Zepbound coverage varies by insurance plan; prior authorization is often required, and costs depend on formulary placement and plan specifics.
Zepbound is an FDA-approved injectable medication for weight management, approved in late 2023 for adults with BMI of 30+ or 27+ with health conditions like diabetes or high blood pressure. It works as a dual agonist mimicking GLP-1 and GIP hormones, helping control blood sugar, suppress appetite, and promote weight loss. Originally approved as Mounjaro for diabetes, tirzepatide's success in clinical trials led to its approval for weight loss. Participants in trials lost up to 20.9% of their body weight over 72 weeks. Zepbound is intended for those with medically diagnosed obesity or related health issues, not for cosmetic weight loss due to potential serious side effects.
The retail price for Zepbound without insurance ranges from approximately $373.61 to $1143.42 per month, depending on dosage and pharmacy. Eli Lilly offers a self-pay program via LillyDirect® Self Pay Pharmacy Solutions, reducing costs for uninsured patients. Additional savings are available through platforms like GoodRx, SingleCare, and WellRx. No generic version of Zepbound exists currently.
Coverage depends on your insurance provider and plan. Many insurers have not yet added Zepbound to their formulary, requiring prior authorization for approval. If your plan covers it, Zepbound is often placed in formulary Tier 3, which influences your copay. Contact your insurer or benefits department to confirm coverage status and required steps.
If covered, your out-of-pocket costs depend on your plan's formulary tier, copay, and deductible. Most insurers likely place Zepbound in Tier 3, with typical copays varying accordingly. You may pay only your copay if your plan does not require meeting a deductible, or pay full price until deductible is met. Verify with your insurer for exact costs.
Insurance coverage varies by type: federal marketplace plans may cover Zepbound if included in the formulary; employer plans depend on the specific plan; government insurance programs like Medicaid generally do not cover Zepbound, though exceptions exist such as VA or TRICARE with prior authorization. Check your plan’s formulary and speak with your benefits coordinator.
For uninsured patients, Eli Lilly’s self-pay program offers Zepbound at reduced rates: approximately $349/month for lower doses and $499/month for higher doses. Additional savings may be available through prescription discount platforms like GoodRx, SingleCare, and WellRx. Compounded tirzepatide from pharmacies can cost as little as $350, but consult your healthcare provider before use.
No generic version of Zepbound is available yet. However, compounded tirzepatide may be a less expensive alternative, created by compounding pharmacies using pharmaceutical-grade ingredients. It may be suitable for patients seeking cost savings or with allergies, but it lacks FDA approval and safety data comparable to Zepbound. Always discuss with your healthcare provider before considering compounded options.
Creating a personalized weight management plan is easy with Klarity. Our platform connects you with licensed healthcare professionals specializing in chronic weight management. They can evaluate whether Zepbound or alternative medications are appropriate for your needs. Appointments are generally available within 24 hours. Book your consultation today at helloklarity.com.
To qualify for insurance coverage, you may need a prior authorization, which your healthcare provider can initiate by submitting necessary documentation. Contact your insurer or benefits coordinator for specific details. For patients on government plans, coverage for Zepbound is unlikely, and they may need to pay retail prices or select alternative treatments.
For those paying out-of-pocket, Eli Lilly’s self-pay options and discount programs can significantly reduce costs. Always consult your healthcare provider regarding compounded tirzepatide or alternative weight-loss medications. Remember, this information is for educational purposes and not medical advice.
Medical Disclaimer: This content is for informational purposes only and does not substitute professional medical advice. Always consult a qualified healthcare provider for diagnosis and treatment decisions.
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