Does UnitedHealthcare cover Zepbound? A coverage guide

UnitedHealthcare plans often do not cover Zepbound (tirzepatide) for weight loss, but may cover it when prescribed for obstructive sleep apnea. Below, we explain how to find out whether your specific UnitedHealthcare plan covers Zepbound, and if so, what steps may be required to secure coverage. We also share tips for saving on Zepbound if your plan doesn’t cover it.

UnitedHealthcare’s coverage for Zepbound depends on the details of your plan and what you’re taking Zepbound for: weight loss or obstructive sleep apnea (OSA), a condition where your breathing stops then restarts many times during sleep. In general, Zepbound is less likely to be covered when it’s used for weight loss than when it’s prescribed to treat OSA.

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Does UnitedHealthcare cover Zepbound for weight loss?

Not always. Employers can choose whether to cover Zepbound for weight loss, so coverage varies by plan. When UnitedHealthcare plans do cover Zepbound for weight loss, you must have either:

• A body mass index (BMI) of 30 or higher; or

• A BMI of 27 or higher with a weight-related health condition, such as high cholesterol or high blood pressure

Also, coverage is not instant. Your healthcare provider will need to submit prior authorization before your plan approves (or denies) coverage.

Does UnitedHealthcare cover Zepbound for obstructive sleep apnea? 

Yes, UnitedHealthcare plans may cover Zepbound for obstructive sleep apnea, even if they don't cover it for weight loss. To get coverage, your healthcare provider will need to submit prior authorization showing that you meet certain criteria, including having:

• A BMI of 30 or higher (you can check yours with this BMI calculator)

• A diagnosis of moderate-to-severe OSA confirmed by a sleep study showing at least 15 breathing pauses per hour

• At least one prior unsuccessful attempt to lose weight through diet

• Problems using positive airway pressure (PAP) therapy or symptoms that continue despite using PAP

Yes, UnitedHealthcare typically requires prior authorization for Zepbound, whether you're taking it for weight loss, OSA, or both. You can confirm this by calling the member services number on the back of your insurance card or reviewing your plan's list of covered drugs (also called a drug formulary).

If Zepbound is covered, it will appear on the list. And if prior authorization is required, you’ll see a “PA” next to it. Note that  “prior authorization” is paperwork your provider sends to your insurer on your behalf showing that you meet their coverage criteria for a medication.

Prior authorization for Zepbound for weight loss

If your UnitedHealthcare plan covers Zepbound for weight loss, your prior authorization paperwork must include documentation showing that you have:

• A BMI of 30 or higher, or a BMI of 27 or higher and at least one weight-related health condition (e.g. high cholesterol, high blood pressure, sleep apnea)

• Plans to use Zepbound with other lifestyle changes to lose weight, such as diet, exercise, or weight loss programs

If approved, the initial authorization lasts for six months. At that point, your healthcare provider will need to submit new paperwork showing that you:

• Have lost at least 5% of your body weight since starting Zepbound

• Plan to continue lifestyle changes, such as diet, exercise, or weight loss programs

If approved, this reauthorization lasts for 12 months.

Prior authorization for Zepbound for sleep apnea

If your UnitedHealthcare plan covers Zepbound for sleep apnea, your prior authorization paperwork must show that you have:

• A BMI of 30 or higher

• Moderate-to-severe OSA with an apnea-hypopnea index (AHI) of at least 15 events per hour on either a polysomnogram or home sleep apnea test

• Tried to lose weight through diet at least once before without success

• Tried PAP therapy without success, or are currently using it but still experiencing symptoms of OSA

• Plans to use Zepbound with a reduced-calorie diet and increased physical activity

If approved, the initial authorization lasts for six months. At that point, your healthcare provider will need to submit new paperwork showing that you have:

• Experienced a decrease in your AHI since using Zepbound, based on medical records

• Lost 10% or more of your body weight since starting Zepbound

• Made lifestyle changes, such as diet and exercise

• Still require treatment for OSA

If approved, this reauthorization lasts for six months to one year, depending on how long you have been using Zepbound.

There are several ways to see if your UnitedHealthcare plan covers Zepbound. 

