Figures published c. 2005 by the World Bank. The Millennium Development Goals program concluded in 2015; this site is preserved as a historical record.
Low- and middle-income countries are the economies the World Bank places in its low-income, lower-middle income, and upper-middle income groups. Everything above that line is high income. Economic status is determined by gross national income (GNI) per capita, converted to US dollars by the World Bank Atlas method and revised every year on 1 July.
This page covers the four income groups, the current fiscal year’s thresholds, and the method behind them, as well as explaining some misconceptions. We use the income groups to compare what a year of semaglutide and tirzepatide costs against each income threshold.
Development Goals documents the classification and cites the World Bank as its source. It does not publish or maintain it.
Low- and middle-income countries (LMICs) defined and explained
In World Bank usage, the term low- and middle-income countries (LMICs) covers three of the four income groups taken together: low income, lower-middle income, and upper-middle income. The term is defined as much by exclusion as inclusion. An LMIC is any economy the World Bank has not placed in the high-income group. LMIC is an income grouping, not a statement about a country’s institutions, health system, or development trajectory.
Some funders, journals, and grant schemes use LMIC to mean the lower-middle income group alone, excluding low income and upper-middle income, because the same four letters also abbreviate lower-middle income country. The two readings produce different country sets. Check the definition given inside whatever document sets the eligibility rule.
The World Bank publishes the three groups as a combined low- and middle-income data series for aggregate figures.
The four World Bank income groups and current thresholds
The classification below applies to the World Bank’s fiscal year 2027, which runs from 1 July 2026, to 30 June 2027, and uses GNI (gross national income) per capita for calendar year 2025.
| Income group | GNI per capita, Atlas method, 2025 | Counted as an LMIC? |
|---|---|---|
| Low income | $1,175 or less | Yes |
| Lower-middle income | $1,176 to $4,635 | Yes |
| Upper-middle income | $4,636 to $14,375 | Yes |
| High income | More than $14,375 | No |
Source: World Bank Country and Lending Groups, fiscal year 2027 classification. These figures were set on 1 July 2026 and will be revised in July 2027.
These numbers are subject to change each year along with natural trends in inflation, population, and economic activity. In the July 2026 release, Jordan, Micronesia, the Philippines, Sri Lanka, and Vietnam moved from lower-middle to upper-middle income, and Togo moved from low-income to lower-middle income, according to the World Bank.
What counts as a high-income country
Under the fiscal year 2027 classification, a high-income country is one with GNI per capita above $14,375. It does not consider governance, health indicators, or regional groupings. High income is a threshold, not a fixed club, so any published list of high-income countries is a snapshot of one fiscal year.
This site’s regional country list sets out the World Bank regional and income classifications as they were used for Millennium Development Goals monitoring, which ended in 2015. Use the World Bank income table for current figures.
Why medicine prices track income group
The World Bank income groups are used for more than statistics. Aid eligibility, concessional lending terms, and tiered pharmaceutical pricing arrangements all use GNI per capita thresholds to decide who qualifies for what.
Gavi, the Vaccine Alliance, supports a country if its most recent GNI per capita, published by the World Bank each July using the Atlas method described above, is at or below US$2,300. A country that crosses a threshold can therefore begin paying a different price for the same medicine, without anything changing for the people buying it. Gavi’s programs target the infectious disease burden, which falls hardest on the countries below that line.
What is the Zepbound cost compared to World Bank income thresholds?
Tirzepatide (Mounjaro, Zepbound) is a GIP and GLP-1 receptor agonist. Mounjaro is approved to improve blood sugar control in adults and children age 10 and older with type 2 diabetes. Zepbound is approved with a reduced-calorie diet and increased physical activity.
It is approved to reduce excess body weight and maintain that reduction long term in adults with obesity or overweight with at least one weight-related comorbid condition. It is also approved to treat moderate to severe obstructive sleep apnea in adults with obesity. Long-term treatment means the recurring monthly Zepbound cost matters.
On October 6, 2026, US self-pay prices started at $299 a month for the 2.5 mg starting dose. The 5 mg dose was $399, and the 7.5 mg, 10 mg, 12.5 mg, and 15 mg doses were $449 when refilled within 45 days under the Zepbound Journey Program. Regular prices were $499 for 7.5 mg and $699 for 10 mg, 12.5 mg, and 15 mg if not refilled within 45 days. These are listed prices, not what every patient pays.
The lowest listed price applies to the starting 2.5 mg dose, and higher prices apply to different doses and refill conditions. Because treatment is long term, the annual cost is substantial. Any yearly total is illustrative, not a prediction for any individual plan. Zepbound is not approved to treat type 2 diabetes; that indication belongs to Mounjaro. Semaglutide (Ozempic, Wegovy) is in the same broader class, but its pricing should not be substituted for tirzepatide’s.
