Is Zepbound covered by insurance?

If you’re considering Zepbound® for weight loss, you may have some questions—including how to pay for it. Zepbound costs over $1,000 per month—and most people need their insurance plan to cover it to make it affordable. 

How do you know if your insurance covers Zepbound—and what are your options if it doesn’t? Here, we explore the ins and outs of Zepbound insurance coverage and options for saving money on out-of-pocket expenses.

What is Zepbound, and how does it help people lose weight?

Zepbound is an FDA-approved drug manufactured by Eli Lilly for chronic weight management. It contains tirzepatide, the same active ingredient in Mounjaro® (a type 2 diabetes treatment). 

Zepbound officially got the stamp of approval from the U.S. Food and Drug Administration (FDA) in November 2023, making it the newest treatment for chronic weight management in adults with obesity. Studies show notable weight loss results with this medication: People lost between 15% to 20.9% of their total body weight, on average, in a 72-week, double-blind, randomized, controlled clinical trial with over 2,500 adults with obesity or weight-related complications, depending on the dose taken.

Similar to the active ingredients in other “G meds” (like semaglutide, sold under the brand name Wegovy®), tirzepatide is a synthetic molecule that mimics hormones naturally occuring in your gut. Zepbound works by binding your body’s GLP-1 and GIP hormone receptors, like your natural hormones do. As a result, it increases insulin secretion, slows down digestion, regulates blood sugar levels, and helps to reduce appetite.

Is Zepbound covered by insurance?  

Some insurance plans cover the cost of Zepbound and other weight loss medications; others don’t, and some require prior authorization. 

Unlike private, commercial insurance (such as plans you get through your employer or buy on your own), state or local laws inform what’s covered under insurance programs sponsored by the American government:

• Medicare: The U.S. federal government’s drug coverage program, Medicare Part D, does not currently cover the costs of Zepbound or other weight loss medications (unless indicated for an additional health benefit like lowering the risk of stroke or heart attack).
  
  
• Medicaid: Under Medicaid, states determine whether or not to cover weight loss medications. Each state has a Preferred Drug List (PDL), which shows which drugs are covered. If your state doesn’t cover Zepbound, ask your health care provider about filing an appeal. (As of March 2024, at least 16 states covered one or more weight loss drugs under Medicaid.) 
  
  To see if Zepbound is on your state’s PDL, try the self-guided tool at the bottom of Zepbound’s coverage and savings page, under the drop-down menu labeled “I have insurance through Medicaid.” (Found does not accept Medicaid.) 

How much does Zepbound cost out of pocket?

The list price for Zepbound is $1,059.87 per month.

If your commercial insurance doesn’t cover Zepbound, you might qualify for a reduced rate through a savings card program called the Zepbound Savings Card (think of it like a coupon). With the Zepbound Savings Card, you can get up to $563 off your 1-month prescription fill of Zepbound. The card savings can be used for up to 13 prescription fills over a calendar year, for a maximum savings of up to $7,319 per calendar. This savings program expires on December 31, 2024.

How much does Zepbound cost with insurance?

Costs (including copays and deductibles) vary depending on your insurance plan. Some require prior authorization. 

If you have commercial insurance coverage, you may be eligible to pay a discounted rate of $25 for a one- two-or three-month prescription fill with the Zepbound Savings Card. This Zepbound savings offer runs through the end of 2024, and it can be used to save up to $1,800 per calendar year. If your commercial drug insurance doesn’t cover Zepbound, you may qualify for a reduced rate of $550 for a one-month fill of your prescription.

Will Found help me determine whether my insurance covers Zepbound? 

If your Found provider prescribes Zepbound, Found’s insurance team will fill out a pre-authorization request for your insurance company, which will either approve or deny the prescription. (Prescriptions are up to a medical provider’s discretion.) 

To start your weight journey and get a personalized prescription, take the Found quiz. 

Does using Found impact the cost or coverage of Zepbound?  

Found only prescribes medication. What you pay for Zepbound depends on your insurance coverage and any savings programs you join. If your insurer approves coverage for Zepbound, you may have a copay and/or deductible. Found membership does not cover your copay; that’ll be an out-of-pocket expense. 

What are my options for medical weight loss if my insurance won't cover Zepbound? 

If your insurer doesn’t cover Zepbound, you’ve still got options. Many insurance companies require a process called step therapy. This essentially means they’d like you to try a less expensive medication first. Your Found provider works with a diverse portfolio of medications that are effective for weight loss, and many of them can be used in step therapy. 

What to know about taking Zepbound for weight loss 

How it’s taken: To take Zepbound, you’ll give yourself once-weekly injections under the skin in your upper arm, stomach or upper thigh, with the pre-filled “pen.”

Dose: Clinicians can customize the dose depending on your specific factors, including weight and how well your body tolerates the medication. Typically, patients start with a 2.5 mg weekly dose for the first four weeks, and the health care provider increases the amount over time, up to a maximum of 15 mg.

Side effects: The most common side effects of Zepbound and GLP-1s include constipation, diarrhea, indigestion, nausea, stomach pain, vomiting, gastroesophageal reflux disease, hair loss, fatigue, and injection-site reactions. These reactions may subside over time.

Risks: Though less common, using Zepbound, Mounjaro, or GLP-1s can lead to more serious side effects, including severe stomach problems, kidney failure, serious allergic reactions, hypoglycemia, and depression or thoughts of suicide. Don’t use Zepbound with any other GLP-1 medication. Those with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 should not take Zepbound. Do not take it if you've ever had thyroid cancer. If you are pregnant, breastfeeding, or planning to become pregnant, do not take tirzepatide. Find detailed side effects and risk information for this and other drugs on our dedicated medication page.

The choice to take Zepbound—or any treatment—is highly individual. Talking with a Found-affiliated provider trained in obesity medicine can help you sort through your unique circumstance to determine whether this medication is the best match for you, or if another option would be more suitable.

While tirzepatide is effective for weight loss, it is not clinically appropriate for everyone. Eligibility for these drugs is based on a provider’s evaluation of your medical history, MetabolicPrint™, and lab work. If tirzepatide is not appropriate for you, our providers will work with you to determine an effective medication for your health profile.

About Found

Found is among the largest medically-supported telehealth weight care clinics in the country, having served nearly 250,000 members to date. To discover your MetabolicPrint™ and start your journey with Found, take our quiz.

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