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. 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 your insurance covers some or all of the cost of Zepbound, you still may be required to meet the FDA approved uses for Zepbound, which are:

• to reduce excess body weight and maintain weight reduction long term in adults with obesity or adults with overweight in the presence of at least one weight-related health condition (such as (like high blood pressure, type 2 diabetes, high cholesterol, or heart disease).
• to treat moderate to severe obstructive sleep apnea (OSA) in adults with obesity.

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 or obstructive sleep apnea, 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. Pen strengths from up to 15 mg are covered with the savings card.

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 cash price for Zepbound subcutaneous injection is around $1,125 for a 30-day supply of 4 injectable pens, 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 Lilly for the vial injections as low as $650 for a one month prescription of Zepbound pen.

Also, be sure to discuss treatment options with your healthcare provider to determine if any other medicines 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.

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.

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 / GIP or GLP-1 agonist 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, obstructive sleep apnea or established cardiovascular (heart) disease, your insurance may be more likely to cover these types of drugs.

Related questions

• Ozempic Side Effects to Watch For
• How do Ozempic, Mounjaro, Wegovy, Zepbound compare for weight loss?
• Why am I not losing weight on Mounjaro?

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. You may need to meet certain weight limits for obesity or previously tried other treatments for OSA. Criteria can vary among insurance carriers.

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. This may also require further follow-up by your healthcare provider.

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

What if I have no insurance?

If you do not have any prescription drug 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.

You may also be eligible to pay a discounted price through Eli Lilly Self Pay for the Zepbound 2.5 mg and 5 mg vial injections (not pens) for as low as $549 per month. This may save you about $510 per month compared to the Zepbound pen.

You cannot use any insurance or a savings card with self pay, but you may use your FSA/HSA cards. This savings program is only available through the Lilly Direct Self-Pay Pharmacy (not from your local pharmacy).

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 the generic option, known as tirzepatide, will be available.

A generic drug has the same active ingredient as the brand name drug, but is usually more affordable.

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. Criteria can vary, but 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.
• not had success, not eligible or refused treatment using positive airway pressure (PAP) therapy, such as CPAP.

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 to:

• reduce excess body weight and maintain weight reduction long-term in adults with obesity or adults with overweight in the presence of at least one weight-related comorbid (health) condition.
• to treat moderate to severe obstructive sleep apnea (OSA) in adults with obesity.

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) and 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.

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.