Tirzepatide is a novel weight loss medication, classified as a glucagon-like peptide-1 (GLP-1) receptor agonist, similar to semaglutide. However, high costs have become an obstacle for many people seeking effective weight loss solutions. This article will provide information about coupons, insurance coverage, what tirzepatide is, how it works, and the current state of research.

What is Tirzepatide?

Tirzepatide is a medication developed by Eli Lilly and initially approved for medical use in the United States in May 2022. The U.S. Food and Drug Administration (FDA) approved it for the treatment of diabetes in 2022 and as an adjunct to diet and exercise for chronic weight management in adults with obesity in November 2023.

Like semaglutide, tirzepatide works by mimicking GLP-1 (glucagon-like peptide-1) hormone receptors in the gut, which are responsible for feelings of fullness. However, tirzepatide is a dual-acting medication that also activates GIP (glucose-dependent insulinotropic polypeptide) receptors. This dual-action sets tirzepatide apart from other options and contributes to its increased effectiveness compared to traditional treatments.

Understanding Costs of Tirzepatide Without Insurance

Tirzepatide helps regulate blood sugar and promote weight loss. Without insurance, the branded version of this medication can cost over a thousand dollars per month, with the actual price depending on factors like dosage and where you obtain the medication. Some patients have reported even higher costs. Insurance coverage, drugmaker discount programs, and compounding are crucial for making these medications accessible to more people.

Insurance Coverage: A Complex Landscape

Insurance coverage for these medications is complex, depending on your insurance plan, formulary, and medical necessity. These drugs are often considered higher-tier medications, a label insurance companies use for high-cost medications. Insurance plans have specific criteria for coverage, so meeting them is crucial for affordable access.

Checking Insurance Coverage: Step-by-Step Guide

1. Review Insurance Policy Documents:

Check your insurance policy documents for prescription drug coverage details.

2. Check Formulary Lists:

Review the formulary to find which tier tirzepatide belongs to.

3. Understand Coverage Criteria:

Learn about any requirements for coverage, such as prior authorization or step therapy.

4. Consult Healthcare Providers:

Discuss medication choices with your healthcare provider and ask about their experience with insurance authorization.

5. Contact the Insurance Provider:

Call your insurance provider for precise information about coverage, copayments, and approval steps.

6. Utilize Online Tools:

Explore online tools offered by your insurance provider for drug coverage details.

Coupons and Savings Cards

Also known as drugmaker discount programs, manufacturer-sponsored prescription coupons, or savings cards, coupons are discounts given out by pharmaceutical companies to individuals who qualify for a prescription medication. Eli Lilly offers discounts on branded versions of tirzepatide for qualifying patients with commercial insurance, which you can read in detail here or summarized below.

Eli Lilly

Also known as drugmaker discount programs, manufacturer-sponsored prescription coupons, or savings cards, coupons are discounts given out by pharmaceutical companies to individuals who qualify for a prescription medication. For patients with commercial insurance, Eli Lilly offers discounts on tirzepatide, with various rules and restrictions.

• With insurance - card savings are subject to a maximum monthly savings of up to $150 per 1-month prescription, $300 per 2-month prescription, or $450 per 3-month prescription fill and separate maximum annual savings of up to $1800 per calendar year. Card may be used for a maximum of up to 13 prescription fills per calendar year
• Card savings are not available to patients without commercial drug insurance or who are enrolled in any state, federal, or government funded healthcare program, including, without limitation, Medicaid, Medicare, Medicare Part D, Medicare Advantage, Medigap, DoD, VA, TRICARE®/CHAMPUS, or any state prescription drug assistance program.
• You must have commercial drug insurance that covers the branded version of tirzepatide and a prescription consistent with FDA-approved product labeling
• Without insurance - card savings are subject to a maximum monthly savings of up to $563 and a separate maximum annual savings of up to $7,319 per calendar year. Card may be used for a maximum of up to 13 prescription fills per calendar year.

‍Dosage and How to Use

Doctors prescribe different dosages of tirzepatide depending on the treatment purpose and individual patient needs. A typical starting dose for weight loss is 2.5mg weekly, injected subcutaneously. The branded version of the medication comes in a pre-filled pen for easy injection, but it's important to follow your doctor's instructions closely to achieve the best results.

The Research

Several studies have explored the effectiveness and safety of tirzepatide, primarily the SURMOUNT trials, a series of clinical trials funded by Eli Lilly and used in the FDA approval process. Most of the information on the tirzepatide label came from data collected during these trials.

The SURMOUNT 1 trial involved 2,539 adults with a BMI of 30+ or 27+ with another weight-related complication. Individuals with diabetes were excluded, and participants were treated for 72 weeks at four different doses, including placebo. The trial found that the average person lost 20.9% of their body weight on the highest dose over 72 weeks of treatment. The SURMOUNT 2 trial, which only included diabetic individuals, found that the average person lost 14.7% of their body weight at the highest dose over 72 weeks of treatment.

The most frequently reported side effects were related to the gastrointestinal system, which is consistent with other medications that target the GLP receptor, such as semaglutide. These side effects were mostly mild to moderate in intensity and occurred mainly when the dose was increased. Treatment discontinuation due to adverse events was observed in 4.3%, 7.1%, 6.2%, and 2.6% of participants receiving tirzepatide doses of 5 mg, 10 mg, 15 mg, and placebo, respectively. Overall, between 78.9% and 81.8% of participants treated with tirzepatide reported experiencing at least one adverse event during the treatment period, compared to 72.0% of participants in the placebo group.

Our Solution

At MD Exam, we offer affordable medications using pharmaceutical compounding, providing the same active ingredients as branded versions, namely semaglutide and tirzepatide, at lower costs. We provide the same active ingredients, semaglutide and tirzepatide, for as little as $225 a month. Compounding pharmacies play a crucial role in American healthcare by filling medication supply gaps and creating custom formulations for specialized needs. MD Exam ensures accessibility by delivering effective medication at an affordable price.

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