Nicholas Saraceno, Editor

Image Credit: Adobe Stock Images/Douglas.com

 noted that Hims & Hers began selling various Eli Lilly drugs on their platform—both branded forms of tirzepatide—including Zepbound, a glucagon-like peptide-1 (GLP-1) receptor agonist approved by the FDA for weight loss, and Mounjaro, which is not approved for weight loss but for the treatment of type 2 diabetes. The telehealth company is also now selling generics of Novo's diabetes drug, liraglutide, approved for type 2 diabetes and obesity indications.

GLP-1s have traditionally treated type 2 diabetes, but surged in popularity for battling weight loss; they have also recently been approved in other indications, such as cardiovascular disease prevention and sleep apnea.

On the Hims & Hers website, both the Zepbound and Mounjaro injections will run customers $1,899 a month. Meanwhile, Lilly’s LillyDirect platform

 that was launched back in January 2024—which is known for providing resources for disease management, featuring access to independent healthcare providers, support, and direct home delivery of certain Lilly medicines through third-party pharmacy dispensing services—offers different prices.

In fact, the pharma company released a statement

 yesterday, noting that “Eli Lilly and Company (NYSE: LLY) has no affiliation with hims & hers. Zepbound (tirzepatide) can be prescribed by any licensed healthcare professional. People who are commercially insured with coverage for Zepbound may be eligible to pay as low as $25. For those who self-pay, Zepbound is available starting at $349 per month on LillyDirect.”

Hims & Hers also sells Novo Nordisk’s Wegovy (semaglutide), another GLP-1 for weight management.

1. SK Sneha, Singh P. Hims & Hers to sell Lilly's weight-loss drug on its telehealth platform. 

. April 2, 2025. Accessed April 2, 2025. 

https://www.reuters.com/business/healthcare-pharmaceuticals/hims-hers-sell-lillys-zepbound-its-telehealth-platform-2025-04-01/

2. Saraceno N. Beyond the GLP-1 Headlines. 

. February 12, 2025. Accessed April 2, 2025. 

https://www.pharmaceuticalcommerce.com/view/beyond-the-glp-1-headlines

3. Tracy D. Lilly Introduces Single-Dose Vials of Zepbound, Expanding Access for Adults with Obesity. 

. August 27, 2024. Accessed April 2, 2025. 

https://www.pharmaceuticalcommerce.com/view/lilly-introduces-single-dose-vials-zepbound-expanding-access-adults-obesity

4. Saraceno N. Lilly Adds New Zepbound Vial Doses to the Mix. 

. February 25, 2025. Accessed April 2, 2025. 

https://www.pharmaceuticalcommerce.com/view/lilly-adds-new-zepbound-vial-doses

5. Statement: Lilly has no affiliation with hims & hers. Lilly. April 1, 2025. Accessed April 2, 2025. 

https://investor.lilly.com/news-releases/news-release-details/statement-lilly-has-no-affiliation-hims-hers

Articles

The telehealth company is offering Lilly’s branded form of tirzepatide—approved for weight loss—on its site for $1,899 a month, while Lilly also sells the GLP-1 via its LillyDirect platform.

Hims & Hers Begins Selling Zepbound

Understanding Copay Accumulators, Maximizers, and Alternative Funding Programs

chief strategy offer at the National Pharmaceutical Council

, describes how in response to rising healthcare costs, employers have turned to high-deductible health plans and higher out-of-pocket (OOP) expenses, causing patients to pay more for healthcare. To help alleviate this financial burden, manufacturers offer copay assistance programs, which are aimed at improving medication adherence and preventing disease progression. However, insurers have introduced cost-shifting programs such as copay accumulators, maximizers, and alternative funding programs (AFPs) to manage these costs.

Copay accumulators redirect the value of copay assistance to the insurance plan instead of counting it toward the patient's OOP max or deductible. This means that patients face surprise copay costs once the copay assistance runs out, essentially "double dipping" as the plan captures the benefit without applying it to the patient's financial responsibility.

Copay maximizers also shift assistance from the patient to the plan but manipulate the patient's copay to extract the maximum benefit from the copay assistance. While the copay assistance helps with a specific medication, it doesn't count toward the patient's deductible or OOP max for other expenses, leaving the patient responsible for other costs.

Alternative funding programs (AFPs) are more complex. In these programs, certain specialty medications are removed from insurance coverage, and patients must enroll in an AFP. They work with a third-party vendor to obtain the medication, often through manufacturer assistance, charity programs, or international pharmacies. While the AFP may provide the medication, it can be a slow and confusing process, and patients may not qualify, leaving them to pay out of pocket or forgo the medication. These cost-shifting strategies aim to manage healthcare expenses but can create additional financial and logistical challenges for patients.

