Zepbound Cost: Coupons, Insurance Coverage and Savings Card.

Zepbound (tirzepatide), the newest weight-loss injection, offers promising results for weight loss and the fight against obesity. But it’s an expensive treatment, and the financial aspect cannot be overlooked.

Whether you plan to get it with insurance or pay out-of-pocket, understanding the costs of Zepbound is important, especially since it’s a long-term treatment you may need for months or even years.

So, let’s break down the specifics:

• How much does Zepbound cost with insurance and without?
• What insurance plans typically cover Zepbound?
• How can you get additional savings through coupons and savings card?

Related article: Zepbound: A Complete Guide About the Newest Weight-Loss Injection!

How Much Does Zepbound Cost Without Insurance?

As long as you have a valid medical prescription for Zepbound, you do not necessarily need a health insurance to get your treatment. You can purchase it on your own and pay out of pocket.

However, be aware that Zepbound is an expensive weight-loss drug, with costs exceeding $1,000 per month if you're not covered by insurance. Yet, Zepbound is on average 20% cheaper than other GLP-1 drugs and obesity medications like Wegovy, Ozempic, or Mounjaro for example. 

But let’s be specific and check out the actual costs of Zepbound without insurance, depending on where you choose to buy it.

Related article: How to Get Zepbound: Prescription, Eligibility, and Coverage Explained!

Zepbound List Price Without Insurance

Eli Lilly, the manufacturer of Zepbound, has set the list price at approximately $1,059.87 for a month's supply. This price covers a package of four pre-filled single-use injection pens, regardless of the dosage.

For you to understand better, the list price of a drug, also referred to as the "sticker price," is the manufacturer's suggested retail price (MSRP) for a medication before any discounts, rebates, or insurance coverage is applied. In other words, it is the price Eli Lilly suggests pharmacies sell Zepbound for to their customers. The list price does not usually reflect what most consumers will pay and often does not include charges related to distribution, dispensing, or taxes.

Besides, the actual amount a patient ends up paying for Zepbound also varies widely depending on insurance coverage, pharmacy markups, discounts, coupons, and patient assistance programs. For instance, you may be able to pay as little as $25 for a 3-month supply of Zepbound with insurance coverage. And even if you don’t have coverage, you may be eligible to Lilly assistance program and pay only 50% of the list price ($550) for a month prescription.

But we’ll talk about that later. First, let’s check out how much Zepbound costs without insurance at different pharmacies.

Related article: Zepbound Dosing Guide: Essential Tips for Sustainable Weight Loss.

Zepbound Cost at The Main Pharmacy Chains

We’ve done our homework and checked it out for you. When purchasing Zepbound from major pharmacies such as CVS, Walgreens, Wegmans, Safeway, Costco, and Rite Aid, on average you will encounter prices ranging from $1,000 to $1,400 for a month supply.

That’s quite a wide range, I know. But a medication retail cost always varies depending on different markups applied by each pharmacy. That’s why it’s always a good idea to compare Zepbound prices across different pharmacies in your area to find the best rate available.

Zepbound Cost at Major Online Pharmacies

Zepbound is also available at online pharmacies with medical prescription.  Platforms like OptumRx and Express Scripts may even have prices competitive to local pharmacy stores.  

Checking the price of Zepbound on these online platforms can sometimes yield savings, especially if they provide specific discounts or promotions, which is often the case.

Zepbound Cost at Lilly Direct

In January 2024, Eli Lilly, the manufacturer of Zepbound, has launched an innovative direct-to-consumer service with their own telehealth and pharmacy service called LillyDirect. You can now purchase Zepbound online directly from its manufacturer at its list price.

You may also be eligible to their own Zepbound assistance program and pay only 50% of the list price ($550) for a month prescription. You can register online and ask your doctor to send your Zepbound prescription directly to LillyDirect. You can also connect with Lilly’s partnering healthcare providers online and get your medical consultation and prescription there (extra fees).

