Does Cigna cover Zepbound?

Without insurance, Zepbound (tirzepatide) costs just over $1,000 for a one-month supply. So, if you’ve recently been prescribed the medication and you have insurance through Cigna, you may be wondering if the weight loss drug is covered by your plan.

In general, weight loss medications are less likely to be covered by insurance plans, including those offered by Cigna. When they are covered, prior authorization is usually required. Read on as we explain how to find out if your Cigna plan covers Zepbound, how prior authorization works, and ways to save on Zepbound if the medication is not covered. 

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Unfortunately, there’s no straightforward answer to the question, “does Cigna cover Zepbound?” Whether Cigna covers Zepbound can vary from plan to plan. Some Cigna insurance plans specifically exclude Zepbound from prescription drug coverage. Others will cover it, but only after prior authorization from a healthcare provider is received and approved. 

Prior authorization is typically required when Cigna does cover Zepbound. The prior authorization process is mostly handled by your healthcare provider and their staff, but they may ask you a few questions during your appointment to ensure they can complete the paperwork on your behalf. These questions will typically revolve around your previous efforts to lose weight, whether through diet, exercise, or medication. The prior authorization process is required to show that Zepbound is a medically necessary treatment for you.

Note: Submitting prior authorization is not a guarantee of coverage. And while Cigna may deny the request and choose not to cover Zepbound, going through the prior authorization process is your best hope of getting insurance coverage for Zepbound. Your healthcare provider will need to show that you meet all four of Cigna’s requirements for prior authorization, which are listed below:

1. You must be at least 18 years old.

2. You have already been making lifestyle changes, including a reduced-calorie diet, for at least three months prior to starting Zepbound.

3. Before starting Zepbound, your baseline body mass index (BMI) must be either 30 or higher or 27 or higher. If your BMI is 27–30, you must also have a weight-related health condition, such as high blood pressure, high cholesterol, or type 2 diabetes.

4. You plan to use Zepbound in combination with lifestyle changes, such as diet and exercise.

If you meet all of these requirements, Cigna may approve your prior authorization for Zepbound for up to eight months. 

After that time, you’ll need to submit prior authorization again if you want to continue getting prescription drug coverage for Zepbound. Your healthcare provider will need to document that you still meet all four of the aforementioned requirements, plus one new requirement: that you’ve lost at least 5% of your body weight since starting treatment with Zepbound. If you fulfill these criteria, Cigna may approve your prior authorization for Zepbound for up to 12 months.

Cigna’s policy is to deny coverage for Zepbound if you’re already taking a weight loss medication or if you’re currently using a GLP-1 medication for managing diabetes, such as Ozempic.

To check if your Cigna plan covers Zepbound, call your insurance company directly using the number on the back of your insurance card. You can also login to the Member Portal on the Cigna website to view your plan’s documents and drug formulary. The formulary contains a full list of the medications covered by your Cigna plan, along with their associated cost tier or coverage requirements. (If Zepbound is not on this list, it may mean that it is not covered by your plan, but you should still call to make sure.) The cost tier corresponds to your expected copay, and the requirements tell you whether prior authorization is required. Usually, this is denoted by the abbreviation “PA.”

Another way to determine whether your Cigna plan covers Zepbound is by using Ro’s GLP-1 Insurance Coverage Checker. Once you fill out the form with the information on your insurance card, Ro will reach out to your plan to get your unique coverage details and then send you a free, personalized coverage report with an easy-to-understand breakdown of your coverage and estimated costs or copays. 

If Cigna won’t cover Zepbound, you’ll have to pay out-of-pocket for your prescription. The list price for a one-month supply of Zepbound is $1,059.87 without insurance, although you may pay more or less depending on the pharmacy, your location, and whether you qualify for any savings cards or pharmacy discounts.

You can also ask your healthcare provider if a Zepbound alternative could be a good fit for you. Some weight loss medications are more affordable than Zepbound, even if you pay full price, and some may be covered by your plan, which would also make them more economical than Zepbound. For example, some Cigna plans may cover oral appetite suppressants such as Contrave (naltrexone/bupropion), Qsymia (phentermine/topiramate), and Xenical (orlistat)—all of which tend to have lower out-of-pocket prices, too.

If your Cigna healthcare plan doesn’t cover Zepbound, there are still ways you can save on the price of the medication. 

Apply for the Zepbound Savings Card 

Eli Lilly, the maker of Zepbound, offers a Zepbound Savings Card. To qualify for the discount, you must have a commercial insurance plan, such as a Cigna health benefits plan through your employer. People with Medicare, Medicaid, or other state- or federal-sponsored health insurance are not eligible for the offer. If your Cigna plan doesn’t cover Zepbound, you can still reap (some) reward with the Zepbound Savings Card.

For those with Cigna insurance coverage for Zepbound: The Zepbound Savings Card can reduce the cost of a one-, two-, or three-month supply of the medication down to as little as $25. The savings cap is $150 for a one-month supply, $300 for a two-month supply, and $450 for a three-month supply, or up to $1,800 per calendar year. 

For those with commercial insurance but no coverage for Zepbound: The Zepbound Savings Card can reduce the cost of a one-month supply to as little as $25, with savings of up to $463 per month. The savings cap is $150 for a one-month supply, $300 for a two-month supply, and $450 for a three-month supply, or up to $2,315 per year. 

At the time of writing, Eli Lilly does not offer a patient assistance program for Zepbound.

Use a pharmacy discount card

The list price of Zepbound is $1,059.87 per month, but pharmacies can set their own retail price. That means Zepbound can be more or less expensive, depending on the pharmacy from which you purchase the medication. It can be worth calling around to different pharmacies in your area to see which one offers the lowest price on Zepbound. 

You can also use a pharmacy discount card to save even more on Zepbound. Websites such as GoodRx, SingleCare, and Optum Perks aggregate these coupons, which can help you save as much as 25% off the pharmacy’s retail price.

Whether or not Cigna covers Zepbound depends on the details of your specific plan, which you can find out by calling Cigna directly or using a tool such as Ro’s GLP-1 Insurance Coverage Checker. If Zepbound is covered, prior authorization may be required. If it’s not covered, you can still save on Zepbound by using the Zepbound Savings Card, if eligible, or a pharmacy discount card. You can also talk to your healthcare provider about whether another, more affordable weight loss medication could be a good fit for you. 

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

October 17, 2024

Written by

Amelia Willson

Fact checked by

Patricia Weiser, PharmD

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About the medical reviewer

Patricia Weiser, PharmD

Patricia Weiser, PharmD, is a licensed pharmacist, health content writer, and medical reviewer with more than a decade of clinical experience in community and hospital pharmacy.