Westrich also comments on how these accumulators, maximizers, and alternative AFPs are impacting patients, manufacturers, and healthcare ecosystems; sessions that have caught her eye; and much more.

What exactly are accumulators, maximizers, and alternative funding programs?

Before I define them, I'm going to step back and tell you a little bit about how we got here, where did they come from? As overall healthcare costs are going up, employers are looking for ways to manage their costs, and with some of the things that are happening to benefit design—we're seeing high- deductible health plans, we're seeing higher out-of-pocket (OOP) maxes, higher co-pays—patients are being asked to pay more than ever before, and then manufacturers are putting copay assistance in place to help mitigate some of the financial burden that patients are facing, because as they're facing that financial burden, there's problems with adherence and persistence, which can cause problems with disease progression, so manufacturers provide copay assistance, which helps patients manage this financial burden.

That brings us to cost shifting and these programs. What we're seeing is that insurers are increasingly using what we say are cost-shifting programs, and these programs are things like accumulators, maximizers, alternative funding programs. So, what are they? I will put these in my own words, kind of simplify it. We just published a primer in 

 earlier this week on copay accumulators and maximizers, which goes into a deep dive for anyone who wants to know more. For copay accumulators, I like to use the phrases redirecting and double dipping. The copay accumulators are redirecting the manufacture of copay assistance that's intended to patients.—it's redirecting it to the plans. What will happen is the patient will go to the pharmacy counter, the copay assistance card is covering the cost of their medications—like expected throughout the year—and then all of a sudden, there's a copay surprise, when the copay assistance runs out, and the patient is asked to pay the full cost. What has happened is the plan has captured the value of the copay assistance and not put that value towards the patient's out of pocket max, towards the patient's deductible. Then, the patient is asked to pay again, and that's where the double dipping part comes in. Before the copay accumulator was in existence, the patient would be able to meet their OOP max, their high deductible, with the copay assistance. With the copay accumulator, that copay assistance is shifted to the plan, and then the patient has to pay as well, double dipping. So that's the accumulator.

With the maximizers, the keyword here is maximizer. You've again got this shifting idea where the assistance is going from the patient to the plan, but the patient's copay is manipulated and set in such a way that the plan can extract the maximum amount from the manufacturer’s copay assistance. So that's the keyword, maximum. Here it gets a little tricky: copay assistance is not counting towards the patient's deductible, their OOP max, so for expenses other than the medication that's in the copay maximizer program, the patient is still having to pay their deductible, having to pay their copays in order to meet those expenses. They are, however, getting financial assistance from the copay assistance for that one particular product. So those are maximizers.

Then, we get to the alternative funding programs (AFPs), which are a little bit of a different bird shall we say. They still have this cost shifting idea. What happens with an alternative funding program is certain specialty medications are completely removed from the patient's insurance. They're not covered, so the patient appears to be uninsured for those products. And then what happens is they have to enroll in an AFP, and they work with a third-party vendor who then attempts to get the product for them from a manufacturer assistance program, from a charity, maybe from an international pharmacy. If they're successful in getting the product, then the patient gets the medication through the AFP, but it can take time. It can be very confusing for the patient. They might not qualify for these programs, and then they end up either having to pay out of their own pocket or going without their medication.

Videos

In the first part of her video interview with Pharma Commerce Editor Nicholas Saraceno, Kimberly Westrich, chief strategy officer at the National Pharmaceutical Council, lays out the basics surrounding accumulators, maximizers, and AFPs. 

Hubs East 2025: Understanding Copay Accumulators, Maximizers, and Alternative Funding Programs

Oscar de Bok, CEO of DHL Supply Chain, and Jerrell Shelton, CEO of Cryoport. Image Credit: DHL Supply Chain


DHL has purchased CRYOPDP, Cryoport’s specialty courier powered by clinical trials, biopharma, and cell and gene therapies.

 In that same breath, the parties also noted that they’ve reached a strategic partnership that’s intended to augment both of their supply chain service offerings for the global life sciences and healthcare field.

This deal increases DHL’s capabilities when it comes to specialized pharma logistics—the courier currently handles over 600,000 shipments annually, and provides services to patients and clients in over 135 countries. DHL Supply Chain hopes to expand upon its pharma network by combining CRYOPDP services with the air services that DHL Express and DHL Global Forwarding bring to the table. The deal also supports its “Strategy 2030” plan, which highlights the value of temperature-controlled networks; first and last mile specialty courier coverage; and integrated solutions.

