Insurance Coverage

Zepbound: Coupons, Coverage, and Research Explained

Zepbound, a novel weight loss medication developed by Eli Lilly, mimics GLP-1 and GIP hormone receptors, boasting dual-action effectiveness, but its high costs pose accessibility challenges, mitigated through insurance coverage, drugmaker discount programs, and compounding options like those offered by MD Exam.


  • Wednesday, April 24, 2024

Zepbound is a novel weight loss medication, classified as a glucagon-like peptide-1 (GLP-1) receptor agonist, like Ozempic, Wegovy and Mounjaro. However, high costs have become an obstacle for many people seeking effective weight loss. If you read our Zepbound overview here, or our guide to drugmaker discount programs here, some of this information may sound familiar. If not, read on to learn about coupons, insurance coverage, what Zepbound is, how it works, and the current state of research.

What is Zepbound?

Zepbound (tirzepatide) is a medication developed by Eli Lilly and initially approved for medical use in the United states in November of 2023. It was approved by the U.S. Food and Drug Administration (FDA) as an adjunct to diet and exercise for chronic weight management in adults with obesity. Zepbound contains the same active ingredient as Mounjaro, but is approved for treatment of obesity rather than diabetes.

Like other popular medications Ozempic, Wegovy, and Rybelsus, Zepbound works by mimicking GLP-1 (glucagon-like peptide-1) hormone receptors, receptors in the gut responsible for feelings of fullness. Unlike these other medications, however, Zepbound is a dual-acting medication, so it also activates GIP (glucose-dependent insulinotropic polypeptide) receptors. This dual-action is what truly sets Zepbound apart from the competition, and is part of the reason it is so much more effective than traditional options.

Understanding Costs of Zepbound Without Insurance

Zepbound helps regulate blood sugar and promote weight loss. Without insurance, this medication can cost over a thousand dollars per month, but the actual price depends on factors like dosage and where you get the medication. Some patients have had to pay even more! Insurance coverage, drugmaker discount programs and compounding are crucial for making these medications accessible to more people. Though we won't cover compounding in detail in this article, you can read about it in more detail here.

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. If you are wondering if Zepbound is covered by your insurance plan specifically, you can utilize the following steps.

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 Zepbound 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 that qualify for a prescription medication. For patients with commercial insurance, Eli Lilly also offers discounts of $150 per month for Mounjaro and Zepbound, but also offers discounts up to $573 per month for individuals uncovered by insurance. There are various rules and restrictions, which you can read in detail here, summarized below.

Eli Lilly

  • 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 Zepbound®(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

Much like any other medication, when it comes to Zepbound, doctors prescribe different dosages depending on what they’re treating and who they’re treating. Dosages can vary, but a typical starting dose for the purpose of weight loss is 2.5mg weekly, injected under the skin. The medication comes in a pre-filled pen to make it easy to inject, but it’s important to follow your doctor’s instructions closely to get the best results.

The Research

There have been a number of studies exploring the effectiveness and safety of tirzepatide, chiefly the SURMOUNT trials, a series of clinical trials funded by Eli Lilly and used in the approval process of Zepbound by the FDA. Most of the information on the Zepbound label came from data collected during these trials.

The SURMOUNT 1 trial consisted of 2539 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 4 different doses, including placebo. The SURMOUNT 1 trial found the average person lost 20.9% of their bodyweight on the highest dose over 72 weeks of treatment. The SURMOUNT 2 trial, which only included diabetic individuals, found 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 in line with other medications that target the GLP receptor, such as Ozempic and Wegovy. 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. We provide the same active ingredients, semaglutide and tirzepatide, for as little as $300 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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