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Key takeaways
United Healthcare may cover Zepbound, but it will depend on a person’s specific health insurance plan.
If United Healthcare does cover Zepbound, your doctor will likely first need to obtain pre-authorization for insurance coverage.
Zepbound without insurance typically costs around $1,500 for four single-use pens, which is a 28-day supply.
If your United Healthcare plan doesn’t cover Zepbound, there are still ways to save money on the drug. One option is using a prescription discount card from SingleCare.
GIP/GLP-1 agonists, like Zepbound (tirzepatide), are prescription medications that have had a massive surge in popularity over the past years. In fact, one in eight adults has taken a GLP-1 agonist medication at some point, according to the latest data from KFF.
Semaglutide medications, like Ozempic and Wegovy, are probably the best-known GLP-1 drugs on the market. Ozempic was initially developed to help manage Type 2 diabetes, but like Wegovy, Zepbound is FDA-approved as a weight management treatment. Zepbound is also approved to treat obstructive sleep apnea, which is often caused by excess weight.
“Tirzepatide is a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist,” said Dr. Chhaya Makhija, a physician who specializes in diabetes, endocrinology, and metabolism at Unified Endocrine and Diabetes Care in California.
Dr. Makhija explained that Zepbound works in several ways to help patients manage their weight. It increases insulin secretion and reduces glucagon (a hormone that raises blood glucose levels). It also slows the stomach’s emptying and reduces appetite and cravings for most patients.
If you want to test out the Zepbound to reduce your body weight, it’s important to note that getting it covered by your insurance plan can be tricky — especially if it’s for weight loss rather than treating sleep apnea. Zepbound prescription cost coverage will depend on your healthcare provider and the health benefit plan you’re on.
Does United Healthcare cover Zepbound?
Many factors influence insurance coverage of Zepbound, and it can often be highly complicated as every plan is different — even when plans are from the same healthcare provider.
United Healthcare may cover Zepbound in some cases, but it’s difficult to determine if the provider will cover the medication without knowing the details of your specific health plan.
Does United Healthcare cover Zepbound for weight loss?
“Coverage for Zepbound varies depending on the specific United Healthcare (UHC) plan,” said Dr. James Lyons, an M.D. and medical consultant for Synergy Houses. He continued, “Some plans may include Zepbound if prescribed for medical reasons, such as obesity-related health conditions, while others may not cover it for weight loss.”
All that to say, some United Healthcare members may receive coverage for Zepbound, and others may not. The only way to guarantee that you’re covered is to check your health plan’s formulary. Common requirements influence coverage, including the medical reason for taking the medication, prior authorization approval, and which tier the drug falls into.
Reason for prescription
According to United Healthcare, weight loss drugs are part of “an optional program that is put in place for clients or businesses that have elected to cover weight loss products.” This coverage requires prior authorization, and patients must meet regulatory requirements to be approved for it.
While your United Healthcare plan may not cover Zepbound for weight loss, there may be a workaround if you have an obstructive sleep apnea diagnosis. Since Zepbound has been FDA-approved to treat sleep apnea, it’s possible United Healthcare could cover the medication when treating the sleeping disorder, even if they don’t cover it for weight loss.
Prior authorization
If your United Healthcare plan covers the cost-sharing of Zepbound for weight loss, there’s a very high chance it will require preauthorization for approval.
“From my clinical experience, most health insurance plans require pre-authorization to cover Zepbound,” said Dr. Makhija. She added, “In cases where a patient has Type 2 diabetes, and their insurance formulary includes Mounjaro (tirzepatide), pre-authorization may not always be necessary due to its FDA approval for diabetes treatment. However, for Zepbound, most insurers require pre-authorization for obesity treatment.”
To receive approval under prior authorization, patients will need to meet explicit requirements outlined in their specific health benefits plan. These requirements can even be state-specific, so they could vary further depending on where you live.
