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You Deserve a Choice in Your Treatment Options.

As a medicine company, we believe patients and healthcare providers should be able to choose the medicine that best fits a person’s health needs—not be limited to just one option because of formulary (or lists of prescription medicines that your health insurance plan agrees to help pay for) decisions.

Text "Rx" to 85099 to receive updates if you were impacted by the CVS Caremark decision. We will continue to update this site as we learn more.

See below for important updates on Zepbound® coverage with CVS Caremark®.

On this page:

What to know

CVS Caremark decision

Effective July 1, 2025, CVS Caremark—the pharmacy benefits management division (or the part of the company that helps manage prescription drug coverage) of CVS Health, stopped covering Zepbound as a preferred obesity management medicine on some insurance plans.

Insurance coverage changes & current prescriptions

If you are affected, there are options available to continue treatment on Zepbound. See below for details on options for moving forward.

CVS Caremark is different than CVS, the retail pharmacy

CVS Caremark manages prescription drug coverage for insurance plans, while CVS Pharmacy is the retail store where you pick up your medicines.

This update is only about insurance coverage and does not apply to CVS Pharmacy stores. You can still fill your Zepbound prescription (for the single-dose pen) at a CVS retail pharmacy.

Options for impacted patients

If impacted, talk with your healthcare provider about your options

If you want to stay on Zepbound with your insurance:

If you and your healthcare provider decide that Zepbound is still the right medicine for you, ask about next steps. Your healthcare provider may be able to submit a prior authorization with a letter of medical necessity to your insurance plan. If your prior authorization is denied, your healthcare provider can submit an appeal.

See below for more information on the appeals process.

Click here to download the appeals guide or letter of medical necessity.

Consider additional options to stay on Zepbound:

If you no longer have coverage, there are other savings options available to help support continued access to treatment:

  1. If you’re looking for Zepbound without going through your health insurance, single dose vials (2.5 mg*, 5 mg, 7.5 mg and 10 mg) are available through LillyDirect Self Pay Pharmacy Solutions. 12.5 mg and 15 mg vials are coming soon. No insurance needed or accepted†‡.
  2. If you have commercial drug insurance but it does not cover Zepbound, you may be eligible to pay as low as $650§ for a 1-month supply of the Zepbound single-dose pen. Terms and Conditions apply.

*2.5 mg is the starting dose and not approved as a maintenance dose.

†Additional taxes, fees, and conditions may apply, including that patients must certify that they have been prescribed the Zepbound vial for an approved use consistent with FDA-approved product labeling.

‡The vial is distributed in a one-month supply, defined as 28 days and 4 vials.

§Estimated payment based on savings of up to $469 per month.

One month is defined as 28 days and up to 4 pens.

Learn more about LillyDirect Self Pay Pharmacy Solutions

How to appeal

If you’ve been impacted by the CVS Caremark coverage decision for Zepbound, we’ve developed resources to help keep you on the medicine that you and your healthcare provider decide works best for you.

You may be able to stay on Zepbound if:

  • Wegovy® (semaglutide) did not work for you or caused side effects.
  • You have moderate to severe obstructive sleep apnea (OSA) with obesity. This is a condition where your breathing starts and stops repeatedly while you sleep.

Talk to your healthcare provider about all your medical conditions to understand your options.

Step 1

Ask your healthcare provider if they will initiate a new prior authorization.

Ask your healthcare provider if it is appropriate to include a letter of medical necessity, which may help the prior authorization get approved.

Step 2

Wait to hear from CVS Caremark (assume 3-4 days).

Step 3

If denied, you or your healthcare provider can initiate an appeal* with additional rationale to support your need for Zepbound.

If your healthcare provider did not submit a letter of medical necessity with the prior authorization, ask your healthcare provider to include this for the appeal (see below).

*If you and your healthcare provider decide Zepbound is right for you, it may require multiple appeal submissions to approve coverage. When talking with CVS Caremark, it's important to know what medical information they need you to submit. This information may help them determine if they can approve coverage for your medicine.

For help with claim denials, try looking up “appeals for GIP + GLP-1” online—you may discover companies offering assistance.

Learn more about navigating the appeals process with your healthcare provider by downloading the guide

Download the Appeals Guide

Letter of Medical Necessity

Use this template to start the conversation with your healthcare provider to stay on Zepbound.
This template is intended for your healthcare provider to complete and submit on your behalf.

Download the template

Frequently Asked Questions

CVS Caremark® is a registered trademark of CVS Pharmacy, Inc.
Wegovy® is a registered trademark of Novo Nordisk A/S.

SAFETY SUMMARY WITH WARNINGS

Warning:

Warnings - Zepbound may cause tumors in the thyroid, including thyroid cancer. Watch for possible symptoms, such as a lump or swelling in the neck, hoarseness, trouble swallowing, or shortness of breath. If you have any of these symptoms, tell your healthcare provider.

  • Do not use Zepbound if you or any of your family have ever had a type of thyroid cancer called medullary thyroid carcinoma (MTC).
  • Do not use Zepbound if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).
  • Do not use Zepbound if you have had a serious allergic reaction to tirzepatide or any of the ingredients in Zepbound.