A WHO news release about the Essential Medicines List update says high prices for semaglutide and tirzepatide limit access. Tirzepatide was added for glucose-lowering therapy in adults with type 2 diabetes who have established cardiovascular disease or chronic kidney disease and obesity. Obesity is defined as a body mass index of at least 30. Obesity and diabetes are part of the wider noncommunicable disease burden, and this burden affects countries at every income level.
An income classification measures average national income, and it does not show whether people in that country can afford a particular medicine; it was not designed to. Comparing a monthly or annual price with personal burden requires measures such as the poverty gap ratio.
What a year of Zepbound costs against each income threshold
At the United States self-pay prices above, a year of Zepbound costs between $3,588 (2.5 mg at $299 a month) and $5,388 (7.5 mg to 15 mg at $449 a month). Setting that beside the GNI per capita thresholds in the table earlier on this page shows what the classification can and cannot tell you.
| Income group | GNI per capita, Atlas method, 2025 | One year of Zepbound as a share of that figure |
|---|---|---|
| Low income | $1,175 or less | 305% to 459% |
| Lower-middle income | $1,176–$4,635 | 77% to 458% |
| Upper-middle income | $4,636–$14,375 | 25% to 116% |
| High income | More than $14,375 | Up to 37% |
GNI per capita is a national average, so it says nothing about the distribution of income inside a country. No country outside the United States pays the United States cash price because tiered pricing, national purchasing, and licensing all intervene. The table shows the scale of the gap, not what any given country is charged.
Moving into a higher income group does not automatically make a particular medicine affordable. A year of tirzepatide at the higher United States price still exceeds GNI per capita for every low-income and lower-middle-income country, and for the bottom of the upper-middle income group. Semaglutide may have a different price, but its cost should be assessed separately.
How the World Bank calculates GNI per capita: The Atlas method
A country’s income group can shift without its economy shifting if the currency conversion is done carelessly. The Atlas method exists to stop that.
Gross national income is the income earned by a country’s residents, at home and abroad. Converting it to US dollars is the hard part because a single year’s exchange rate can swing for reasons unrelated to output.
The Atlas method converts GNI per capita from local currency units to current US dollars using a three-year moving average, price-adjusted conversion factor. The World Bank describes the result as adjusted to smooth out short-term swings in exchange rates.
So, one sharp devaluation does not immediately push a country down a group, and one year of appreciation does not push it up. Movement between groups usually reflects a sustained change. The Atlas method converts at market exchange rates, not at purchasing power parity, so it does not adjust for differences in price levels between countries.
The importance of fiscal year
If you’re just looking at general trends, outdated income values aren’t much of a concern. But if you need the most up-to-date information, check the fiscal year of your data.
The World Bank updates its classifications on 1 July each year, using GNI per capita for the previous calendar year. The thresholds themselves are adjusted annually for inflation, using the SDR deflator. The label therefore trails the economy by about a year by design.
Funders, journals and aid reporting frameworks fix a World Bank vintage and hold it until their own review cycle comes round, so two current documents can quote different thresholds for the same country. The OECD example below shows how far two vintages can drift apart. The rule for citing this correctly is short. Give the fiscal year and the reference year of the GNI data, not just the group. “Upper-middle income, World Bank fiscal year 2027 classification, based on 2025 GNI” can be checked. “Upper middle income” on its own cannot.
Related global economic classifications
Four labels are used interchangeably: World Bank income groups, least developed countries, developing countries, and countries eligible for official development assistance. Different agencies set them, on different criteria and different schedules, for different purposes.
| Classification | Set by | Criteria | Updated | Used for |
|---|---|---|---|---|
| Income groups | World Bank | GNI per capita, Atlas method | Every 1 July | Statistical grouping |
| Least developed countries | UN, via the Committee for Development Policy | GNI per capita, human assets index, economic and environmental vulnerability index | Triennial review | Access to international support measures in aid and trade |
| Developing countries | No single body; informal | No agreed definition | Not applicable | General usage. Retired from World Bank data |
| DAC List of ODA Recipients | OECD Development Assistance Committee | World Bank income data plus the UN LDC list, with exclusions | Every three years | What members may report as official development assistance |
Least developed countries: UN DESA defines LDCs as low-income countries confronting severe structural impediments to sustainable development, highly vulnerable to economic and environmental shocks, and with low levels of human assets. There are 44 countries on the list, reviewed every three years by the Committee for Development Policy. Income alone does not decide it. At the 2024 triennial review the graduation thresholds were GNI $1,306 or above, a human assets index of 66 or above, and a vulnerability index of 32 or below. The Committee recommended Cambodia, Djibouti, and Senegal for graduation.