Zepbound cost at Amazon Pharmacy  

Zepbound is now available at Amazon Pharmacy as well, where it costs $1,301.82 for a month supply (one box of four injector pens), with insurance prices available.

We are quite above the $1,059.87 recommended list price, making Amazon Pharmacy definitely not the cheapest option for now.

Related article: How to Use the Zepbound Injector Pen: A Comprehensive Guide.

How Much Does Zepbound Cost with Insurance

Most people looking to get Zepbound will likely do so through their health insurance to cover the high costs. But you should first make sure that Zepbound is covered under your insurance plan. Depending on your policy, you might find that your tirzepatide injections are fully or only partially covered.

Zepbound cost with insurance may sometimes be as low as $25 for a month’s supply. But on average, insured patients can expect to pay anywhere from $25 to $550 per month for Zepbound, largely depending on whether their plan covers the drug and to what extent.

How to Get Approved for Zepbound Coverage

First, it’s important to understand that not all insurances cover for Zepbound and similar GLP-s drugs for weight-loss. It depends on your plan.

Then, getting your health insurance to cover Zepbound cost typically involves a process called prior authorization. This is not always the case, but often.

This process requires your healthcare provider to prove to your insurance company that Zepbound is medically necessary for you. You must be able to present a solid case that includes your medical history, BMI, any weight-related health conditions, and perhaps evidence of past weight loss efforts. Meeting the FDA’s eligibility requirements for Zepbound is a good start, but your insurance may have additional prior authorization criteria. So, make sure to call your insurer first and ask what is required.

Generally, to get Zepbound approved by your insurance, you should follow these steps:

1. Check if your insurance covers Zepbound. If Zepbound is covered, it should be listed in your insurance provider’s formulary, which is essentially their list of approved medications.
2. Ask your healthcare provider to help you gather relevant data on your medical history, including your specific needs regarding weight loss, and any prior treatments you've undergone for example.
3. Have your doctor submit a prior authorization form to your insurance. This document should clearly justify the need for Zepbound in your treatment and include supporting clinical evidence of its efficacy for your specific situation.
4. Stay proactive with follow-ups! Given that the prior authorization process can be lengthy, proactively following up with your insurance company might help speed things along.

What to Do if Your Insurance Denies Coverage

If your health insurance denies your Zepbound coverage, there are still several steps you can take to try and get Zepbound without paying out of pocket.

• Appeal your insurance denial decision. If your prior authorization request for Zepbound is denied, you always have the right to appeal the decision. If you wish to do so, work with your healthcare provider to gather additional supporting information and submit an appeal to your insurance company.

• Check the manufacturer savings program and coupons. Eli Lilly offers a savings card program that can significantly reduce the cost of Zepbound, even for those whose insurance does not cover it. Check the eligibility requirements and apply if you qualify (information below).

• Consider alternative weight-loss treatments. If you don’t qualify for any coverage or assistance and you can’t afford to pay the cost of Zepbound on your own, ask your doctor about alternative GLP-1 drugs or weight loss medications that might be covered by your insurance or more affordable.

Remember, Zepbound is a long-term treatment. You’re probably embarking for months, and even years of medication. So, it’s important to make sure you can sustainably afford this treatment over time. Initiating treatment with Zepbound only to discontinue it after a short period due to financial constraints can undermine its effectiveness. Always plan your finances with the long haul in mind, ensuring you can consistently manage the costs associated with your ongoing treatment.

Related article: How Long Does It Take for Zepbound to Work?

What Insurance Covers Zepbound?

Getting your weight-loss prescriptions like Zepbound, Wegovy, Saxenda, and others covered by insurance isn't always straightforward. Unfortunately, many health insurance companies shy away from covering weight-loss treatments. However, it's not all cut and dried—some plans do offer coverage, and it really comes down to the specifics of your policy. Make sure to touch base with your insurance provider early on. Ask them about what's covered under your plan and any requirements you need to meet to get Zepbound covered.

Related article: How to Store Zepbound? Does it Need to Be Refrigerated?

