While weight-loss drugs like Zepbound and Wegovy offer significant health benefits, their high costs make them economically inefficient under current U.S. healthcare standards, according to recent research.
Published on March 14, 2025, in the JAMA Health Forum, the study evaluated national survey data concerning the long-term impacts of four anti-obesity medications: tirzepatide (the active ingredient of Zepbound) and semaglutide (the active ingredient of Wegovy), along with naltrexone-bupropion and phentermine-topiramate. Researchers found these drugs could potentially help prevent obesity-related complications such as heart disease and diabetes. Nevertheless, their price points—$12,648 yearly for tirzepatide and $13,618 for semaglutide—fall far above the standard cost-effectiveness threshold of $100,000 to $150,000 per quality-adjusted life-year (QALY), which is the metric often used to evaluate whether treatments are financially justifiable.
The study suggests significant price reductions are needed to make these medications viable options: tirzepatide’s price would need to drop by 30.5%, and semaglutide’s by 81.9%. “Efforts to reduce the net prices of new anti-obesity medications are necessary to guarantee equitable access to effective treatments,” the authors asserted.
This research coincides with initiatives from the Centers for Medicare & Medicaid Services (CMS) aimed at lowering drug prices. Earlier this year, CMS designated 15 drugs for its upcoming price negotiations, which included Novo Nordisk's Ozempic and Wegovy, with reduced Medicare prices expected to roll out by 2027. Both Novo Nordisk and Eli Lilly, the manufacturers behind Zepbound, have introduced direct-to-consumer pricing options, allowing patients to purchase the medications at lower costs when paying out-of-pocket.
Tirzepatide and semaglutide are part of the glucagon-like peptide-1 (GLP-1) receptor agonist class of medications, which have revolutionized diabetes management. Alongside their benefits for diabetes, studies note they also have cardiovascular advantages. While these medications show substantial promise, researchers pointed out the high prices and inadequate insurance coverage could limit their accessibility, especially for patients from racial and ethnic minorities or those with lower socioeconomic backgrounds. This could exacerbate existing health disparities.
While some assessments indicate semaglutide could be cost-effective when compared to no treatment, other analyses challenge this by arguing both semaglutide and tirzepatide are less cost-effective than lifestyle modifications. Investigators conducted simulations utilizing data from the 2017 to 2020 National Health and Nutrition Examination Survey. These involved 4,823 individuals aged 20 to 79 who were either obese or had weight-related comorbidities.
The simulations revealed all four medications, alongside lifestyle modifications, yielded more favorable outcomes, reducing obesity, diabetes, and cardiovascular disease rates over 60 years. Particularly, tirzepatide and lifestyle changes produced the highest number of health benefits per 100,000 individuals. Naltrexone and bupropion yielded the least improvement. The researchers noted tirzepatide and semaglutide delivered remarkable healthcare cost savings alongside reduced productivity lost due to enhanced health, yet the medications’ high costs nullified those gains.
Specifically, average per-person healthcare expenditures were estimated at $154,028 for tirzepatide and $160,974 for semaglutide, with the incremental cost-effectiveness ratio (ICER) estimated at $197,023 and $467,676 per QALY, respectively.
Critically, the study highlighted the limited development of alternatives to GLP-1 medications, which include compounded variations of GLP-1 receptor agonists. Yet, safety and efficacy of compounded treatments remain uncertain.
“Future research should rigorously evaluate the safety, efficacy, and cost-effectiveness of these alternatives compared with treatments approved by the U.S. Food and Drug Administration,” the authors concluded.
The economic viability of weight-loss medications is not just how much they cost but their ability to create tangible health benefits. An analysis reported last week concluded these medications were not found cost-effective over their projected lifetimes. To be deemed economically feasible, tirzepatide would need to reduce its price by 30%, and semaglutide's price must drop by 82%.
Further estimates showed these medications could yield immense lifetime health benefits, yet their expense significantly outstrips any potential savings they could generate for patients and the healthcare system. The research determined current net prices for tirzepatide and semaglutide could be pushing the costs of achieving quality-adjusted life years (QALY) between $200,000 and $460,000—far higher than the acceptable threshold.
Considering future insurance trends gives rise for concern. Many insurers and employers are tightening coverage for these high-cost medications, creating barriers for patients seeking such treatments. Insurance providers face challenges due to the “churn” factor; namely the high turnover of patients which limits the span over which the savings from such medications could be realized.
Also, non-persistence is plaguing the use of GLP-1 medications. Studies revealed alarming statistics: only about 25% of patients remained on Wegovy or Ozempic two years post-initiation of their treatment, with some estimates falling as low as 15%.
Despite clear health advantages demonstrated, including evident cardiovascular benefits noted within clinical trials, the existing financial burdens of GLP-1s may skew perceptions of their effectiveness. These hurdles may unintentionally obstruct equitable access to potentially life-saving medications.
While tirzepatide and semaglutide show the potential to help fight the obesity epidemic and its associated diseases, their sustainability within the framework of the U.S. healthcare system remains heavily challenged by the cost versus benefits debate surrounding their use.