Developing countries: No agreed statistical definition exists. The World Bank’s own Data Blog states that “the World Development Indicators no longer provide aggregations by ‘developing’ countries” and recommends low- and middle-income countries in its place. That is why LMIC is the term to reach for in a methods section.
DAC List of ODA Recipients: The list effective for reporting on 2025 flows sorts recipients using World Bank GNI per capita for 2022, with column cutoffs of $1,135 or less, $1,136 to $4,465, and $4,466 to $13,845. Those are correct for that list and different from the fiscal year 2027 figures above. The list also carries a sustained-income rule. It notes that Guyana and Panama exceeded the high-income threshold in 2022, and that if they hold high income until 2026, they will be proposed for graduation at the review scheduled in 2027.
If a document sets eligibility, the definition inside that document governs, not the general term. The Millennium Development Goals framework, which ran to 2015, used the same income split to define who gave and who received under Goal 8. See indicator 42 on HIPC debt relief.
What the income classification does not measure
The classification applies one number identically to every economy. That is its strength and the whole of its limitation.
Four documented limits:
- It is an average, so it says nothing about distribution. A large share of the world’s poorest people live in countries classified as middle income.
- It converts at market exchange rates rather than purchasing power parity, so it does not reflect what the income buys locally.
- It can understate income where the informal sector is large.
- The thresholds sit on no natural economic boundary. They descend from late-1980s lending criteria and have been adjusted for inflation since.
The classification is absolute rather than relative. A country’s group depends on its own GNI per capita, not on its rank, so several economies can move up in the same year without any moving down.
Income group is also not lending category. The World Bank prints IDA, IBRD, and Blend in the same table, but they are separate assignments.
Income group answers one question well. Treat it as a filing category, not as a description of a country.
FAQ
What does LMIC stand for?
LMIC stands for low- and middle-income countries, comprising the World Bank’s low income, lower-middle income, and upper-middle income groups together, excluding high income. Some funders use LMIC more narrowly to mean the lower-middle income group alone, so check the definition in the document that sets the rule.
How often does the World Bank update the income classification?
Every year on 1 July. Each update uses GNI per capita for the previous calendar year, calculated by the Atlas method, with the thresholds adjusted for inflation. The classification in force from 1 July 2026 to 30 June 2027 is the fiscal year 2027 classification, based on 2025 GNI.
Is a least developed country the same as a low-income country?
No. The World Bank low-income group is set by GNI per capita alone. The UN least developed countries category adds a human assets index and an economic and environmental vulnerability index, is reviewed every three years by the Committee for Development Policy, and covers 44 countries. A country can have a low-income designation without being an LDC.
Does the World Bank still use the term developing countries?
Not in its data aggregations. The World Bank’s Data Blog states that the World Development Indicators no longer provide aggregations by “developing” countries and recommends “low- and middle-income countries” instead. The term survives in general writing, but no agreed statistical definition sits behind it.
Can a high-income country still receive official development assistance?
It can stay on the OECD DAC List of ODA Recipients for a period. Graduation requires sustained high-income status confirmed at a triennial DAC review. The list effective for 2025 flows notes that Guyana and Panama passed the high-income threshold in 2022 and would be proposed for graduation in 2027 if they hold that status until 2026.
Do medicine prices differ between high-income and low-income countries?
Yes. Tiered pricing arrangements, donor programs, and voluntary licenses commonly use World Bank income classifications to set eligibility, so the group a country sits in can affect the price it pays and whether it receives support at all.
Sources
- World Bank, World Bank Country and Lending Groups, fiscal year 2027 classification.
- Gavi, the Vaccine Alliance, eligibility policy.
- World Bank Data Blog, post on the July 2026 changes to the income classification.
- World Bank, What is the World Bank Atlas method?
- World Bank, World Development Indicators, low- and middle-income aggregate.
- World Bank Data Blog, post on retiring the term developing world.
- United Nations Department of Economic and Social Affairs, Least developed countries.
- United Nations Committee for Development Policy, excerpt on the 2024 triennial review of least developed countries (PDF).
- OECD Development Assistance Committee, DAC List of ODA Recipients for reporting on 2025 flows (PDF).
- World Health Organization, news release on the first global guideline on GLP-1 medicines for obesity, 1 December 2025.
developmentgoals.org documents these statistics and cites the agencies that produce them. It does not produce them.