Lilly To Levy A Fat Tax For Its Weight Loss Drug in Canada

If you're prescribed tirzepatide for obesity in Canada, come January, you'll be paying double what you would pay if you were prescribed it for type 2 diabetes

Dusting off the blog because I just received a notice from drug giant Lilly that basically says they’re going to add a fat tax to tirzepatide (aka Mounjaro and Zepbound) such that if it’s prescribed to you for obesity, you’re going to pay more than twice as much as if it were prescribed to you for type 2 diabetes.

The notice refers to the launch of their preloaded tirzepatide pens. These pens have been available in the US for some time, but here in Canada, tirzepatide has been sold in single use vials where, depending on your pharmacy, each vial costs somewhere between $250 and $350 regardless of dose.

According to the Lilly circular, moving forward, it looks like there’ll be a bump in price for all doses (the prices on the circular are wholesale prices and will see markups in pharmacies), and especially at the higher doses, that is unless you have diabetes.

Because if you’re prescribed this medication for diabetes, Lilly has set up a website where you can logon, input your medical and insurance details, tell them you have diabetes, and you will then receive, “comprehensive and enhanced financial assistance” which will see the price of the pens come, “close to what they are paying for the vials today”.

Now this post isn’t about why a plastic casing and a spring somehow leads the price of the exact same medication to double and cost likely near $1,000 a month after pharmacy markups at its highest doses, nor about why Lilly won’t even throw in the necessary needles with their $1,000/month pens, but rather about why patients prescribed this medication for obesity don’t qualify for financial assistance.

You see in Canada tirzepatide is formally approved for use in type 2 diabetes, however physicians regularly prescribe it off label (meaning for a condition it is not yet formally indicated by regulators) for use with obesity while we wait for Health Canada approval (the FDA approved it for obesity on November 8th, 2023, while the EU’s European Commission approved it for obesity on April 24th, 2024). Off label use is not a phenomenon unique to obesity medications. MDs prescribe medications off label all the time for dozens of conditions. But what I’ve never heard of before are patients with an off-label use prescription having to pay more for their medications. And here we’re talking about a medication recently shown to lead to greater weight loss than our next best obesity medication.

And I’m not sure what reasonable argument could be made to support the practice. It’s not about drug shortages, because they’re over (and even if there were ongoing shortages, there are literally dozens of medications available for the treatment of type 2 diabetes but less than a handful for obesity). It’s also not about protecting patients as if MDs feel a medication is appropriate to prescribe, that’s on them, not the drug companies.

There’s one obvious unreasonable argument though. People with obesity are desperate and willing to pay for effective medications, even if ultimately it is just another example of the disparity in healthcare they receive consequent to societal weight bias.

Plainly, it’s a fat tax. And I do hope Lilly rethinks this plan.