What insurance companies cover Zepbound?

In this article:

• Is Zepbound covered by insurance?
• What insurance companies cover Zepbound?
• Factors that affect Zepbound insurance coverage
• How to check whether your insurance covers Zepbound
• How to save on Zepbound if insurance won’t cover it

In this article

• Is Zepbound covered by insurance?
• What insurance companies cover Zepbound?
• Factors that affect Zepbound insurance coverage
• How to check whether your insurance covers Zepbound
• How to save on Zepbound if insurance won’t cover it

Zepbound is a popular GIP/GLP-1 drug that’s FDA-approved for weight loss and long-term weight management in adults with obesity or who are overweight and have a condition like high blood pressure or high cholesterol. It is also FDA approved to treat adults who have both moderate to severe obstructive sleep apnea (OSA) and obesity. You likely know that injectable weight-loss drugs like Zepbound are expensive: A typical one-month supply costs $1,540 without insurance. Because Zepbound is costly, you’ll want to know whether your insurance covers it before starting treatment.

Is Zepbound covered by insurance?

Zepbound coverage varies by insurer and plan, as well as the reason it’s being used. 

Some people take Zepbound for the FDA-approved use of weight loss and long-term weight management. While some insurance plans cover weight-loss drugs, others do not provide coverage for any type of weight-loss drug. Some plans may cover Zepbound with a prior authorization, requiring your healthcare professional to provide information to your plan as to why you need this medicine. 

Zepbound is also FDA-approved for the treatment of moderate to severe obstructive sleep apnea in obese adults. Insurance plans may cover Zepbound for this use, although individual plans vary, and prior authorization is often required. Coverage can also vary across Medicare and Medicaid plans. Medicare currently does not cover weight-loss drugs, but some Medicare prescription plans may cover Zepbound for OSA. Medicaid plans vary by state.

What insurance companies cover Zepbound?

It’s hard to make definitive statements regarding whether an insurance company will cover Zepbound. Even within the same insurance company, there are various plans, and they may vary in coverage and requirements. Employer-sponsored plans also vary, since each employer sets its own coverage details. The best way to find out if your specific plan covers Zepbound is to check with the plan directly. We’ve done some research to give you an idea of what you may expect from several popular insurance plans. 

It’s worth noting that while Zepbound is FDA approved for weight loss and OSA, it is not approved for Type 2 diabetes. Lilly, the manufacturer of Zepbound, also makes Mounjaro, which contains the same active ingredient (tirzepatide) but is FDA approved for Type 2 diabetes. 

Kaiser

If you have insurance coverage through Kaiser Permanente, coverage depends on your specific region and plan, as well as whether you meet certain criteria. For example, some plans may cover Zepbound for weight loss if you have a body mass index (BMI) of 30 or higher (obesity) or a BMI of 27 or higher (overweight) with a weight-related medical condition. Many plans also require you to try other weight-loss medications first and often require prior authorization. 

Blue Cross Blue Shield

Blue Cross Blue Shield (BCBS) coverage also varies by plan. For weight loss, some plans may not cover Zepbound and other weight-loss drugs like Wegovy (semaglutide) or Saxenda (liraglutide) at all. Others provide coverage for patients who meet certain requirements, such as a BMI of 30 or more, or a BMI of 27 or more along with a weight-related medical condition. Plans that cover Zepbound often require prior authorization. BCBS plans may also cover Zepbound for OSA, but will often still require prior authorization. 

United Healthcare

United Healthcare varies in its Zepbound coverage. Depending on the details of your specific health insurance plan, weight loss may or may not be covered. When a plan does offer Zepbound coverage, whether for weight management or OSA, it will often require prior authorization. 

Aetna

As with other insurance plans, Aetna coverage of Zepbound varies by plan and often requires prior authorization. In addition to BMI requirements, Aetna requires the patient to participate in a weight management program incorporating diet and exercise for at least six months before it will cover Zepbound for weight loss.  

Cigna

Cigna coverage of Zepbound depends on the specific plan. The drug would require prior authorization, although the company announced that for commercial insurance plans, it would cap monthly out-of-pocket costs for Zepbound at $200 and loosen the prior authorization requirements.

RELATED: What insurance plans cover weight loss medication?

Factors that affect Zepbound insurance coverage

There are various factors that affect Zepbound coverage on your specific plan, such as:

• FDA-approved uses: Some plans may cover Zepbound for weight loss or OSA. Others may cover it for OSA, but not for weight loss, even though weight loss is an FDA-approved use. Some insurers do not cover weight-loss medications at all. 
• Prior authorization requirements: Many plans require prior authorization for drugs like Zepbound. Your healthcare provider must submit documentation explaining why the drug is necessary. The plan then decides whether to cover it. Some insurance plans may require that you try another, less expensive weight-loss drug before they will approve Zepbound. This is known as step therapy. Additionally, many plans require documentation that the drug is working in order for them to continue to cover it. 

How to check whether your insurance covers Zepbound

There are several ways to find out whether your plan covers Zepbound:

• Call your plan. You can contact your insurance provider directly by calling the member services phone number on your insurance card. Have your card available, as the representative will ask you for information such as your ID number and group number. Ask the representative whether Zepbound is covered and whether any other requirements are needed, such as prior authorization or other documentation.
• Visit your plan website. Log in to your plan’s website to find out more about Zepbound coverage. You can usually find this information on the formulary, or list of covered drugs and their tiers of payment. However, even if Zepbound is listed on your formulary, it may not be covered for weight loss if your plan excludes weight-loss drugs.
• Check the Zepbound website. You can check the Eli Lilly Zepbound website for more information on how to find out about coverage based on the type of insurance you have, along with other information such as a doctor discussion guide and resources from the Obesity Action Coalition to assist you in getting your medicine covered by insurance.
• Ask the pharmacy. You can ask your healthcare provider to send a prescription to your preferred pharmacy. The pharmacy staff can process your prescription and tell you right away whether Zepbound is covered, requires a prior authorization, or is not covered at all. 

How to save on Zepbound if insurance won’t cover it

What if your insurance does not cover Zepbound, or your out-of-pocket costs after insurance coverage are still high? The good news is that there are other ways to save on Zepbound. 

• SingleCare prescription discount card: SingleCare is a reliable way to save on your prescription drugs every month. You can use the SingleCare discount at over 35,000 pharmacies in the United States and Puerto Rico. What’s more, you can use the discount every month to help pay for your refills, too. Without insurance, a typical one-month supply of Zepbound (four 5 mg pens) costs about $1,540. But with a free SingleCare card or coupon, you can pay as low as $950 for your prescription, saving almost $600 per month. 
• Manufacturer savings cards: Drug manufacturer Lilly offers Zepbound savings cards for people who have commercial insurance plans. If your plan covers Zepbound, you may be able to use a savings card to pay even less for your Zepbound prescription. You can check the website for more information and eligibility requirements. 
• Self-pay: Lilly also offers a self-pay option. For this option, you would receive your medicine through Lilly’s pharmacy, and the medicine comes in vials, rather than pens. The benefit may be a lower cost for those who do not have any coverage, but the downside is that you have to draw up the medicine yourself with a syringe. 

You can also ask your healthcare provider or pharmacist if they know of any local resources in your community to help you save on your Zepbound prescription. As always, consult your healthcare provider for medical advice on your condition and treatment.