Zepbound is the brand name for tirzepatide, a prescription weight management medication. FDA approved, this GIP and GLP-1 receptor agonist has shown amazing results in studies with patients losing 5-18% of their body weight in 52 weeks.
While Zepbound is great for people with obesity or overweight conditions, the cost is a big barrier for many patients. How much does Zepbound cost? Cost varies with insurance, and monthly and yearly expenses can be high. Access to affordable weight loss medications like Zepbound is key as it can lead to better health outcomes and long term healthcare savings.
This article show the various costings and potential savings for the injectable medication. We will also highlight some Zepbound alternatives both over the counter and prescription only
Zepbound Pricing
Retail cost without insurance:
One month supply of Zepbound is approximately $1,126 no matter the dosage. This high cost is due to the medication’s newness and effectiveness but is a barrier for many patients.
Insurance scenarios:
Insurance coverage for Zepbound varies. Some plans will cover with a copay, others will require prior authorization or have high out of pocket costs but using insurance benefits can save you big and reduce monthly expense. Check with your insurance provider to see what your coverage is.
Zepbound Savings Card Program
To make Zepbound more affordable, the manufacturer, Eli Lilly, has a savings program:
Explanation of the manufacturer’s savings program: The Zepbound Savings Card program allows eligible patients to get their prescription for as low as $25 a month, with a maximum savings of $150 every 28 days or $1,800 a year.
Eligibility requirements: To be eligible for the program you must:
- Have a commercial drug insurance plan that covers Zepbound
- Have a valid prescription for a 30 or 90 day supply
- Meet other criteria set by the manufacturer
How to get the Zepbound savings card:
You can get the savings card through the Zepbound website or ask your healthcare provider. The card can be used at participating pharmacies to get the discounted price.
Keep in mind that while this program will help many patients save, those without insurance will still have high out of pocket costs. In the next section we’ll discuss more ways to make Zepbound more affordable.
Zepbound for $25 with Insurance
How to Use the Savings Card with Insurance
- Get the Zepbound Savings Card from the website or your healthcare provider.
- Bring both your insurance card and savings card to the pharmacy when you fill your prescription.
- The pharmacist will process your insurance first, then apply the savings card to your out of pocket cost.
- If successful you’ll pay as little as $25 a month.
Insurance Hurdles and How to Get Over Them
Prior Authorization
Many insurers require prior authorization for Zepbound. Work with your healthcare provider to get the paperwork in quickly.
Step Therapy
Some plans may require you to try less expensive options first. Your doctor can appeal this if Zepbound is medically necessary for you.
High Deductibles
If you haven’t met your deductible you’ll have high initial costs. The savings card can help with those costs. Also check your insurance cover zepbound as many health insurance plans don’t currently cover it due to its newness. But coverage is expected to expand in the future and can vary by insurer.
How to Maximize Insurance Coverage
- Know your plan’s formulary and coverage tiers for weight loss medications.
- Switch to a plan with better Zepbound coverage during open enrollment if you can.
- Appeal coverage denials with your healthcare provider’s support.
- Check if your plan has lower copays for 90 day supplies or mail order pharmacies.
Zepbound for $25 without Insurance
Using the Zepbound Savings Card for Uninsured Patients
- The Zepbound Savings Card program requires commercial insurance coverage.
- Uninsured patients may get some discounts:
- Check if Eli Lilly has any patient assistance programs for uninsured patients.
- Some uninsured patients may get a one month supply for around $550 through the savings program, but this varies.
- Patients enrolled in any government funded healthcare program including Medicaid, Medicare, Medicare Part D and Medicare Advantage are not eligible for the savings card.
Other Discount Programs or Pharmacies
- Prescription discount cards like GoodRx, SingleCare or WellRx may have lower prices at certain pharmacies.
- Compare prices at different pharmacies, including online and mail order.
- Check membership programs at big box retail pharmacies which sometimes offer discounts on prescription medications.
Ways to Reduce Zepbound Out of Pocket Costs
- Consider compounded tirzepatide which may be cheaper than brand name Zepbound weight loss medication. Talk to your doctor about this option.
- Ask your doctor about lower cost weight loss medications that might be right for you.
- Check if there are manufacturer sponsored free trial programs or starter kits available.
- See if you qualify for any state or local programs that help with prescription costs.
- Check if you’re eligible for Medicaid or other government assistance programs that cover weight loss medications.
Remember, while these may help reduce costs, always work with your healthcare provider to get safe and effective treatment. Never ration medication or seek out unverified sources to save money. Always talk to your doctor about financial concerns, they may know of other resources or alternatives.
More Cost Saving Strategies
Patient Assistance Programs
Manufacturer Programs
Many pharmaceutical companies including Eli Lilly (Zepbound manufacturer) have patient assistance programs for those who can’t afford their medications.
- Eligibility: These programs have income requirements and are open to both insured and uninsured patients.
- Application process: Submit financial information and a form completed by your healthcare provider.
- Benefits: Free or heavily discounted medication for a certain period.
Non-Profit Organizations
Several non-profit organizations offer assistance for prescription medications:
- NeedyMeds: Database of patient assistance programs and resources.
- Patient Advocate Foundation: Case management and financial assistance for patients with chronic conditions.
- The Assistance Fund: Patient assistance for out of pocket costs for specific medications using Alternative Funding Programs.
Compare Pharmacies
Online Pharmacy Comparison Tools
Use websites and apps that compare prescription prices across pharmacies:
- GoodRx
- SingleCare
- WellRx
These will show big price differences between pharmacies, even in the same area.
Mail-Order Pharmacies
Consider mail order options which may be cheaper:
- Check if your insurance has a preferred mail order pharmacy.
- Some online pharmacies like HealthWarehouse or Blink Health may have competitive pricing.
