What insurance covers Zepbound?

What insurance covers Zepbound?

Insurance coverage for Zepbound (tirzepatide) can vary depending on the provider and the specific insurance plan you have. Here are some key points to consider:

1. Commercial Insurance: Many commercial insurance plans may cover Zepbound, but it often requires prior authorization. This means your healthcare provider will need to submit a request to your insurance company detailing why you need the medication. Some plans might also have additional requirements, like step therapy, where you need to try other weight-loss medications first, or quantity limits on how much you can receive over a certain period.
2. Savings Programs: If you have commercial insurance but Zepbound is not covered, you might be eligible for Lilly’s savings card program, which can significantly reduce your out-of-pocket costs. With coverage, you may pay as little as $25 per month. Without coverage, the cost might be around $550 per month.
3. Government Insurance: Medicare typically does not cover anti-obesity medications like Zepbound, though some Medigap and Medicare Advantage plans might in certain cases. The Veterans Affairs (VA) healthcare system may cover Zepbound under its MOVE! program for weight management. TRICARE and Medicaid coverage can vary, so it’s important to check with your specific plan.
4. Formulary Listings: As of December 2023, Zepbound has been added to the national preferred formulary for Express Scripts and Cigna Healthcare, making it more accessible for those insured under these plans.

To confirm whether Zepbound is covered by your insurance, you should:

• Check your insurance plan’s drug formulary.
• Contact your insurance provider directly.
• Discuss with your healthcare provider, who can help navigate the prior authorization process if needed.

Understanding your specific plan’s requirements and utilizing savings programs can help manage the cost and accessibility of Zepbound.