{"id":632471,"date":"2025-06-06T12:06:24","date_gmt":"2025-06-06T16:06:24","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=632471"},"modified":"2026-01-23T15:25:47","modified_gmt":"2026-01-23T20:25:47","slug":"does-kaiser-cover-zepbound","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-kaiser-cover-zepbound\/","title":{"rendered":"Does Kaiser cover Zepbound?"},"content":{"rendered":"<p><a href=\"https:\/\/www.singlecare.com\/prescription\/zepbound\"><span style=\"font-weight: 400;\">Zepbound (tirzepatide)<\/span><\/a><span style=\"font-weight: 400;\"> is a medication approved by the Food and Drug Administration (FDA) to treat obesity and <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/news\/zepbound-sleep-apnea-fda-approval\/\"><span style=\"font-weight: 400;\">obstructive sleep apnea<\/span><\/a><span style=\"font-weight: 400;\"> (OSA) in combination with a reduced-calorie diet and increased exercise. It is known as a GIP\/glucagon-like peptide-1 receptor (GLP-1) agonist and has the same active ingredient as <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/mounjaro\"><span style=\"font-weight: 400;\">Mounjaro<\/span><\/a><span style=\"font-weight: 400;\"> (tirzepatide).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">With Zepbound\u2019s retail prices averaging $1,557 per month, having insurance coverage can help significantly. However, coverage for weight loss drugs is somewhat limited.\u00a0<\/span><\/p>\n<h2 id=\"does-kaiser-permanente-cover-zepbound\"><span style=\"font-weight: 400;\">Does Kaiser Permanente cover Zepbound?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Some Kaiser Permanente insurance plans cover Zepbound for weight loss or OSA. Coverage varies by region, plan, and whether you meet certain criteria. For example, Kaiser Northwest members <\/span><a href=\"https:\/\/healthy.kaiserpermanente.org\/content\/dam\/kporg\/final\/documents\/formularies\/nw\/kp-zepbound-nw-en.pdf\"><span style=\"font-weight: 400;\">may have Zepbound coverage for weight loss<\/span><\/a><span style=\"font-weight: 400;\"> if they:\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Have a diagnosis for chronic weight management<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Are 18 years or older<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Have a body mass index (BMI) greater than or equal to 30 kg\/m2 (classified as obesity) or 27 kg\/m2 (classified as overweight) and have a diagnosis of high blood pressure, diabetes, or high cholesterol<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Are following a diet and exercise program<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Have previously tried at least two drugs such as phentermine, diethylpropion, <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/qsymia\/what-is\"><span style=\"font-weight: 400;\">Qsymia<\/span><\/a><span style=\"font-weight: 400;\"> (phentermine\/topiramate), or <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/contrave\/what-is\"><span style=\"font-weight: 400;\">Contrave<\/span><\/a><span style=\"font-weight: 400;\"> (naltrexone\/bupropion) without success (or cannot take or tolerate other drugs)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Tried semaglutide (Wegovy or Ozempic) and it didn\u2019t work, or they can\u2019t take semaglutide due to an allergy, serious side effects, or contraindication<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">The same Kaiser plan may cover Zepbound for OSA for members who are 18 or older who have obesity and meet all of the following criteria:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Have no personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Have been diagnosed with severe sleep apnea, but does notinclude central or complex apnea<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Have had a sleep study within the three past years<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Are following a diet and exercise program<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Have tried other preferred medications or have allergies to them<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Some Kaiser plans may also require your healthcare provider to submit <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/prior-authorization\/\"><span style=\"font-weight: 400;\">prior authorization<\/span><\/a><span style=\"font-weight: 400;\"> before the drug is covered.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If a Kaiser Permanente member doesn\u2019t have Zepbound on its covered drug formulary, they will have to pay the cash price for the medication or use prescription discount cards or coupons to save.\u00a0<\/span><\/p>\n<h2 id=\"does-kaiser-cover-tirzepatide\"><span style=\"font-weight: 400;\">Does Kaiser cover tirzepatide?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The active ingredient in Zepbound, tirzepatide, is also found in the drug Mounjaro, an FDA-approved drug for Type 2 diabetes. Some Kaiser Permanente plans cover Mounjaro but not Zepbound. For example, Kaiser Permanente Insurance Company (KPIC) plans in California <\/span><a href=\"https:\/\/healthy.kaiserpermanente.org\/content\/dam\/kporg\/final\/documents\/formularies\/ca\/kaiser-permanente-insurance-company-pos-formulary-ca-en.pdf\"><span style=\"font-weight: 400;\">may cover Mounjaro<\/span><\/a><span style=\"font-weight: 400;\"> for managing diabetes.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Due to cost, limited insurance coverage, and previous drug shortages, some people may consider <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/zepbound-vs-compounded-tirzepatide\/\"><span style=\"font-weight: 400;\">compounded tirzepatide<\/span><\/a><span style=\"font-weight: 400;\"> as an alternative to Zepbound. <\/span><a href=\"https:\/\/www.joinflyte.com\/about\"><span style=\"font-weight: 400;\">Katherine Saunders<\/span><\/a><span style=\"font-weight: 400;\">, MD, co-founder of FlyteHealth and obesity medicine specialist at Weill Cornell Medicine in New York City, explains, \u201cThe lack of coverage, high cost, and drug shortages are tremendous barriers to tirzepatide access right now, so many patients ask about compounded medications.\u201d However, that doesn\u2019t mean it is safe or even legal.