Onswik (Efsitora) Pricing 2026: Lilly's Weekly Insulin vs Awiqli, Tresiba, and Lantus

Onswik is a branded prescription insulin, not a compounded peptide. The FDA approved Eli Lilly's Onswik (insulin efsitora alfa-gobe) on September 24, 2026, for adults with type 2 diabetes. It is a basal insulin, the slow, background kind that controls blood sugar between meals and overnight, and it is injected once a week instead of once a day. Insulin is a peptide hormone. In efsitora, a modified single-chain insulin is joined to a fragment of an antibody, which slows its removal from the body; the label puts its half-life at about 17 days. That is why it appears in this site's peptide pricing section. The label says it is not recommended for type 1 diabetes because of a higher risk of severe low blood sugar.

Lilly has not announced a price. Its September 24 release said Onswik will reach U.S. pharmacies "in the coming months" and gave no list price. The list price is also called the wholesale acquisition cost, or WAC. It is the sticker price a drugmaker charges wholesalers before rebates, and most insured people never pay it directly. As of October 5, 2026, Onswik was also not on the list of insulins covered by the Lilly Insulin Value Program, the company's $35-a-month offer for people with commercial insurance or no insurance. Lilly may add it at launch, but it has not said so.

Medicare has a firm $35 cap, but only for insulins a plan covers. Since 2023, the Inflation Reduction Act has limited Part D cost sharing to $35 for a month's supply of each covered insulin, with no deductible. People with employer or individual insurance have no federal cap. Their cost depends on the formulary, the plan's list of covered drugs, which is built by a pharmacy benefit manager (PBM) such as CVS Caremark, Express Scripts, or Optum Rx. So the price that matters for most people will be set by whether their plan adds Onswik, not by its list price alone.

The best guide to Onswik's eventual price is the weekly insulin already on sale. Novo Nordisk's Awiqli (insulin icodec) won FDA approval on March 27, 2026, and reached U.S. pharmacies on August 11 with a reported list price of $99 per package. Novo says insured patients can pay as little as $35 a month and uninsured patients $55. Daily basal insulins now cost far less at list than they did a few years ago: Novo lists a five-pen box of Tresiba at $141.43, and Sanofi sells a 30-day supply of any of its insulins, including Lantus and Toujeo, for $35 to anyone with a prescription.

Pen size will matter more than a monthly price. Each Onswik pen comes alone in its carton. The U-500 pen holds 1,500 units, so at the 100-unit starting dose it covers 15 weekly shots, and the label says to throw a pen away 16 weeks after first use. People on higher doses will go through pens faster. For how the newest diabetes guidance places insulin next to GLP-1 drugs and SGLT2 inhibitors, see our guide to the 2026 ADA-EASD consensus. For how prior authorization works at the pharmacy counter, see GLP-1 insurance coverage and prior authorization. Prices below were checked on October 5, 2026.