At Better Your RX, we believe in empowering you with knowledge about your treatment options. Today, we will discuss Zepbound (tirzepatide), a recently approved FDA prescription medication for weight management. We’ll explore the pricing, insurance coverage, available discounts, and useful tips to afford this treatment.
Overview Of Zepbound
According to CDC data, approximately 40% of U.S. adults 20 and older are dealing with obesity, and nearly 9% have severe obesity, which can lead to severe health conditions like hypertension, Type 2 diabetes, and sleep apnea.
Zepbound, a novel weight-management medication from Eli Lilly, was FDA-approved in November 2023. It targets the needs of those struggling with obesity and provides a pharmaceutically supported option for weight management.
What is Zepbound?
Zepbound is an injectable medication that you administer once a week. It’s made up of the same active ingredient as the Type 2 diabetes treatment, Mounjaro—both contain tirzepatide.
Clinical studies have shown that Zepbound helped participants lose an average of 34 lbs to 48 lbs after 165 months (72 weeks). Around a third of people on the maximum dose managed to lose up to 25% or more of their initial body weight.
The Cost of Zepbound
While Zepbound has considerable potential, it comes with a substantial price tag. A 28-day supply of Zepbound has a list price of $1060, making the annual cost $13,800 without any insurance or manufacturer discounts. However, this is approximately 20% less than the price of Novo Nordisk’s weight-loss medication, Wegovy (semaglutide), making Zepbound a more affordable option.
Insurance Coverage for Zepbound
Insurance coverage for Zepbound can be complex and often varies significantly. Many insurers do not cover weight-loss medications due to their high cost, although some may cover Zepbound under particular conditions, such as with prior authorization.
- Medicaid
Coverage of Zepbound under Medicaid depends on the state. If Zepbound isn’t covered by your state’s Medicaid program, it may be possible to submit an appeal through your healthcare provider.
- Medicare
Medicare plans generally don’t cover weight-loss medications. Although, there may be coverage under some retiree health insurance plans.
- Veterans Affairs (VA)
The VA may cover weight-loss medications and management, but it depends on individual benefits and options.
- Tricare
Tricare may cover Zepbound upon a successful coverage review, essentially a prior authorization.
Discounts and Affordability
Eli Lilly offers a savings card program to help manage Zepbound’s high costs.
- For Insured Patients
Patients with insurance that covers Zepbound might be able to get the medication for as low as $25 per prescription through December 31, 2024.
- For Uninsured Patients
Uninsured patients might be eligible to pay $550 per prescription, approximately half the list price.
Unfortunately, those covered by government-sponsored insurance programs, including Medicare and Medicaid, aren’t eligible for this discount scheme.
How Does Zepbound Work?
Zepbound works by triggering the release of insulin in the body, which subsequently slows down the digestion process. This action contributes to a feeling of fullness, helping users to manage their caloric intake and promote weight loss.
Long-term use of medications like Zepbound is often recommended as weight typically returns after cessation of medication.
Bottom Line
Zepbound, a revolutionary weight management medication, proves promising in aiding considerable weight loss. Despite its high cost – around $1060 for 28 days or $13,800 annually – there are ways to navigate these costs depending on your insurance coverage and potential eligibility for manufacturer savings programs.
At Better Your RX, we aim to provide reliable and up-to-date information and support the choices that would lead you to improved health and quality of life. We’re here to accompany you on your journey to wellness. To learn more, get in touch with us today!
