Fills for Weight-Loss Medications Like Wegovy and Mounjaro Rise Despite High Out-of-Pocket Costs
Key takeaways:
Since the start of 2024, fills for Wegovy and Zepbound have increased by over 100% and 300%, respectively.
Only 9% of those with commercial insurance have unrestricted coverage of Zepbound, and 14% have unrestricted coverage of Wegovy. The average insured person taking Zepbound can expect to pay over $2,500 a year in copays.
Nearly 1 in 5 people with commercial insurance have no coverage of at least one brand-name GIP and GLP-1 agonist prescribed specifically for weight loss. Without insurance, people face retail costs of over $1,100 per prescription.
People without insurance can save an average of $250 monthly, or $3,000 annually, using GoodRx. In the past year, Americans have overspent by at least $200 million by paying full retail price for GIP and GLP-1 agonists.
Demand for weight-loss medications — especially GIP and GLP-1 agonists like Ozempic, Wegovy, Mounjaro, and Zepbound — is skyrocketing. However, limited insurance coverage leaves many Americans paying high out-of-pocket costs.
But despite steep costs and access issues like insurance restrictions and formulary exclusions, GoodRx data reveals a surge in weight-loss medication fills.
Fills for weight-loss medications are increasing
Ozempic, a brand-name medication that quickly became a media sensation, has been steadily gaining in popularity for years. It’s a GLP-1 agonist that was initially approved in 2017 for Type 2 diabetes. But Ozempic’s weight-loss benefits led to a rise in demand.
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Wegovy contains the same active ingredient as Ozempic (semaglutide). But it’s prescribed specifically for weight loss. Its fill rate has doubled since the start of 2024. In March 2024, Wegovy was also approved to lower the risk of serious heart problems in people with a larger body size. Since then, demand has increased for both Ozempic and Wegovy — so much so that both these medications have been in shortage.
Mounjaro and Zepbound are GIP receptor / GLP-1 receptor agonists with the same active ingredient (tirzepatide). Since their approval, they have become the second- and fourth-most popular drugs in the category, respectively. Fills for Zepbound have grown over 300% since the beginning of 2024.
Liraglutide (Victoza, Saxenda) is another weight-loss medication in the same drug class as semaglutide. Fills for the recently approved generic version of liraglutide have increased.
With the rise in popularity of GIP and GLP-1 agonists, fills for older weight-loss medications like phentermine declined slightly in the last year.
Some states see higher use of weight-loss medications than others
As the map below shows, fills for weight-loss medications prescribed specifically for Type 2 diabetes (Ozempic, Mounjaro, and Victoza) are higher in Southern states like Oklahoma, Alabama, Louisiana, and Texas.
Meanwhile, Northeastern states like Massachusetts, New Jersey, Rhode Island, and Delaware have some of the highest fill rates for medications prescribed specifically for weight loss (Wegovy, Zepbound, Saxenda, Qsymia, and phentermine).
However, Alaska has the highest combined fill rate for all weight-loss medications in the U.S.
People face steep out-of-pocket costs for weight-loss medications
The cost of weight-loss medications can add up because there aren’t many generic options. As the figure below shows, the average spent out of pocket on weight-loss medications from January 2023 to October 2024 ranged from $13 per fill for phentermine to over $230 per fill for Zepbound. Out-of-pocket cost includes amount paid without insurance and insurance copays.
People pay more out of pocket for these medications when they are prescribed for weight loss instead of diabetes. On average, people taking Zepbound for weight loss paid $141 more per fill than those taking Mounjaro for diabetes even though both medications have the same active ingredient. Similarly, people taking Wegovy for weight loss paid $30 more per fill than those taking Ozempic for diabetes. And people taking Saxenda for weight loss paid $40 more per fill than those taking generic liraglutide for diabetes.
Overall, people can expect to pay over $97 out of pocket per fill for medications specifically prescribed for weight loss. That’s over six times the national average for out-of-pocket spent per prescription in 2024.
Insurance coverage for weight-loss medications is often lacking
The out-of-pocket spend for weight-loss medications depends on the type of medication and whether or not it’s covered by insurance. Commercial insurance often doesn’t cover weight-loss medications without some restrictions. And Medicare is barred from covering these medications solely for weight loss.
