Zepbound, which contains the active ingredient tirzepatide, has Food and Drug Administration (FDA) approval for the following:

  • weight management in adults with obesity
  • weight management in adults with overweight who have at least one weight-related condition
  • obstructive sleep apnea (OSA) in adults with obesity

Whether your insurance will cover Zepbound will depend on several factors, including your specific plan and whether you meet certain prescribing criteria.

Insurance coverage for Zepbound depends on several factors:

  • Eligibility criteria: Typically, you’ll need to meet eligibility criteria for insurance to cover medications. To be eligible for Zepbound, you must have obesity — typically a body mass index (BMI) of 30 or higher — or overweight — a BMI of 25 or higher — with at least one weight-related condition. You may also have OSA and obesity. The eligibility criteria may differ based on different plans or insurers.
  • Your specific health plan: You’ll need to look at the details of your plan to see whether Zepbound is covered by insurance. More and more plans are beginning to cover weight loss medications. For example, a 2024 survey found that 33% of health plans and employers were providing coverage for GLP-1 drugs for obesity.
  • Your drug formulary: Your insurance plan will usually have a drug list of covered medications, known as a formulary. You can check your formulary to see if Zepbound is listed.
  • Prior authorization: Your insurance may need prior authorization from your doctor before it covers the drug. This involves the doctor submitting approval that the drug is medically necessary, safe, and cost-effective. It may involve providing proof that other treatments have not worked for your condition.

There are several reasons why your insurer may not cover Zepbound:

  • Formulary exclusions: Many formularies exclude weight loss medications due to their high costs.
  • Not meeting eligibility criteria: If you don’t meet the required BMI criteria or you don’t have a weight-related condition, insurance may not cover the drug.
  • Off-label prescribing: If the doctor is prescribing Zepbound for an indication other than its FDA-approved uses, insurers may be less likely to cover the costs.
  • You haven’t tried step therapy: You may need to try cheaper medications and prove they didn’t work for you before a medication like Zepbound is covered.

To get Zepbound covered by insurance, you can contact your insurer and look at your specific plan. You can check the manufacturer website to see if your insurance covers Zepbound.

You may need to ask your doctor to submit a prior authorization request. You may also need to try step therapy (where you try cheaper treatments to see if they work) before Zepbound will be covered.

If your claim is denied, you can appeal the decision and gather evidence to show that Zepbound is medically necessary for you.

 

One of the cheapest ways to get Zepbound is through manufacturer savings programs. For example, the manufacturer currently offers a savings card where you can get Zepbound for $25 if you have commercial insurance that covers the medication.

If you don’t have insurance or your insurance doesn’t cover Zepbound, you can still use the savings card, instead paying $299 per month for the 2.5 milligram (mg) vials, $399 monthly for the 5 mg vials, or $499 monthly for all other strengths.

The cost of Zepbound with insurance will vary depending on your plan. If you have full coverage, you may not need to pay anything at all. If you have partial coverage or you still need to meet your deductible, you may need to pay more.

If you have insurance that covers Zepbound, the manufacturer savings card may mean you will only pay $25 per month.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.