All About LillyDirect

We break down how LillyDirect works for people who want GLP-1 medications like Zepbound but can’t get insurance coverage or face an unaffordable copay. We walk through the ordering flow, device choices, safe handling basics, and the pricing rules that can save you money or unexpectedly raise your cost. 
• why GLP-1 access is so frustrating in the US and what is changing 
• what LillyDirect is and how direct-to-consumer fulfillment works through Gifthealth 
• delivery options and what to expect after your clinician sends the prescription 
• Zepbound quick pen vs single-use vials and why we usually prefer the pen 
• priming the pen each dose and where to get additional needles if needed 
• refrigeration guidance, what to do if it reaches room temperature, and what the 30-day guidance really means 
• LillyDirect pricing by dose and how higher doses change monthly cost 
• the 45-day refill window, grace periods, and how late orders can raise prices 
• when a copay coupon at the pharmacy may be a better long-term move 
• why LillyDirect purchases do not apply to your insurance deductible 
If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. 

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Transcript

Welcome And Medical Disclaimer

Dr. Lindsay Ogle 0:00

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, Board Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatments. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you.

Why GLP-1 Coverage Fails Patients

Dr. Lindsay Ogle 0:44

If you are currently prescribed a GLP1 medication or are considering one to treat your obesity or other metabolic health condition, but your insurance does not cover GLP1 medications, then you definitely want to listen to this video. I very regularly prescribe GLP1 medications to my patients with obesity, overweight, and metabolic health conditions. And some of my patients are fortunate enough to have insurance coverage, and others do not. And for my patients who do not, I very often utilize Lily Directs program. And this video is going to talk about this program in detail. One of the very frustrating things about the US healthcare system in regards to treating obesity and a lot of our metabolic health conditions is that we have wonderful medications available to treat these conditions, particularly our GLP ones, but insurance is not required to cover these medications. So many patients qualify medically for these treatments, but their insurance does not cover them. Or maybe they cover them, but there's a very, very high copay. And this can be very confusing and, like I said, frustrating for both patients and providers. Fortunately, there's a lot of advocacy going on and that is improving access. Particularly one win that we've had recently is the Medicare GLP1 Bridge Program, which I talked about in a recent video and will link here. But for anybody who does not have Medicare, um, is uninsured or has commercial insurance but is interested in utilizing a GLP1 but doesn't have that insurance coverage, I highly recommend considering Lily Direct.

How LillyDirect Works Step By Step

Dr. Lindsay Ogle 2:35

Now, Lily Direct is a direct-to-consumer program. So this is Eli Lilly, the manufacturer of Zepbound and Fondeo and many other medications. They created the medication, designed it, studied it, and they manufacture it. This program cuts out that pharmacy middleman and with a prescription from a patient's provider, you will get the medication directly from Lily, the manufacturer. And so the way that this works is that you will see your medical provider just like any other visit, but instead of them sending the prescription to your local pharmacy, they will send it to LilyDirect. Once LilyDirect gets that prescription, they'll process it. Then they will reach out to you, the patient, via text from an organization called Gift Health. They will confirm that they received the prescription, they will confirm your delivery address, and then they will accept your payment for the medication. So you'll be able to review the prescription, delivery address, make that payment to gift health, and then Lily will send you the medication. And the medication can go to your home directly, um, or it can go to I believe it's Walgreens is the pharmacy that they have partnered with. So whatever you feel most comfortable with, whether that's you know delivering it to your home or your local Walgreens, um you can make that choice when you purchase the medication.

Pens Vs Vials And Other Options

Dr. Lindsay Ogle 4:11

Now, what medications are available through LilyDirect? There are a few, but I strongly recommend Zapbound um quickpins. And here is a pic or a sample of the Zapbound quick pin. I recently did a full video about how to use these quick pins, especially when you're prescribed a higher dose and are taking a lower dose to make the pin and the prescription last longer to save you money. Um, so I'll link that here and I highly recommend you check that out. I'm not gonna go into the details of this video, um, but I recommend the quick pin because they're easier to use, they're more environmentally friendly because it's just one pin. Um, versus for Zetbound through LilyDirect, they have single-use vials. So if you chose the vials or you prefer those for whatever reason for your preference, you get single dose vials with a syringe and needle to use for each dose. Um, so it's just a little bit more complicated to dose yourself using that method because you pull the medication from the vial into the syringe and then dose yourself that way. So there's more steps, more room for air, more opportunity for infection, um, and also less environmentally friendly. And so for those reasons, I do recommend the quick pin multi-dose pin versus the single-use vials. But some people do prefer the vials, and that's okay as well. Other than Zutbound, there is um Oral Fondeo, which is the newest FDA-approved obesity management medication. I did a video about that recently, which I'll also link so you can learn more about that option. But you can get a 30-day supply of those pills through LilyDirect. Even though I'm not going to get into the weeds about how to dose the Zapbound quick pins, this is something, of course, talk to your provider, and you can also reference my last video for tips on that or you know, information again to take to your provider to verify that it is safe for you.