Insurance usually covers Mounjaro, Ozempic, or Victoza if they’re prescribed for Type 2 diabetes. But it may impose restrictions. Only 26% of people with commercial insurance have unrestricted coverage for Ozempic. Meanwhile, 71% of people with coverage must meet additional requirements such as prior authorization or step therapy. Similarly, only 24% and 27% of people with commercial insurance have unrestricted coverage for Mounjaro and Victoza, respectively.
When it comes to GIP and GLP-1 agonists prescribed specifically for weight loss:
9% of those with commercial insurance have unrestricted coverage of Zepbound.
13% of those with commercial insurance have unrestricted coverage of Saxenda.
14% of those with commercial insurance have unrestricted coverage of Wegovy.
More often than not, people with commercial insurance have to jump through hoops to get coverage for these medications. This includes filling out paperwork for prior authorization or trying a different medication first.
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However, 18% of people with commercial insurance have no coverage at all for at least one brand-name GIP and GLP-1 agonist prescribed for weight loss. This means nearly 1 in 5 commercially insured people may be left to pay the full price for medications like Zepbound, Wegovy, and Saxenda. Likewise, 17% and 18% of insured people have no coverage for phentermine and Qsymia, respectively.
No coverage can lead to paying more
If people don’t have insurance coverage or don’t meet their insurance plan’s coverage requirements, they may pay over $1,100 per prescription.
For example, people taking Wegovy who don’t have insurance coverage face an average cash price of $1,644 per fill out of pocket. That’s compared to an average copay of $66 per fill with insurance coverage. Similarly, people taking Saxenda who don’t have insurance coverage face an average cash price of $1,657 per fill. The average insurance copay is $52.
Even with insurance coverage, copays for weight-loss medications can add up. People taking Zepbound paid an average of $209 per fill even with insurance coverage. That means a full year of taking Zepbound can cost people over $2,500 out of pocket, even with coverage.
Savings tips
Even with limited insurance coverage, demand for weight-loss medications remains strong and is growing. People without coverage can still save on the full retail price through prescription discount programs like GoodRx.
GoodRx can save people an average of $235 per month on semaglutide, tirzepatide, or liraglutide. These savings add up to an average of $3,000 annually.
Many people are still paying full retail price for these medications. In the past year, we estimate that Americans have overspent by at least $200 million by paying full retail price for their weight-loss GIP and GLP-1 agonists.
The bottom line
Insurance coverage for popular weight-loss medications is limited. There’s poorer coverage when these drugs are prescribed for chronic weight management compared to diabetes. As a result, these treatments are still very expensive for many Americans.
Despite the financial barriers, demand for weight-loss medications continues to rise.
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Methodology
Prescription fill rate: We calculated the fill percent for each weight-loss medication by taking the fill count for a medication as a percentage of fills for all medications, excluding vaccines. We used a representative sample of U.S. prescription fills. We calculated state-level fill rates for claims filled between January 1, 2024 and October 31, 2024.
Out-of-pocket costs: We calculated average out-of-pocket cost per prescription using a representative sample of U.S. prescription fills from January 1, 2024 through October 31, 2024. We normalized amounts paid based on the dispensed quantity to a 30-day supply. Average out-of-pocket cost with insurance reflects claims with commercial insurance payment. Average out-of-pocket without insurance reflects the average usual and customary cash price.
Commercial insurance coverage: We sourced prescription insurance coverage from Managed Markets Insight and Technology, LLC™, a trademark of MMIT, as of November 13, 2024. Data reflect share of commercial and health exchange covered lives for the most common form and dosage of each medication.
GoodRx savings: We calculated average GoodRx savings off retail prices for prescriptions filled for each drug using GoodRx from November 1, 2023 through October 31, 2024. We calculated estimated overpayment relative to full retail price by multiplying the amount spent out of pocket on cash-pay prescriptions by the average GoodRx discount off the retail price for each drug. We sourced data on cash-pay prescriptions from IQVIA paid claims data for the third quarter of 2023 to the second quarter of 2024.
References
ASHP. (2024). Semaglutide injection.
