Does Cigna Insurance Cover Zepbound?

If you're wondering whether Cigna insurance covers Zepbound, it's essential to understand the basics first. Cigna is a reputable health insurance provider with a wide range of coverage options.

Cigna offers various health insurance plans, including individual and family plans, as well as group plans for employers. These plans can be customized to fit different needs and budgets.

Cigna's insurance plans often cover a range of medical expenses, including doctor visits, hospital stays, and prescription medications. However, the specifics of coverage can vary depending on the plan and the individual's circumstances.

Cigna insurance coverage for Zepbound may vary depending on the specific health insurance plan. You can review your plan to see if it includes coverage for prescription weight-loss medicines.

To determine if Zepbound is covered by your Cigna plan, you can take the following steps:

The list price for a one-month supply of Zepbound is $1,059.87 without insurance, although you may pay more or less depending on the pharmacy, your location, and whether you qualify for any savings cards or pharmacy discounts.

If Cigna won't cover Zepbound, you can ask your healthcare provider if a Zepbound alternative could be a good fit for you.

Cost considerations for Zepbound can be a concern for many people.

Insurance plans may cover weight-loss medicines like Zepbound, but coverage specifics can vary greatly. You may need to review your insurance plan and discuss options with your healthcare provider to understand what's covered and for how long.

The cost of Zepbound can be over $1,000 for a one-month supply without insurance. If your Cigna plan doesn't cover Zepbound, you can still save on the price of the medication by using the Zepbound Savings Card or pharmacy discounts.

Some insurance plans may cover Zepbound, but prior authorization is usually required. This means you'll need to get approval from your healthcare provider before you can fill your prescription.

Here are some potential savings with the Zepbound Savings Card:

If your Cigna plan doesn't cover Zepbound, you may want to talk to your healthcare provider about alternative weight-loss medications that are covered by your insurance plan. They may also be able to provide information about patient assistance programs or lower-cost medication options.

Cigna's coverage of Zepbound may vary depending on the specific health insurance plan. You can review your plan or contact Cigna directly to determine if Zepbound is covered and to what extent.

Prior authorization is typically required when Cigna does cover Zepbound. This process is mostly handled by your healthcare provider and their staff, but they may ask you a few questions during your appointment to ensure they can complete the paperwork on your behalf.

To get prior authorization, your healthcare provider will need to show that you meet all four of Cigna's requirements, which include being at least 18 years old, having already made lifestyle changes for at least three months, having a BMI of 30 or higher or 27 or higher with a weight-related health condition, and planning to use Zepbound in combination with lifestyle changes.

If you meet these requirements, Cigna may approve your prior authorization for up to eight months. After that time, you'll need to submit prior authorization again and document that you've lost at least 5% of your body weight since starting treatment with Zepbound.

Cigna's policy is to deny coverage for Zepbound if you're already taking a weight loss medication or if you're currently using a GLP-1 medication for managing diabetes, such as Ozempic.

If Cigna won't cover Zepbound, you'll have to pay out-of-pocket for your prescription, which can cost up to $1,059.87 for a one-month supply without insurance.

Here are some alternative weight-loss medications that may be covered by your Cigna plan or have lower out-of-pocket prices:

Your healthcare provider can work with you to determine the most suitable treatment plan within the scope of your insurance coverage.