"The acquisition of CRYOPDP is a pivotal move for our supply chain business as we aim to expand our pharma specialized network to meet the evolving needs of clinical trials, biopharma and cell & gene therapies, in addition to further increasing our footprint in the conventional pharma and life science healthcare segment,” explained Oscar de Bok, CEO of DHL Supply Chain. “The acquisition of CRYOPDP and the extended partnership with Cryoport Inc. will enable us to deliver integrated end-to-end solutions, enhancing our service capabilities."

This partnership is also beneficial for the temperature-controlled supply chain solution provider, who has wanted to prioritize its efforts on growing its reach to the Asian Pacific (APAC) and Europe, Middle East, and Africa (EMEA) markets.

"We are indeed pleased to build on our trusted relationship with the DHL Group” said Jerrell Shelton, CEO of Cryoport. “Working together we will bring an enhanced set of supply chain solutions to meet companies' and patients' critical supply chain needs. This strategic partnership taps into the strong expertise of DHL's Supply Chain and CRYOPDP, presenting a substantial opportunity for Cryoport to further expand its reach to global growth markets such as APAC and EMEA."

1. DHL Group acquires CRYOPDP from Cryoport to strengthen "DHL Health Logistics." DHL. March 31, 2025. Accessed April 1, 2025. 

https://group.dhl.com/en/media-relations/press-releases/2025/dhl-group-acquires-cryopdp-from-cryoport-to-strengthen-dhl-health-logistics.html

CRYOPDP—centered around clinical trials, biopharma, and cell and gene therapies—augments DHL’s specialty pharma logistics expertise.

DHL Purchases Cryoport’s Specialty Courier

The Financial Barrier to GLP-1s

, Colin Banas, MD, DrFirst’s chief medical officer, describes have many Americans face significant challenges in accessing GLP-1 drugs due to their high cost. Despite the growing popularity and usage of these medications, which were originally developed for diabetes treatment, the price remains largely unchanged. Even with insurance coverage, patients often encounter co-pays or out-of-pocket expenses upwards of $500 to $600, making the medications unaffordable for many. Research indicates that once out-of-pocket costs exceed $100, medication adherence drops dramatically, further limiting access.

Additionally, insurance companies frequently require patients to try other medications first, a process known as step therapy, which can delay access to GLP-1 drugs. The drugs' weight loss benefits have garnered attention, but insurance companies still primarily cover them for diabetes treatment, leaving individuals seeking them for weight loss without coverage options. Moreover, as ongoing research uncovers more potential benefits of GLP-1 drugs—such as their positive effects on cardiovascular disease, Alzheimer's, and chronic kidney disease—insurance policies have not yet adapted to these expanded uses. As a result, many Americans who could benefit from these drugs for conditions beyond diabetes find that coverage is not available.

Banas also comments on patients turning to direct-to consumer (DTC) platforms following insurance denials; rumors of DTC advertising being banned; and much more.

What challenges do many Americans face regarding the affordability of GLP-1 drugs?

Affordability is the biggie, I would say, and it's two-fold. These drugs still are quite expensive. We’re probably two years into what I would call the GLP-1 run, and the usage—by our own data and by any other metric—is continuing to increase almost at an exponential rate. But the cost has really not fluctuated too much. For a lot of folks, even with insurance, you're facing co-pays or out of pockets (OOPs) that are upwards of $500, $600, which is a lot. There's actually data out there that shows that once you get to the OOP around $100, the first-fill adherence for a drug drops precipitously. I'm not surprised at all that if you're in the hundreds of dollars for a GLP-1, most folks might find that to be simply unattainable.

Even with insurance, there's often a lot of what we step therapy, a lot of hoops or prior medications that you have to attempt first, and then I would say the third thing is, these drugs really were brought around for diabetes, and the weight loss aspect of it was a nice byproduct, and now we're continuing—as we research them—to find more and more benefit, whether it's cardiovascular disease or Alzheimer's.

Chronic kidney disease is the latest one that I've seen in the literature, but the primary indication was diabetes. The insurance companies still haven't quite shifted to the outside of diabetes use cases, so a lot of folks who feel like they want to access these medications for weight loss are finding that it's simply just not covered for weight loss yet.

In the first part of his video interview with Pharma Commerce Editor Nicholas Saraceno, Colin Banas, MD, DrFirst’s chief medical officer, discusses the challenges that many Americans face regarding the affordability of GLP-1 drugs.