Do Medicare and Medicaid Cover Zepbound?

As of now, Medicare does not cover weight-loss and obesity medications like Zepbound. However, recent developments in April 2024 suggest there may be some changes soon.

The Centers for Medicare and Medicaid Services (CMS) has indicated that Medicare Part D drug benefits plans might start covering weight-loss drugs for patients with specific health risks.

But for Zepbound to be covered under Medicare, Eli Lilly will need to demonstrate additional benefits in clinical trials. Currently, the manufacturer is conducting studies to prove that Zepbound can reduce morbidity and mortality associated with obesity, with results expected by late 2027. If these studies prove successful, Zepbound may also qualify for Medicare coverage under the new guidelines.

So, stay informed and keep up to date with any changes in Medicare policy that might impact coverage eligibility for Zepbound.

Although Medicare does not currently cover Zepbound, patients enrolled in certain Medicare Advantage plans or Medigap might be covered, as these plans sometimes include additional coverage for medications not typically covered by traditional Medicare.

Does BCBS Cover Zepbound?

Yes, Blue Cross Blue Shield health insurance may cover Zepbound. But coverage can vary depending on your specific BCBS plan. To find out if you're covered, look over your insurance policy or give BCBS a quick call.

For Zepbound coverage under BCBS insurance, adults over 18 who have a BMI of 30 or higher, or a BMI of 27 with related health conditions like diabetes or high blood pressure, are typically eligible. But there's a bit more to it—you'll probably need to go through a prior authorization process.

BCBS usually requires that you have been actively engaged in a lifestyle program with diet and exercise for at least six months before they approve Zepbound coverage.

Related article: Zepbound Diet: What Foods to Eat, What Foods to Avoid?

Does Cigna cover Zepbound?

Yes, Cigna does cover Zepbound too. As of December 1, 2023, Zepbound (tirzepatide) was added to the national preferred formulary for Express Scripts and Cigna Healthcare, meaning it is now included in the list of approved drugs for insurance coverage. However, getting Zepbound covered by Cigna depends on your specific insurance plan.

Cigna may cover the cost of Zepbound for adults when it’s considered medically necessary, and the patient meets the FDA-approval requirements (BMI over 30 or BMI over 27 with related conditions). Besides, the insurance company requires the patient to have actively engaged in a program of behavioral modification and dietary restriction for at least three months prior to coverage. For more information, please consult the Cigna Coverage Policy for Zepbound here.

Does Aetna Cover Zepbound?

Aetna may cover Zepbound, but only under specific insurance plans. Thanks to the company online search tool, you can check if any medication is covered under your purchased health insurance plan.

Does United Healthcare Cover Zepbound?

Last that we heard of, United HealthCare did not cover Zepbound. But Zepbound is still a new drug, and things can change fast. Your key to know whether UHC covers Zepbound lies in understanding Prescription Drug Lists (PDLs). These lists, or formularies, categorize meds into tiers, affecting how much you pay out of pocket. UHC has its own PDL, shedding light on the coverage status and cost of medications like Zepbound.

• Marketplace Plans. Your plan's PDL is your go-to for seeing if Zepbound is covered and what your share of the cost might be.
• Small and Large Group Plans. If your coverage is through an employer's Small or Large Group plan, the specifics of Zepbound coverage will be outlined in your plan's PDL.
• Medicare Plans. For those with Medicare through UHC, check out the Medicare-specific PDL on the UHC Medicare website. This will give you the lowdown on Zepbound tier placement and cost-sharing info.
• Medicaid Plans. Medicaid coverage can vary by state. For the skinny on Zepbound under your Medicaid plan, log into your account on the UHC Community Plan website for all the details.

Does Kaiser cover Zepbound?

According to Kaiser Permanente itself, “Zepbound is covered under the prescription drug benefit for weight loss only for members with coverage for medications used to treat weight loss”.

