas additionally competing with Zepbound clones: It’s providing the drug on to sufferers at a steep low cost. By delivering Zepbound this fashion, it makes the drug obtainable to extra sufferers and takes conventional pharmacies and pharmacy profit managers out of the equation. The transfer might pave the best way for extra medication from Lilly and different drugmakers to comply with swimsuit.

Zepbound, a peptide designed to activate GLP-1 and GIP receptors to set off its metabolic results, has an inventory worth of $1,059.87 for a month’s provide. However that worth doesn’t mirror what Lilly will get for the drug or what insurance coverage corporations pay. Pharmacy profit managers negotiate reductions that decrease the price of a drug for the well being plans they work for.

The one-dose vials of Zepbound that Lilly launched final week are just for self-pay sufferers—individuals who don’t have employer-sponsored insurance coverage or need to pay for his or her remedy outdoors of their insurance coverage. The drug can be obtainable to sufferers by means of LillyDirect, a direct-to-consumer digital well being platform that Lilly launched earlier this yr. Lilly says the channel provides a means to make sure that sufferers are getting genuine Zepbound, not fakes or untested knockoffs. The corporate provides that it’s additionally a means to make sure that the drug goes to people who find themselves utilizing it for weight problems, not beauty weight reduction.

Even when sufferers pay out of pocket for Zepbound, they nonetheless want a prescription. The brand new vials can be found solely in 2.5 mg and 5 mg doses, that are the 2 lowest doses of the six doses of Zepbound obtainable in self-injector pens. The brand new vials of Zepbound lower the value of the drug practically in half, with a one-month provide costing $549, or $137.25 per vial. By distributing the drug on to sufferers, payer entry points are prevented, stated Lee Brown, world sector chief for healthcare at analysis agency Third Bridge. Whereas PBMs say they lower your expenses and go these financial savings on to their shoppers, additionally they hold a few of it, Brown stated. Promoting on to sufferers places PBMs out of enterprise.

“I believe the drugmakers are asking themselves, in a world that’s simplified by e-commerce, as a result of we’ve come up to now in transport, we don’t really want you,” Lee stated of PBMs. “We will provide the identical engaging reductions and we all know the client goes to get that.”

Tirzepatide, the important thing pharmaceutical ingredient in weight-loss drug Zepbound and kind 2 diabetes drug Mounjaro, has turn out to be Lilly’s largest income generator. Within the first half of this yr, the corporate reported $4.9 billion in Mounjaro gross sales, in contrast with $1.7 billion in Zepbound gross sales in the identical interval. In a analysis notice issued after Lilly reported its second-quarter 2024 monetary leads to August, Morningstar analyst Damien Conover wrote that the drugmaker’s manufacturing scale-up is essentially assembly present demand for its tirzepatide merchandise, however that offer might be constrained if demand will increase quickly. Sturdy demand has made it tough for each Lilly and Novo Nordisk to produce ample portions of their respective metabolic dysfunction merchandise, resulting in drug shortages.

Indicators level to an easing of the shortages. Lilly’s tirzepatide in all doses for Mounjaro and Zepbound can be found and now not in brief provide, in response to the FDA’s drug scarcity database. For Novo Nordisk’s semaglutide, the primary ingredient within the weight-loss drug Wegovy, the FDA lists availability for all doses besides the bottom, which is in restricted provide as a result of elevated demand.

Brown stated the provision constraints within the market are tied to autoinjectors, not energetic pharmaceutical substances. As proof, he notes that compounding pharmacies could make their weight problems medicines with out restrictions on tirzepatide or semaglutide. Sufferers who order dwelling supply of GLP-1 medicines from compounding pharmacies accomplish that due to the decrease price, Brown stated. Lilly's direct-to-consumer providing is aimed toward these price-conscious shoppers. By providing Zepbound by means of LillyDirect, Lilly is replicating the service choices of the compounders at costs which can be aggressive with the compounded drug, Brown defined. As well as, sufferers don't have to fret about purity points which can be an issue with compounded medicines.

Brown stated that when Lilly launched LillyDirect, he noticed it as a negotiating technique to provide managed care organizations and PBMs extra entry to formularies, the listing of lined medicines. With the brand new Zepbound vials, Lilly is now signaling that it doesn't want PBMs for sure medicines, Brown stated.

Final week, Pfizer adopted Lilly into direct-to-consumer medicines with the launch of PfizerForAll. Along with telehealth choices, the platform will assist sufferers entry medicines and diagnostics for situations like Covid-19, migraines and the flu. Brown stated direct-to-patient gross sales received’t make sense for all medication, and that pharmaceutical corporations will proceed to work with PBMs for some merchandise. However the strikes by Lilly and Pfizer sign that extra corporations might select to make extra medication obtainable on to sufferers.

“You're taking the leverage away from the pharmacy profit managers,” Brown stated. “Over time, that might result in worth will increase that aren’t in one of the best curiosity of sufferers. But when everybody strikes on this course, you would have a number of direct gross sales channels.”

Picture: Craig F. Walker/The Boston Globe, by way of Getty Photographs