Does Insurance Cover Tirzepatide for Weight Loss?

Tirzepatide is a medication approved by the FDA for weight loss, but insurance coverage can be a hurdle for many people. In many cases, insurance companies may cover tirzepatide for weight loss if it's prescribed for type 2 diabetes.

Insurance coverage for tirzepatide varies depending on the insurance provider and the specific plan. Some insurance companies may cover tirzepatide for weight loss under certain circumstances, such as if the patient has a BMI of 30 or higher.

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Insurance coverage for tirzepatide, also known as Zepbound, can be complex and varies depending on your insurance provider.

Medicare does not currently cover Zepbound, but Congress has proposed bills to expand Medicare coverage to include weight loss drugs.

Medicaid coverage for Zepbound varies by state, so it's essential to check your state's preferred drug list.

Veterans Affairs (VA) may cover Zepbound through the MOVE! Weight Management Program, but you'll need to talk to your VA benefits provider for details.

Related reading: Does My Insurance Cover Zepbound for Weight Loss

TRICARE may also cover Zepbound in certain situations, but prior authorization is required.

Employer-sponsored insurance plans can vary in their coverage of Zepbound, and even if they do offer coverage, the specifics may differ from the standard options offered by the insurance company.

To determine if your insurance covers Zepbound, call the number on the back of your insurance card or talk to your employee benefits coordinator.

If your insurance won't cover Zepbound, there are still options to reduce your out-of-pocket cost.

Here are some alternatives:

The cost of Zepbound with insurance will vary depending on your insurance company and plan, ranging from zero dollars per month with full coverage to higher amounts with partial coverage or deductible requirements.

Individuals with insurance can also benefit from the Zepbound savings card, which offers a 1-month or 3-month prescription for as low as $25.

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The cost of tirzepatide can be overwhelming without insurance. Without insurance, the list price of tirzepatide is $1,059.87 for a one-month supply.

You may be able to find a lower cost at specific pharmacies, but this is not always the case. At Weight Wise in Florida, a one-month supply of tirzepatide starts at $480, which is around ⅓ of the out-of-pocket cost you can expect to pay in a doctor’s office.

The cost of tirzepatide with insurance will vary depending on your insurance company and your specific insurance plan. If your insurance covers tirzepatide, you may only have to pay a copay, which can be as low as $25 with some insurance plans.

If you have commercial insurance, you may be eligible for the tirzepatide Savings Card, which can bring the cost of a 1-month, 2-month, or 3-month supply down to as little as $25. The maximum savings are up to $150 for a 1-month prescription, $300 for a 2-month prescription, and $450 for a 3-month prescription, or up to $1,800 per calendar year.

Here's a comparison of the costs of tirzepatide with and without insurance:

If your insurance won't cover tirzepatide, you still have options for reducing the cost you pay at the pharmacy. You can try using a patient assistance program, a pharmacy discount program, or a savings card, or explore alternative medications that may be covered by your insurance.

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