How Much Does Zepbound (Tirzepatide) Cost Without Insurance

Among U.S. adults 20 and older, about 4 in 10 have obesity and 9% have severe obesity. Excess weight can lead to a higher risk of many serious health conditions, including hypertension (high blood pressure), Type 2 diabetes, and sleep apnea. That may be why, according to a 2022 Gallup poll, more than half of adults in the U.S. expressed a desire to lose weight between 2017 and 2021.

While some people find success losing weight through diet and exercise alone, others turn to medical interventions such as bariatric surgery and medication. Zepbound (tirzepatide) is a weight-management medication that was approved by the FDA in November 2023.

Interest in medications like Zepbound has rapidly increased in recent years and is expected to continue. In fact, about 15 million adults in the U.S. may be taking weight-loss medication by 2030, according to Goldman Sachs research. But weight-loss medications can be costly and not all health insurance plans will cover them.

What is Zepbound?

Zepbound is a long-term option for managing body weight that was FDA-approved for adult use 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 15 to 25% of their excess body weight (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 is Zepbound without insurance?

The list price for a 28-day supply of Zepbound is $1,060. This means that, without insurance or manufacturer discounts, the medication can cost $13,800 per year. In September 2024, Eli Lilly introduced single-use pens of Zepbound for half the cost and even less. The direct-to-consumer price for a 4-count package of one-dose pens - a 4-week supply - is $399 for 2.5 mg/,05 mL doses and $549 for 5 mg/,05 mL doses. Eli Lilly reported that the 28-day supply cost for Zepbound is lower than the $1,350 list price of competitor Novo Nordisk's weight-loss medication Wegovy (semaglutide).

Does insurance cover Zepbound?

If you have insurance, your health plan may or may not eventually cover Zepbound. Many prescription medication plans do not cover them, but some plans may pay for them with a prior authorization. Zepbound could eventually appear on plan formularies - which can change during a plan year.

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:

• 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.

• Medicare: Medicare Part D plans don't cover weight-loss medications, but there is a recent exception: Wegovy, which was FDA approved in March 2024 to reduce the risk of a life-threatening cardiovascular event in adults who are considered obese or overweight and have a cardiovascular condition. That's why Wegovy is covered under Part D when prescribed to prevent a heart attack, stroke, or other severe cardiovascular condition in a person with overweight or obesity. It's also important to note that some retiree health insurance plans may cover weight-loss medications.

• 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.

• 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.

• Government employee benefits: 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:

• California

• Connecticut

• Delaware

• Hawaii

• Kansas

• Louisiana

• Michigan

• Minnesota

• Mississippi

• New Hampshire

• Pennsylvania

• Rhode Island

• South Carolina

• Texas

• Virginia

• 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 on single-dose pens through the Zepbound savings card program:

• If your plan covers Zepbound, you may be able to get the medication for as low as $25 for a 28-day prescription (one month) or a 84-day prescription (three months).

• If your plan doesn't cover Zepbound, you may be eligible to pay as little as $650 per 28-day prescription - though the new single-use, one-dose pen prices are lower.

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.

If you have to pay out of pocket for Zepbound, GoodRx or a GoodRx Gold membership can help you find the pharmacy near you that offers the lowest price. You may be able to save 17% or more on Zepbound through GoodRx.

Compounded medication

Only certain pharmacies can compound injectable medications such as tirzepatide. Also, beware of counterfeit Zepbound or tirzepatide, particularly any of these medications that you can access without a prescription.

How does Zepbound treat chronic obesity? [How it works]

Zepbound works by setting off certain pathways in the body. The end result is that the body releases more insulin after eating, creates less new sugar and feels fuller longer.

Eli Lilly recommends that people taking Zepbound start with the lowest dosage and work with their healthcare providers to gradually increase it, if needed. People who take Zepbound may find that, over time, their weight loss stops or plateaus.

And people who stop taking weight-loss medications typically regain much, but not all, of the weight they lost. So long-term use of medications like Zepbound is usually recommended.