Is Zepbound covered by insurance?

The US Food & Drug Administration approved Zepbound (tirzepatide) for weight loss in 2023. Since then, the medication has been making waves for its impressive weight loss results—up to 20.9% in a year and a half. 

Due to its popularity, it’s no surprise that many people are asking, “Is Zepbound covered by insurance?” 

If you’re considering taking Zepbound for weight loss, you’re probably wondering how much you’ll have to pay out-of-pocket, and how much you can expect your insurance to cover. Read on as we navigate the current state of insurance coverage for Zepbound.

It depends. Whether your insurance covers Zepbound will depend on your specific insurance plan’s prescription drug benefits. As a newer and fairly expensive weight loss medication, insurance coverage for Zepbound isn’t always guaranteed. Sometimes, it takes insurance companies a bit to catch up and cover new prescription drugs. And sometimes, even when they do cover them, the newer, more expensive drugs (like Zepbound) can have higher out-of-pocket costs.

The best way to know for sure if your insurance covers Zepbound is to contact your insurance company. You can call them using the phone number listed on the back of your insurance card. 

You may also be able to review your plan’s drug formulary on the plan’s website. This lists all of the drugs covered by your plan, along with the drug tier they are in. The drug tier helps you estimate how much you’ll have to pay for Zepbound. Generally, drugs in lower tiers have lower copays and out-of-pocket costs than drugs in higher tiers. 

Again, it depends. Although times are changing, insurance companies have historically been less likely to cover weight loss medications. 

Today, government-funded insurance plans are still unlikely to cover weight loss medications. For example, Medicare does not currently cover Zepbound, although Congress has proposed bills to expand Medicare coverage to include weight loss drugs. Medicaid coverage varies by state, so it is possible your state may offer coverage for Zepbound. Check your state’s preferred drug list to be sure. 

If you have health insurance through the VA (Veterans Affairs), Zepbound may be covered under the MOVE! Weight Management Program. Talk to your VA benefits provider for details. TRICARE may also cover Zepbound in certain situations, although prior authorization is required.

Employer-sponsored insurance plans—such as Aetna, Blue Cross Blue Shield, Cigna, and others—can vary in their coverage of Zepbound. These plans are not required to offer prescription drug coverage, and even if they do, employers may create their own formulary that differs from the standard options offered by the insurance company. To determine if your insurance covers Zepbound, call the number on the back of your insurance card or talk to your employee benefits coordinator.

Typically, insurance plans require prior authorization for Zepbound. Some plans may even have a separate prior authorization form for weight loss medications like Zepbound, as Blue Cross Blue Shield of Massachusetts does for some of its HMO, PPO, and Indemnity plans. This means that your healthcare provider will need to submit a form on your behalf to your insurance company before they will agree to cover the medication. 

“Often, [the insurance company] asks for confirmation that the patient has tried diet and exercise previously or plans to continue lifestyle therapies along with the anti-obesity medication,” shared Dr. Beverly Tchang, MD, an endocrinologist who treats patients with obesity, and an advisor to Ro. “Some prior authorizations will ask for a list of prior anti-obesity medications that have been tried.”

Additionally, your healthcare provider will need to confirm that you meet the eligibility criteria for Zepbound, said Dr. Tchang. For Zepbound, that means that you fall under the FDA-approved indications and uses. The FDA has approved Zepbound for use in combination with diet and exercise in adults with a body mass index (BMI) of:

• 30 or higher (defined as “obesity”); or

• 27 or higher and a weight-related health condition, such as high blood pressure, high cholesterol, type 2 diabetes, obstructive sleep apnea, or heart disease

Prior authorization can be required for medications that are more expensive or aren’t considered “first-line” options. In the case of Zepbound, first-line options might be diet and exercise or other, more affordable medications for weight loss. On the prior authorization form, your healthcare provider will attest that you have tried these other options already and need a more effective treatment for weight management. 

Eli Lilly offers a Prior Authorization Resource Guide for Zepbound on its website to help healthcare providers with this process. 

If you have insurance coverage for Zepbound, the amount you pay for Zepbound will depend on the specific coverage details of your plan, including your deductible and the copay associated with Zepbound’s drug tier. With some insurance plans, you may only have to pay a copay for Zepbound. With others, you may need to meet a deductible first, which means you’ll pay full price for Zepbound until you reach your deductible. To get a better estimate of your total costs for Zepbound, contact your insurance provider. 

If you have commercial insurance (either through your employer or purchased on your own), you may be eligible for the Zepbound Savings Card—even if your plan doesn’t provide specific coverage for Zepbound. Here are the expected costs of Zepbound with the savings card, depending on your insurance coverage:

• For those with coverage for Zepbound: The savings offer can bring the cost of a 1-month, 2-month, or 3-month supply of Zepbound down to as little as $25. The maximum savings are up to $150 for a 1-month prescription, $300 for 2-month prescription, and $450 for a 3-month prescription, or up to $1,800 per calendar year.

• For those without coverage for Zepbound: The Zepbound savings offer can bring the cost of a 1-month supply down to as low as $550. The maximum savings with the card are up to $563 for a 1-month refill, or up to $7,319 per calendar year.

People with government-funded insurance are not eligible for the program. This includes state and federal healthcare plans like Medicaid, Medicare, Medigap, DoD, VA, and TRICARE.

Without insurance, the list price of Zepbound is $1,059.87 for a one-month supply. The list price is set by the manufacturer (in this case, Eli Lilly), and does not take into account any markups or discount programs offered by a pharmacy. 

If your insurance won’t cover Zepbound, you still have options for reducing the cost you pay at the pharmacy. For example:

• Patient Assistance Programs (PAP): Drug manufacturers offer PAPs to provide their medications at low or no cost to people who need financial assistance. Eli Lilly’s Lilly Cares Foundation does not currently include Zepbound as one of its covered medications, but that may change. You can contact The Lilly Answers Center Monday–Friday at 1-800-Lilly-Rx (1-800-545-5979) to see if you qualify for any other financial assistance programs.

• Zepbound Savings Card: As we mentioned above, if you have commercial insurance, you may be eligible for the Zepbound Savings Card, which can significantly reduce the cost of Zepbound for those who qualify.

• Pharmacy discount programs: Websites like Drugs.com, OptumPerks, and GoodRx offer discount cards for individual pharmacies, which may help you save on the cost of Zepbound.

• HSA or FSA funds: If you have a health savings account (HSA) or flexible spending account (FSA), you may be able to use those funds to help pay for Zepbound.

• Zepbound alternatives: Even if your insurance does not cover Zepbound, it may cover an alternative medication for weight loss, such as Wegovy (semaglutide) or Saxenda (liraglutide). 

Zepbound can be expensive, but you have options for reducing your out-of-pocket cost. Talk to your healthcare provider about your options.

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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

July 26, 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.