Will My Insurance Cover Zepbound?

Zepbound (tirzepatide) has rapidly emerged as a leading weight loss medication. Its weight loss results are so impressive, that it was fast-tracked for FDA approval for weight loss.

Out-of-pocket costs can add up quickly, so it is important to know what your insurance plan covers, if you have Zepbound insurance coverage, and what expenses you might face.

How much is Zepbound without insurance?

The current list price for Zepbound is $1059.97 for one month (defined as 28 days and 4 pens) according to the manufacturer.

The actual out of pocket costs will depend on your location, pharmacy, and savings eligibility.

Eli Lilly, the manufacturer, does provide savings options for Zepbound. If you have commercial (private) insurance that does not cover Zepbound, you may be able to qualify to pay as low as $650 for a one month supply.

Zepbound cost with insurance

Eli Lilly does not currently offer information on the pricing for specific plans as the medication is still relatively new. But, if your insurance does provide coverage of Zepbound, you may be eligible for the savings card.

You could be eligible to pay as low as $25 for a 1- or 3-month supply of Zepbound.

Will my insurance cover Zepbound?

While it is possible that you have insurance that covers Zepbound, it is unlikely. Zepbound is FDA-approved for weight loss, but many insurance companies opt not to cover weight loss treatments.

You can check with your insurance provider to see if Zepbound is on the list of approved medications. You may be able to do this through your provider’s app/website or you may need to call to speak to a representative.

Why is Zepbound not covered by insurance?

Weight loss medications are still new and insurance providers are not required to cover them. Insurance companies are only required to provide obesity screening and counseling under the Affordable Care Act.

How to get Zepbound covered by insurance

Even if your insurance plan does not provide Zepbound insurance coverage, it may still be possible to get Zepbound coverage.

Can I switch to an insurance that covers Zepbound?

Of course you can. There is no list of insurance providers or plans that include Zepbound insurance coverage. If you review your current plan and find that they do not provide coverage, you can shop around for a new insurance plan that does.

Keep in mind that with employer-provided insurance, you are paying significantly less out-of-pocket than you would for a private plan. So, the costs may not be offset.

Be sure to shop around for different companies and plans that suit all your needs and then call to confirm coverage of Zepbound before making your decision.

Are any Zepbound alternatives covered by insurance?

Zepbound (tirzepatide) alternatives include Mounjaro (tirzepatide), Ozempic (semaglutide), and Wegovy (semaglutide) among others.

Zepbound and Wegovy are both FDA-approved for weight loss. But, that doesn’t guarantee that your insurance company will cover them. Ozempic and Mounjaro are FDA-approved for type 2 diabetes. Most insurance plans will not cover off-label use.

However, if you suffer from type 2 diabetes, you may be able to get Mounjaro (tirzepatide) or Ozempic (semaglutide) coverage if used for diabetes management.

How to get insurance to cover Zepbound

If switching to a plan that provides Zepbound insurance coverage isn’t an option, you may be able to seek Zepbound insurance approval from your current plan. To do this, you will need to review your current plan.

Check your current police to see if Zepbound is listed under the approved medications. You should be able to check through your plan’s app or website. If you are unable to check online, you can call the number on the back of your insurance card for assistance.

They may not provide coverage, but you may be able to get Zepbound insurance approval through:

Prior Authorization. This is a process insurance companies use to determine whether they will cover a specific medication or treatment. It requires a healthcare provider to submit a form detailing the patient’s need to determine if the medication or treatment is medically necessary.
Step Therapy. This is a treatment protocol that requires patients to try less expensive or better established medications before they will approve the newer or more expensive treatment options.

If your request is denied, you do have the option to file an appeal. But make sure that you have additional support documents to argue your case.

Discuss your options with your healthcare provider

Heally makes it easy to connect with knowledgeable weight loss doctors. You can determine if Zepbound is right for you, discuss your options, and tailor a weight loss plan specifically to your needs.