Is Zepbound covered by insurance?

To find out if Zepbound is covered by your insurance, call and ask about your formulary drug benefits and copay or check the website. Your plan phone number is located on the back of your insurance card. Eli Lilly also offers a $25 copay savings card for patients with commercial insurance.

Your insurance plan may also offer an online tool with your pharmacy benefit manager so you can search for Zepbound drug coverage online through the formulary. A formulary is a list of approved and covered drugs and their tiers that are covered by your insurance. Tiers help to determine what your copay or other out-of-pocket costs may be.

If you still have questions, contact your insurance company directly.

Related: View Zepbound Prices, Coupons and Savings Programs

If you do not have insurance, contact Eli Lilly at 1-800-Lilly-Rx (1-800-545-5979) (Monday-Friday) to determine if you qualify for other patient financial assistance programs.

If your insurance covers some or all of the cost of Zepbound, you still may be required to meet the FDA approved uses for Zepbound. You may need a diagnosis of:

• obesity (BMI of ≥30 kg/m2), or overweight (BMI of ≥27 kg/m2)
• at least 1 weight-related condition (like high blood pressure, type 2 diabetes, high cholesterol, obstructive sleep apnea, or heart disease).

Zepbound is also used with a reduced-calorie diet and increased physical activity.

How much is Zepbound with insurance?

If your insurance plan covers Zepbound for chronic weight loss, your out-of-pocket costs will depend upon your specific deductible, benefit coverage and copay that Zepbound falls under.

Coverage can vary among insurance carriers and a patient’s plan benefits. Contact your insurance to determine your plan benefits and costs.

If you have commercial (private) insurance that includes Zepbound and your doctor prescribes this medicine, it may be more affordable for you to gain access using a Zepbound Savings Card supplied from Eli Lilly, the manufacturer.

Eligible commercially insured patients may pay as little as $25 with a 1-month (4 pens) or 3-month (12 pens) prescription. You may only use the copay card for a maximum of up to 13 prescription fills per calendar year.

There are also some limitations on the savings with the card. There is a maximum monthly savings of up to $150 per 1-month prescription, $300 per 2-month prescription, or $450 per 3-month prescription fill and separate maximum annual savings of up to $1,800 per calendar year.

Copay cards are not typically eligible to patients with government sponsored insurance such as Medicare, Medicaid or TriCare.

Ask your insurance company what your out-of-pocket costs are before your medicines are covered. If you have a yearly insurance deductible for prescriptions, you may need to fully meet your deductible before your insurance would start any medication coverage. Once your yearly out-of-pocket costs are met, your insurance should pay for some or all of your covered medicine.

How much is Zepbound without insurance?

The cost for Zepbound subcutaneous injection is around $1,125 for a supply of 4 injectable pens that contain a month's supply of medicine, using a free online discount coupon.

The Zepbound price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies (like Walgreens, CVS Pharmacy, and Walmart) and may help you save money. Prices can vary depending on the pharmacy you visit or your online coupon. Prices are for cash paying customers only and are not valid with insurance plans.

What if my insurance won’t cover Zepbound?

If you have commercial insurance but your plan does not cover Zepbound, you may be eligible to pay a discounted price through Eli Lilly as low as $550 per month. Contact Eli Lilly at 1-800-Lilly-Rx (1-800-545-5979) (Monday-Friday) to learn about any financial assistance programs you may qualify for.

Ask your insurance company if other weight loss medications are covered on your drug plan. Discuss these options with your healthcare provider to determine if any may be a reasonable alternative to Zepbound if this drug is not covered.

If you have a HSA (Health Savings Account) or an FSA (Flexible Spending Account) through your employer, you may be able to use these funds to help pay for the cost of Zepbound.

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Which insurance companies cover Zepbound?

If you have commercial medical insurance like Blue Cross Blue Shield, United Healthcare, Cigna or Aetna (or others) check with your plan directly to determine if they cover Zepbound. You can usually find the phone number on the back of your insurance card. Your benefits will vary based on your plan benefits, deductible and copay.

The newer GLP-1 products like Zepbound and Wegovy are expensive and you may have a large out-of-pocket cost to access these medications.

Previously, insurance rarely covered medications for weight loss, but this may be changing so it’s important to check with your plan. If you have type 2 diabetes or established cardiovascular (heart) disease, your insurance may be more likely to cover these types of drugs.

Why does Zepbound require a prior authorization?

Your pharmacy benefit manager may require a “prior authorization form” to be filled out by your doctor and sent into the insurance company as part of the insurance approval process for Zepbound.

Prior authorization is sometimes required for certain medications if you have not tried other “first-line” options, either because these medicines are more expensive or have certain safety concerns.

For example, you may need to meet certain criteria, like participation in a recent weight-loss program that encourages behavioral changes, diet and increased exercise for 6 months prior to Zepbound treatment. This may require follow-up by your healthcare provider.

Once the form is received from your healthcare provider, your insurance company will review the criteria, determine if you are eligible, and contact you with the decision.

For more information about how to fill out the Prior Authorization form for Zepbound, visit Eli Lilly’s website.

Can I get Zepbound generically?

Zepbound is only available as a brand name drug at this time. Zepbound was first approved in 2023, and it may be many years before a generic option is available.

See also: Generic Drug FAQ

Who is eligible to use Zepbound?

Your insurance plan will most likely require that you meet certain criteria before you can start treatment with Zepbound. This may include:

• meeting the FDA approved uses
• showing you have have previously used other weight-loss treatments, behavioral programs that encourage meal planning, diet and exercise for 6 months, or
• having successfully lost at least 5% of your weight, or maintained that weight loss, over at least 3 months at a stable Zepbound maintenance dose.

Each pharmacy benefit manager can determine their own specific criteria for use, so these may vary among plans.

FDA approved uses for Zepbound

Zepbound (tirzepatide) injection is approved for adults 18 years of age and older and is to be used with a reduced calorie diet and increased physical activity for chronic (long-term) weight management.

Patients should have an initial body mass index (BMI) of 30 kg/m2 or greater (obesity) or 27 kg/m2 or greater (overweight) in the presence of at least one weight-related medical condition, such as hypertension (high blood pressure), type 2 diabetes mellitus, obstructive sleep apnea, high cholesterol (hyperlipidemia) or heart (cardiovascular) disease.

Zepbound works differently than other weight loss medicines. It activates 2 hormone receptors, GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 (glucagon-like peptide-1). It works by reducing appetite, how much you eat, and lowering your body fat and weight.

It’s given as a self-administered subcutaneous (under the skin) injection once weekly. You, or a caregiver, can learn to inject this medicine from your healthcare provider.

Related: What is my BMI?

This is not all the information you need to know about Zepbound (tirzepatide) for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.