Requirements for coverage can include a certain body mass index (BMI) threshold, documentation of previous healthy lifestyle changes and weight loss efforts, and weight-related comorbidities. Weight-related comorbidities refer to health conditions caused by obesity, like dyslipidemia, hypertension, Type 2 diabetes, or sleep apnea. You may also need a combination of these factors to be approved.
A healthcare professional would then need to submit these details to United Healthcare to further determine if you’re eligible. If United Healthcare does cover initial weight loss treatment with Zepbound, typically, it is only for the first six months. Patients will need to be reauthorized again for continued treatment, but this time, they’ll typically need to meet a certain amount of weight loss and documented continuance of positive lifestyle changes, like getting regular exercise and eating a healthy diet.
Formulary tier
Another factor for Zepbound approval depends on your healthcare plan’s list of covered drugs, which is called the plan formulary or prescription drug list (sometimes referred to as PDL). Plan formularies outline pharmacy benefits by explaining which drugs are covered and the conditions that must be met.
There are typically different tiers on these lists. The lowest tier usually consists of the most affordable medication options and will likely include generic drugs. On the other end, at the highest tier, you’ll find drugs with the highest costs. Sometimes, health insurance companies will have patients try their preferred drugs, which are typically more affordable drugs on the low tier, before approving the specialty, non-preferred, higher-tier drugs, like Zepbound.
“In many cases, even when patients meet all criteria—BMI, FDA-approved indication, and prior weight loss efforts—insurance companies may still require them to try other weight loss medications (typically oral tablets) before approving Zepbound,” explained Dr. Makhija.
Depending on your plan, it’s possible you may need to try other weight loss medications before United Healthcare approves Zepbound coverage.
How much does Zepbound cost?
If you don’t have insurance coverage for Zepbound, like all GIP/GLP-1 or GLP-1 drugs, it can cost a pretty penny. The exact price of Zepbound will vary depending on where you live and which pharmacy you use, but on average, the cost of Zepbound for 28 days can be in the ballpark of $1,500. This covers the cost of four single-dose injectable pens. If you do that math, that means Zepbound could cost more than $18,000 per year if you end up paying out of pocket.
Even if Zepbound is covered by United Healthcare services, it’s important to note that patients can still expect to pay some out-of-pocket costs (which may or may not be added to your deductible, depending on your plan). A copay, or co-payment, is what the customer is left to pay after the insurance coverage has been deducted. According to United Healthcare, the average copay cost for prescription drugs is between $15 to $60. Since Zepbound is a more expensive drug, the copay would likely be at the higher end.
How to check whether your United Healthcare plan covers Zepbound
Zepbound coverage will be dependent on the guidelines in your specific insurance plan. You can find this information in your plan’s formulary, which will show a breakdown of the plan’s prescription drug coverage for generic and brand-name drugs. If you have a Medicare plan through United Healthcare, you should still be able to find information on your prescription drug benefits on this list.
There can be vast differences between various United Healthcare plans and numerous pharmacy programs and formularies. Specific requirements for coverage and exact drug prices will depend on your plan. If you log into your online account, you should be able to look up drug coverage for your formulary.
If you have trouble finding the information on your account, you can also chat with representatives on the United Healthcare website or call the customer care phone number on the back of your member ID card. Keep your card nearby, as the agent will require your membership ID number and additional details found on the card.
How to save on Zepbound
If insurance doesn’t help cut the price of Zepbound, there are still a few ways to reduce the overall costs. Our top advice would be to check out SingleCare discount savings cards. A SingleCare prescription drug discount card can save you hundreds of dollars on Zepbound. Get your free SingleCare discount card here.
For more ways to save on Zepbound, check out our detailed list of Zepbound savings tips.
- KFF health tracking poll May 2024: The public’s use and views of GLP-1 drugs, KFF.org (2024)
- Glucagon-like peptide-1 receptor agonists, StatPearls (2024)
- Zepbound (tirzepatide) is now available in U.S. pharmacies for adults living with obesity, Lilly USA, LLC (2023)