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Compounded tirzepatide is made by compounding pharmacies rather than a pharmaceutical company. Unlike Zepbound and Mounjaro, it is not FDA approved and is unlikely to be covered by insurance. The FDA previously allowed compounded tirzepatide to be made due to a national shortage, but <\/span><a href=\"https:\/\/www.fda.gov\/drugs\/drug-safety-and-availability\/fda-clarifies-policies-compounders-national-glp-1-supply-begins-stabilize\"><span style=\"font-weight: 400;\">that shortage has been resolved<\/span><\/a><span style=\"font-weight: 400;\">, and pharmacies and outsourcing facilities are no longer allowed to compound, distribute, or dispense compounded GLP-1 medications, including tirzepatide.<\/span><\/p>\n<h2 id=\"how-much-does-zepbound-cost\"><span style=\"font-weight: 400;\">How much does Zepbound cost?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Zepbound\u2019s list price from its manufacturer, Lilly, is <\/span><a href=\"https:\/\/pricinginfo.lilly.com\/zepbound\"><span style=\"font-weight: 400;\">$1,086.37 per month<\/span><\/a><span style=\"font-weight: 400;\">, but most people don\u2019t pay the list price. Instead, they pay the average retail price, which fluctuates and varies by pharmacy and location. Without insurance, the average retail price of Zepbound is $1,559 per 4, 0.5 mL of 2.5 mg\/0.5 mL single-dose injector pens, which is a 28-day supply.\u00a0<\/span><\/p>\n<h2 id=\"how-much-does-zepbound-cost-with-kaiser\"><span style=\"font-weight: 400;\">How much does Zepbound cost with Kaiser?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The cost of Zepbound with Kaiser Permanente varies by insurance plan, but can be as low as $25. Kaiser insurance plans have <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/what-is-a-formulary\/\"><span style=\"font-weight: 400;\">formularies<\/span><\/a><span style=\"font-weight: 400;\"> that list covered drugs and categories of coverage from Tier 1 to specialty medication. For example, Zepbound can <\/span><a href=\"https:\/\/healthplans.kaiserpermanente.org\/federal-employees-fehb\/tools-resources\/prescription-drug-cost-lookup\/\"><span style=\"font-weight: 400;\">cost $45 to $65 per month<\/span><\/a><span style=\"font-weight: 400;\"> with certain Kaiser Permanente Federal Employee Health Benefits (FEHB) plans.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">According to Lilly, the manufacturer of Zepbound, someone with a commercial drug insurance plan that covers Zepbound may pay as low as $25 for a one- or three-month supply of Zepbound. You can check the manufacturer&#8217;s website for more information and eligibility requirements.<\/span><\/p>\n<p><strong>RELATED: <a href=\"https:\/\/www.singlecare.com\/blog\/does-aetna-cover-zepbound\/\">Does Aetna cover Zepbound?<\/a><\/strong><\/p>\n<h2 id=\"how-to-check-whether-your-kaiser-plan-covers-zepbound\"><span style=\"font-weight: 400;\">How to check whether your Kaiser plan covers Zepbound\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Kaiser plans may provide a formulary so members can see whether their drugs are covered. Kaiser\u2019s website organizes its <\/span><a href=\"https:\/\/healthy.kaiserpermanente.org\/health-wellness\/drug-formulary\"><span style=\"font-weight: 400;\">covered drug lists by region and plan<\/span><\/a><span style=\"font-weight: 400;\">. You can also log in to your Kaiser Permanente portal online or contact customer service to check whether your Kaiser plan covers Zepbound.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If your insurance plan doesn\u2019t cover a drug, that doesn\u2019t mean that you can\u2019t receive care. \u201cNot having insurance coverage for GLP-1 medications does not mean that an individual can\u2019t receive extremely effective and sustainable medical obesity care,\u201d Dr. Saunders states. Your healthcare professional can provide all the treatment options that are best for you.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Learn more about <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/zepbound-alternatives\/\"><span style=\"font-weight: 400;\">Zepbound alternatives<\/span><\/a><span style=\"font-weight: 400;\"> for weight loss.\u00a0<\/span><\/p>\n<h2 id=\"how-to-save-on-zepbound\"><span style=\"font-weight: 400;\">How to save on Zepbound<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">There are <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/zepbound-savings\/\"><span style=\"font-weight: 400;\">ways to save on Zepbound<\/span><\/a><span style=\"font-weight: 400;\"> even if your Kaiser plan doesn\u2019t cover it. SingleCare offers <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/zepbound#coupons-prices\"><span style=\"font-weight: 400;\">prescription discounts on Zepbound<\/span><\/a><span style=\"font-weight: 400;\"> at participating pharmacies using its free <\/span><a href=\"https:\/\/www.singlecare.com\/prescription-discount-card\"><span style=\"font-weight: 400;\">Prescription Discount Card<\/span><\/a><span style=\"font-weight: 400;\">. With SingleCare, you can pay as low as $937 for 4, 2.5 mg\/0.5 mL single-dose injector pens. That\u2019s $622 less than you\u2019d pay without a SingleCare coupon.\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Zepbound (tirzepatide) is a medication approved by the Food and Drug Administration (FDA) to treat obesity and obstructive sleep apnea (OSA) in combination with a reduced-calorie diet and increased exercise. It is known as a GIP\/glucagon-like peptide-1 receptor (GLP-1) agonist and has the same active ingredient as Mounjaro (tirzepatide).\u00a0 With Zepbound\u2019s retail prices averaging $1,557 [&hellip;]<\/p>\n","protected":false},"author":149,"featured_media":632474,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[21067,608,9825],"coauthors":[21072],"class_list":["post-632471","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-glp-1-drugs","tag-health-insurance","tag-weight-loss","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Does Kaiser cover Zepbound?<\/title>\n<meta name=\"description\" content=\"Some Kaiser plans cover Zepbound, but coverage varies by plan and may depend on the reason you\u2019re taking it. 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