Zepbound will be covered for the first 4 months under the prescription drug benefit if the following conditions are met:

• The patient's insurance includes coverage for weight-loss medications.
• There is a diagnosis for chronic weight management.
• The patient is 18 years or older.
• Active participation in a diet and exercise program.
• A BMI of over 30 kg/m², or over 27 kg/m² with at least one documented comorbid condition such as hypertension, diabetes, or hyperlipidemia, as indicated in the FDA-approval for Zepbound.
• The patient must have unsuccessfully tried at least two of the specified medications or combinations (phentermine, diethylpropion, phentermine + topiramate, naltrexone + bupropion), or have an allergy, intolerance, or contraindication to them.
• The patient must also have failed to respond to, or cannot use, semaglutide (Ozempic/Wegovy) due to similar reasons.

After the initial 4 months, Kaiser insurance may keep covering Zepbound for additional 12 months if the patient has achieved more than a 5% weight loss within the first 16 weeks from initiation, or maintains more than a 5% weight loss thereafter, with evaluations occurring every 12 months.

Does Anthem Cover Zepbound?

Zepbound is included in the list of weight-loss medications covered by Anthem insurance in their Prior Authorization (PA) Form for Weight -loss Management. You will find all prior authorization criteria on this form that must be filled by your doctor in order to apply for Zepbound coverage.

Does Caremark Insurance Cover Zepbound?

While we haven’t found official information regarding Zepbound coverage by CVS Caremark insurance, insured patients have reported having their prescription covered recently. So, depending on your specific insurance plan, you may get Zepbound coverage by Caremark.

What About Other Insurances?

When it comes to other insurance providers and their coverage of Zepbound, the situation can vary widely. Some insurers may include Zepbound in their coverage, while others may not. It really depends on your specific insurance plan.

Keep in mind though that insurance policies are frequently updated. With Medicare recently hinting at potential future coverage for weight-loss drugs, it's likely that other insurers will revisit their policies as well to cover medications like Zepbound in the future.

Related article: Zepbound, Mounjaro, Wegovy, Ozempic: What’s the Difference?

Zepbound Coupons and Saving Cards: How to Get Zepbound Cheaper Without Insurance

Now, if don’t have a health insurance or you’ve tried it all with your health insurance, but they still deny you coverage for Zepbound, there are still ways you can save on Zepbound and get it cheaper. These include Eli Lilly Savings Card,

Zepbound Savings Card from Eli Lilly

If your health insurance does not cover Zepbound, Eli Lilly, the drug manufacturer has launched a Savings Card program to help you reduce the out-of-pocket cost of your prescription. To be eligible for the Zepbound Savings Card, you must meet the following criteria:

• Have a valid prescription for Zepbound that aligns with the FDA-approved labeling for the drug.
• Be covered under a commercial drug insurance plan. This type of insurance is typically provided by private health insurance companies rather than government-funded programs.
• Not be enrolled in any government-funded healthcare programs, including Medicaid, Medicare (including Part D and Medicare Advantage), Medigap, Department of Defense (DoD) programs, Veterans Affairs (VA), and others.
• Be a resident of the United States or Puerto Rico and at least 18 years old.

Eli Lilly states that “Card savings are subject to a maximum monthly savings of up to $563 and a separate maximum annual savings of up to $7,319 per calendar year”. It means that if you’re approved for Lilly assistance program, you can get Zepbound for about half of its list price. You can check the detailed terms and conditions for Zepbound Savings Care here.

Zepbound Coupons

Drug coupons are often offered by pharmaceutical companies to reduce the patient's out-of-pocket costs for specific medications, including Zepbound.

Coupons are generally obtained online from the pharmacy or from your doctor. But these coupons are usually time-limited, may require renewal, and sometimes cover only a set number of refills.

You can search for Zepbound coupons at GoodRX online, directly from your pharmacy, or ask your doctor about them.

Related article: How Long Does It Take for Zepbound to Work?

What about you? Are you on Zepbound? Do you have insurance coverage, or have you applied for the Savings Card? Please share your experience, comments, and questions below!