1. Review your plan’s Prescription Drug List (PDL). Also called a drug formulary, this lists all the drugs covered by your plan. View it online by logging into your member portal and searching for Zepbound. If it’s covered, you’ll see the cost tier (higher tiers are more expensive) and whether you need prior authorization (denoted by “PA”).

2. Contact UnitedHealthcare directly. Call the number on the back of your insurance card to speak to a representative about your prescription drug benefits.

3. Use Ro’s free GLP-1 insurance coverage checker. Just fill out the online form with your insurance card details. Ro will contact your plan directly and send you a personalized report explaining your coverage.

The list price for Zepbound is $1,086.37 for four pens (a monthly 28-day supply). How much you pay depends on your pharmacy, insurance coverage, Zepbound dose, and whether you're using the Zepbound pens or KwikPens.

If you're eligible for Eli Lilly's Zepbound Savings Card, you may be able to get Zepbound KwikPens or vials through your local pharmacy from $299–$449 per month. If your UHC plan approves coverage for Zepbound, this savings card may bring your copay down to as little as $25 for the single-dose pens. People with Medicare, Medicaid, and other government-funded insurance plans are not eligible for this offer.

For those without insurance or paying out of pocket, Zepbound KwikPens on Ro may offer a more affordable option. Here's how much they cost when you pay cash on Ro:

• $299 per month: 2.5 mg dose

• $399 per month: 5 mg dose

• $449 per month: 7.5 mg, 10 mg, 12.5 mg, and 15 mg doses (with manufacturer offer)

If UnitedHealthcare won’t cover Zepbound, you’ve got options.

1. Pay out of pocket. You can still get Zepbound without insurance — you'll just pay out of pocket. Without insurance or pharmacy discounts, the pharmacy retail price is $1,086.37 or more.

2. See if your plan covers another weight loss medication instead. Other injectable GLP-1s include Wegovy (semaglutide) or Saxenda (liraglutide). There are also oral GLP-1s like Foundayo (orforglipron) and the Wegovy pill, or weight loss pills like Qsymia (phentermine/topiramate), Contrave (naltrexone/bupropion), and Xenical (orlistat).

3. Switch insurance plans. If your UnitedHealthcare plan won't cover Zepbound or a suitable alternative, switching plans can be another way to get coverage. For ACA Marketplace plans, open enrollment typically begins November 1; check current deadlines, as they can change year to year.

4. See if you have OSA. If you have trouble sleeping at night, you may want to ask your healthcare provider if it’s possible you have sleep apnea. UnitedHealthcare plans can be more likely to cover Zepbound for OSA than weight loss. However, it’s worth noting that a sleep study — either at home or in a lab — will be required for this option.

If you and your provider determine Zepbound is the best fit for you, and your UnitedHealthcare plan won't cover it, there are still ways to save on the medication. These include:

• Cash price: You can get Zepbound KwikPens on Ro for $299–$449 per month, depending on the dose, thanks to Ro's partnership with Eli Lilly.

• Prescription discount cards: Sites like GoodRx, Optum Perks, and BuzzRx offer free coupons for Zepbound. You'll just need to visit the site, look up your pharmacy and Zepbound dosage, and save or print the coupon to show your pharmacist.

• Zepbound Savings Card: With the official manufacturer savings program, you can get the Zepbound vials or KwikPen for $299–$449 per month, depending on the dose, or Zepbound single-dose pens for as low as $25 per fill, if your plan covers it. People with Medicare, Medicaid, and other government-funded insurance plans are not eligible for this offer.

See if you qualify

UnitedHealthcare’s coverage for Zepbound varies by plan and whether you’re taking it for weight loss or obstructive sleep apnea.

• If your plan covers Zepbound, prior authorization is usually required, with documentation showing that you meet certain BMI and diagnosis criteria.

• To check if your UnitedHealthcare plan covers Zepbound, call the number on your insurance card or log in to the member portal.

• Without insurance, Zepbound costs from $300 to over $1,000 per month, depending on the dose.

• If your plan doesn't cover Zepbound, you can pay out of pocket, change insurance plans, or talk to your healthcare provider about using another weight loss medication.

• Savings options for Zepbound include the official manufacturer savings offer, pharmacy coupons, and cash-pay options for the KwikPens or vials.