GLP-1 Weight-Loss Drugs Keep Getting Cheaper: Thank Competition

By Gale Pooley of Cato. Excerpt:

"When Wegovy’s one-of-a-kind treatment debuted in 2021, a month’s supply cost $1,349. At the time, blue-collar employees were earning an average of $26.12 an hour, putting the time-price at 51.65 hours per month, or more than six days’ wages.

Employer insurance plans balked, and the government’s health programs were barred from covering weight-loss drugs unless there was a specified medical complication. More than half of American adults (137 million) meet the medical criteria to benefit from the FDA’s approved uses of GLP-1s: the cost of covering them all is enormous.

Even with mostly cash payers, demand outstripped supply, putting Wegovy on the FDA’s drug-shortage list. With that designation came a legal path for pharmacies to compound the product themselves, and offer lower-priced alternatives through telehealth and cash-pay programs.

Two years later, a second major company gained FDA approval for an injectable drug for chronic weight management. Eli Lilly’s Zepbound is pharmacologically different, but its effects are similar and it competes for the same patients and insurer budgets. The list price undercut Wegovy, at $1,060.

Here’s where things really get interesting.

Eli Lilly knew few of the potential beneficiaries of its medication would qualify for the medication through their insurers. So it offered a special $550 cash price for patients whose insurance didn’t cover GLP-1s. In 2024, it launched LillyDirect: a direct-to-consumer, cash-pay distribution for its competing product. Direct-to-consumer cash-pay pathways allowed patients to bypass asking “which drug does my insurance cover?” and forced manufacturers to compete in a more retail-like environment.

And compete they did. Novo Nordisk introduced its own cash-pay option for Wegovy — NovoCare. Its lowest dose was priced at $499/month. In April 2025, with the FDA’s shortage resolved and still facing innumerable gray-market and privately compounded copies of semaglutide, Wegovy’s price was reduced again, to make the authentic brand more price-competitive for patients, who Novo knew could easily switch. Standard self-pay injectable Wegovy dropped to $349/month, with a $199/month introductory offer.

In response, Eli Lilly cut Zepbound’s cash pricing, offering the typical maintenance dose for $299 by December 2025. Prescribers and patients became more comfortable switching between major branded therapies that filled essentially the same medical need. That increased the price pressure on drugmakers who were accustomed to negotiating with insurer formularies and formal rebate systems.

Almost immediately after Zepbound’s price reduction, the FDA approved an oral formulation of Wegovy. Clinical trials show the once-a-day pill is almost as effective as the injectable, and the pill form expands the available market to include patients unwilling to self-inject GLP-1s.

Today, the oral maintenance dose of brand-name Wegovy costs $299 a month for self-paying patients. Self-pay pricing for injectable Wegovy settled at $349. Fifty percent of sales of both Wegovy and Zepbound are direct exchanges with cash-paying patients.

Our “average” blue-collar worker from 2021 is now earning $32.53/hour. The time price of his monthly weight-loss treatment has fallen by 75 to 80 percent.

Over the same period, according to BLS reports, hospital services have risen 26.6 percent, and medical care prices, 12.9 percent. Overall consumer inflation (CPI) has increased 22.5 percent."