What is Zepbound?
Zepbound injection is a new, long-term option for managing body weight that was approved by the FDA in late 2023. It’s a once-weekly, injectable medication that has the same active ingredient as the Type 2 diabetes treatment Mounjaro (tirzepatide).
In a clinical study supported by Eli Lilly and published in 2022, Zepbound helped participants lose an average of 34 lbs to 48 lbs after 72 weeks (16.5 months). About a third of people taking the highest dose lost up to 25% of their initial body weight, or more than 58 lbs.
Is Zepbound similar to Mounjaro?
As mentioned, both Zepbound and Mounjaro, which is also produced by Eli Lilly, contain tirzepatide. However, Mounjaro was approved by the FDA in 2022 to treat Type 2 diabetes, while Zepbound is approved for weight loss.
How much does Zepbound Injection cost?
The list price for a 28-day supply of Zepbound is $1,060. That means that, without insurance or manufacturer discounts, the medication can cost $13,800 per year.
Although significant, this cost is approximately 20% less than the $1,350 list price of Novo Nordisk’s weight-loss medication Wegovy (semaglutide), according to Eli Lilly.
But the cost per month is only part of the story. AÂ value analysis published in early 2023Â found that the estimated cost to treat a 1% reduction in body weight with tirzepatide was $985, versus $1,845 with semaglutide. The analysis was based on GoodRx prices from October 2022, before tirzepatide was approved for weight loss under the brand name Zepbound.
Does insurance cover Zepbound Injection?
If you have insurance, your health plan may or may not eventually cover Zepbound. Because of the high cost of some weight-loss medications, many prescription medication plans do not cover them. Though, some plans may pay for them with a prior authorization. Zepbound could eventually appear on plan formularies.
According to Eli Lilly, here’s how Zepbound may be covered by various types of insurance plans in the months following FDA approval for weight loss:
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Medicaid: Medicaid coverage for Zepbound varies by location. Use the Eli Lilly directory at the bottom of this page to find the preferred medication list for your state’s Medicaid program to find out about coverage. If your state’s Medicaid program doesn’t cover Zepbound, you can talk to your healthcare provider about submitting an appeal.
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Medicare: Medicare plans don’t cover weight-loss medications. Some retiree health insurance plans may cover them, however.
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U.S. Department of Veterans Affairs (VA): VA health care may cover weight-loss medications and management. You should talk to your provider about your benefits options if you have coverage through the VA.
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Tricare: Tricare insurance plans may cover Zepbound. But your provider may need to submit a coverage review, which is like a prior authorization. You can talk to your provider or military treatment facility about your options.
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Government employee benefits:Â Coverage for Zepbound varies based on the city, state, local municipality, or federal department you work for.
While most Medicaid programs don’t cover weight-loss medications, there are 16 states where at least one was covered as of July 1, 2023:
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California
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Connecticut
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Delaware
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Hawaii
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Kansas
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Louisiana
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Michigan
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Minnesota
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Mississippi
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New Hampshire
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Pennsylvania
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Rhode Island
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South Carolina
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Texas
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Virginia
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Wisconsin
In November 2023, the American Medical Association (AMA) called on insurance companies to cover weight-loss medications without exclusions. The AMA, which represents physicians and medical students, holds the position that insurance coverage shouldn’t be a barrier to treatment for a major health concern that should be addressed within the patient-physician relationship.
How can I get Zepbound at an affordable price?
If you have commercial insurance, you may qualify for a discount through the Zepbound savings card program:
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If your plan covers Zepbound, you may be able to get the medication for as low as $25 per prescription through December 31, 2024.
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If your plan doesn’t cover Zepbound, you may be eligible to pay $550 per prescription, which is about half the list price.
As mentioned earlier, people covered by government-sponsored insurance, including Medicare and Medicaid, are not eligible for the discount program.
At the time of publication, Zepbound has not been added to the Lilly Cares Foundation Patient Assistance Program, which provides certain medications free of cost to qualifying people.
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