Warehouse Club Pharmacies
Membership based stores often have lower prices:
- Costco (membership not required for pharmacy use in many states)
- Sam’s Club
- BJ’s Wholesale Club
Talk to Your Doctor About Lower Cost Options
Generic or Biosimilar
Zepbound doesn’t have a generic yet, but talk to your doctor if there are similar lower cost medications.
Alternative GLP-1 Receptor Agonists
Your doctor may prescribe a different medication in the same class of weight loss drugs:
- Semaglutide (Wegovy, Ozempic)
- Liraglutide (Saxenda)
Other Weight Loss Medications
Depending on your health and weight loss goals your doctor may recommend:
- Phentermine
- Orlistat
- Naltrexone-bupropion (Contrave)
Compounded Medications
Talk to your doctor about compounded tirzepatide:
- Pros: Cheaper than brand name Zepbound
- Cons: Not covered by insurance, quality variations
Lifestyle Changes
Your doctor may recommend combining a lower dose of medication with more intense lifestyle changes:
- Personalized diet plans
- Structured exercise programs
- Behavioral therapy
Remember any change in medication should only be done under the guidance of your healthcare provider. They can help weigh the pros and cons of different options based on your individual health and circumstances.
By trying these other cost saving options you may be able to find a more affordable way to get Zepbound or an alternative. Always talk to your healthcare team about financial concerns so you get the care you need and can afford.
The Prescription Process
Your Healthcare Provider
Open Communication
- Talk to your doctor about financial and insurance coverage.
- Ask about sample medications or starter packs to try Zepbound before you commit to a full prescription.
Documentation
- Make sure your provider documents medical necessity for Zepbound in your file.
- Ask for detailed notes on why other treatments won’t work for you.
Follow-up Plan
- Create a clear follow-up schedule to monitor and adjust treatment as needed.
- Regular check-ins will help justify continued use of Zepbound to your insurance.
Prior Authorizations
How it Works
- Prior authorization (PA) requires your doctor to justify to your insurance company before they’ll cover Zepbound.
- This can take a few days to several weeks.
Preparation
- Work with your healthcare provider to get all the necessary documentation ahead of time.
- This may include:
- Medical history
- Previous weight loss attempts
- BMI calculations
- Related health conditions
Follow-up
- Check in with your doctor’s office about the PA status.
- Be prepared to provide more information if asked by your insurance company.
If Coverage is Denied
Your Rights
- You can appeal if coverage is denied.
- Most insurance companies have an appeals process outlined in your policy.
The Appeals Process
- Ask your insurance company for a written explanation of the denial.
- Work with your doctor to write a strong appeal letter.
- Include all medical information and documentation.
- Consider adding personal testimony about why you need Zepbound.
- Submit the appeal within the time frame.
External Review
- If your internal appeal is denied you may have the right to an external review by a third party.
- Your state insurance department can tell you about external review process.
Long-term
Ongoing Medication Costs
Budgeting
- Include Zepbound in your long-term financial planning.
- Consider a Health Savings Account (HSA) or Flexible Spending Account (FSA) if available.
Insurance
- During open enrollment periods review your insurance plans based on Zepbound coverage.
- Consider switching to a plan with better coverage if you can and if financially feasible.
Savings Programs
- Stay informed of changes to manufacturer savings programs.
- Set reminders to renew or reapply for assistance programs as needed.
If Zepbound is Too Expensive
Other Medications
- Talk to your doctor about other weight loss medications that may be more affordable. For instance, check if your insurance covers Zepbound, some insurance companies are adding Zepbound to their formularies.
- Look into older, generic medications that are cheaper.
Lifestyle Interventions
- Work with a dietitian to create a personalized nutrition plan while considering the cost of Zepbound for weight loss medications.
- Look into structured programs or work with a personal trainer.
- Consider behavioral therapy or support groups for weight management.
Bariatric Surgery
- For some bariatric surgery may be a long-term cost effective solution.
- Talk to your doctor if you may be a candidate for surgical interventions.
Summary
How to Get Zepbound Affordably
- Use manufacturer savings programs when available.
- Look into patient assistance programs and non-profits for financial help.
- Compare prices at different pharmacies and consider mail order.
- Work with your healthcare provider to navigate insurance and appeals.
- If Zepbound is too expensive consider other medications or approaches.
Work with Your Healthcare Provider and Insurance Company
- Be open with your healthcare team about your financial situation and treatment goals.
- Don’t be afraid to advocate for yourself with your insurance company and use the appeals process when necessary.
- Remember finding the right and affordable treatment takes time and effort but it’s an investment in your health.
- Stay informed of new developments in weight loss treatments and coverage options, things change over time.
By using these strategies and working with your healthcare team you can increase your chances of getting Zepbound or an alternative that fits your budget. Remember your health is a priority and there are always solutions even when it seems impossible.
FAQs: Zepbound Pricing in the USA
Q1: What is the average retail price of Zepbound in the USA?
A1: The average retail price is approximately $1,126 for a one-month supply, regardless of dosage.
Q2: Does insurance typically cover Zepbound?
A2: Coverage varies by insurer. Many require prior authorization, and some may not cover it at all. Check with your specific insurance provider.
Q3: How can I get Zepbound for $25 a month?
A3: Eligible patients with commercial insurance can use the Zepbound Savings Card program to pay as little as $25 per month, with a maximum annual savings of $1,800.
Q4: Are there options for uninsured patients to save on Zepbound?
A4: Uninsured patients may access discounts through manufacturer assistance programs or prescription discount cards, but costs will likely be higher than for insured patients.
Q5: How does Zepbound’s price compare to other weight loss medications?
A5: Zepbound’s price is similar to other newer GLP-1 receptor agonists for weight loss, but it’s significantly more expensive than older, generic weight loss medications.