Priming, Needles, And Storage Rules

Dr. Lindsay Ogle 6:23

Um, but there were a couple of common questions, and I do want to address those here. The first question I got quite a bit with the multi-dose zapbound pins is do you have to prime before each dose? And the answer is yes, that is recommended because that helps to get any air bubbles out before you do your injection. And so I'm gonna quickly just show here how you prime. So you would take your pin, it's set at zero, um, the cap would be off, um, and then you just turn the knob until you get to that first line, the longer line, and then you just press the button. Um, and then as you see, it'll go back to zero, and that's priming. That's all you have to do. And then you would give your you would you know turn the knob if you're taking the full dose as prescribed, you would turn it all the way to one, and every dose is gonna say one here. Um, the first, second, third, and fourth dose, it always will say one, um, and then you give yourself the injection, of course, into your skin. Um, but again, reference my other video for more details about how to use this quick pen. Um, but you do want to prime it with each dose. The next question was if you are using more than four doses with your quick pen, how do you get more needles? I will include a link in the description on information about buying additional needles. You can get several dozen for very inexpensive price. Um, so I will include that below. Another common question was what to do about keeping the pen at refrigeration temperature. So you when you get the medication delivered to you, it'll be in packaging that will keep it at refrigeration temperature. And so as long as the medication has stayed cool, then open the box, put it into your refrigerator right away and keep it there. When you are ready to dose yourself, take the pin out, give yourself your dose, and then put it back in the refrigerator right away. Don't give it time to get to room temperature. At any point, if your pin does get to room temperature, if it arrived and it, you know, isn't cool anymore, if it, you know, you weren't home and it took a while to get to the package, or if you accidentally left it out too long and it's now at room temperature, keep it there. Putting it back in the refrigerator after it's been at room temperature could make the medication less effective. So once it's at room temperature, keep it there. Um, it may, after about a month of being at room temperature, have less effectiveness. But that being said, um, that's a hypothetical, theoretical concern, and I would continue to use it as you have been, especially because you're paying out of pocket for this medication, and I don't want you to waste any of your money. Um, you always could call Lily and see if they are willing or able to give you a replacement if you had um, you know, if the medication was ruined by accidental means, um, but I would continue to use it. Um, of course, you can always ask your doctor what they think is best for you. And then there's the 30-day expiration date after you first use the pen. And that's what the manufacturer says, that's what Lily says. And I will it's important to know that after that 30 days, the medication does not become dangerous by any means. Again, theoretically, it's less effective. Um, so it's designed to be used within 30 days from the first injection, but I have seen clinically that it continues to be effective beyond that 30-day time frame. So if it is right for you, you may want to use it beyond that 30-day window. What is the cost for LilyDirex?

Pricing, Refill Window, And Hidden Gotchas

Dr. Lindsay Ogle 10:24

So this program cost depends on what dose you are prescribed, and the cost increases at higher doses. So the initial dose of Zapbound is 2.5 milligrams, and the 2.5 milligram prescription for either the multi-dose quick pin or the single dose vial, so for four vials, is $299. For the five milligram dose, it's $399, and for 7.5 and higher, so $1.5, 10, 12.5, and 15 milligrams, the cost is $449. And if taken um as intended and as prescribed, that is a cost per month. But again, there are ways to make the quick pin potentially last longer and save you some money there. So talk to your doctor about that option for you. If you are deciding to treat your obesity or metabolic condition with Fondeo, the oral GLP1 medication, then the cost is $149 for the starting dose, $199 for the second dose, and then $299 for all the subsequent doses. And the last thing I want to highlight about the Lily Direct program is that you do have to order your next refill within a 45-day window. So 45 days from the last delivery of your medication. So I typically recommend patients order at least every six weeks. Most patients are taking four doses with each prescription, but if they are taking more doses than that under my medical guidance, or if you're doing that under the guidance of your physician, then it may be lasting you much longer than that. But you always want to be ordering within that 45-day window. If you don't, um they will give a one-time grace period to maintain in the program. But if there's been two times that you have ordered outside of that window, then you will have to be start paying a higher price. Um, and that is a little bit different based on the Zeppelin dose or the Fondeo dose. Um, so I'm not gonna get into that, um, but it can go up to $699. So it's quite a big, big difference and something to really keep in mind when you're starting and andor continuing using LilyDirect. So I hope you found this helpful. I have many patients who use this program and have been very, very happy with the customer service and the ability to get ZipBound specifically for a discounted

Copay Coupons And Closing Requests

Dr. Lindsay Ogle 13:12

price. I'll also mention here that if your insurance does cover Zet Bound or another GLP one and you are going to pick it up at the pharmacy, but there is a very high copay, instead of switching to LilyDirect, it's worth looking in to see if you could use their Copay coupon, which could give you a discount for your copay and may make that much more affordable long term. And another thing I do want to mention here is that the money that you spend at LilyDirect is not going towards your deductible. Um, so that's really important to be aware of. Again, especially if your insurance is covering the medication, those co-pays that you're paying at the pharmacy are going to your pharmaceutical deductible, but the money spent through LilyDirect unfortunately does not go to your deductible. That is a separate program outside of insurance. Thank you for listening and learning how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.