Zepbound may cause serious side effects, including:

Severe stomach problems. Stomach problems, sometimes severe, have been reported in people who use Zepbound. Tell your healthcare provider if you have stomach problems that are severe or will not go away.

Kidney problems (kidney failure). Diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems. It is important for you to drink fluids to help reduce your chance of dehydration.

Gallbladder problems. Gallbladder problems have happened in some people who use Zepbound. Tell your healthcare provider right away if you get symptoms of gallbladder problems, which may include pain in your upper stomach (abdomen), fever, yellowing of skin or eyes (jaundice), or clay-colored stools.

Inflammation of the pancreas (pancreatitis). Stop using Zepbound and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back.

Serious allergic reactions. Stop using Zepbound and get medical help right away if you have any symptoms of a serious allergic reaction, including swelling of your face, lips, tongue or throat, problems breathing or swallowing, severe rash or itching, fainting or feeling dizzy, or very rapid heartbeat.

Low blood sugar (hypoglycemia). Your risk for getting low blood sugar may be higher if you use Zepbound with medicines that can cause low blood sugar, such as a sulfonylurea or insulin. Signs and symptoms of low blood sugar may include dizziness or light-headedness, sweating, confusion or drowsiness, headache, blurred vision, slurred speech, shakiness, fast heartbeat, anxiety, irritability, mood changes, hunger, weakness or feeling jittery.

Changes in vision in patients with type 2 diabetes. Tell your healthcare provider if you have changes in vision during treatment with Zepbound.

Depression or thoughts of suicide. You should pay attention to changes in your mood, behaviors, feelings or thoughts. Call your healthcare provider right away if you have any mental changes that are new, worse, or worry you.

Food or liquid getting into the lungs during surgery or other procedures that use anesthesia or deep sleepiness (deep sedation). Zepbound may increase the chance of food getting into your lungs during surgery or other procedures. Tell all your healthcare providers that you are taking Zepbound before you are scheduled to have surgery or other procedures.

Common side effects

The most common side effects of Zepbound include nausea, diarrhea, vomiting, constipation, stomach (abdominal) pain, indigestion, injection site reactions, feeling tired, allergic reactions, belching, hair loss, and heartburn. These are not all the possible side effects of Zepbound. Talk to your healthcare provider about any side effect that bothers you or doesn’t go away.

Tell your doctor if you have any side effects. You can report side effects at 1-800-FDA-1088 or www.fda.gov/medwatch.

Before using Zepbound

  • Your healthcare provider should show you how to use Zepbound before you use it for the first time.
  • Tell your healthcare provider if you are taking medicines to treat diabetes including an insulin or sulfonylurea which could increase your risk of low blood sugar. Talk to your healthcare provider about low blood sugar levels and how to manage them.
  • If you take birth control pills by mouth, talk to your healthcare provider before you use Zepbound. Birth control pills may not work as well while using Zepbound. Your healthcare provider may recommend another type of birth control for 4 weeks after you start Zepbound and for 4 weeks after each increase in your dose of Zepbound.

Review these questions with your healthcare provider:

❑ Do you have other medical conditions, including problems with your pancreas or kidneys, or severe problems with your stomach, such as slowed emptying of your stomach (gastroparesis) or problems digesting food?

❑ Do you take diabetes medicines, such as insulin or sulfonylureas?

❑ Do you have a history of diabetic retinopathy?

❑ Are you scheduled to have surgery or other procedures that use anesthesia or deep sleepiness (deep sedation)?

❑ Do you take any other prescription medicines or over-the-counter drugs, vitamins, or herbal supplements?

❑ Are you pregnant, plan to become pregnant, breastfeeding, or plan to breastfeed? Zepbound may harm your unborn baby. Tell your healthcare provider if you become pregnant while using Zepbound. It is not known if Zepbound passes into your breast milk. You should talk with your healthcare provider about the best way to feed your baby while using Zepbound.

  • Pregnancy Exposure Registry: There will be a pregnancy exposure registry for women who have taken Zepbound during pregnancy. The purpose of this registry is to collect information about the health of you and your baby. Talk to your healthcare provider about how you can take part in this registry, or you may contact Lilly at 1-800-LillyRx (1-800-545-5979).

How to take

  • Read the Instructions for Use that come with Zepbound.
  • Use Zepbound exactly as your healthcare provider says.
  • Use Zepbound with a reduced-calorie diet and increased physical activity.
  • Zepbound is injected under the skin (subcutaneously) of your stomach (abdomen), thigh, or upper arm.
  • Use Zepbound 1 time each week, at any time of the day.
  • Change (rotate) your injection site with each weekly injection. Do not use the same site for each injection.
  • If you take too much Zepbound, call your healthcare provider, seek medical advice promptly, or contact a Poison Center expert right away at 1-800-222-1222.

Zepbound injection is approved as a 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, or 15 mg per 0.5 mL in single-dose pen or single-dose vial.

Learn more

Zepbound is a prescription medicine. For more information, call 1-800-LillyRx (1-800-545-5979).

This summary provides basic information about Zepbound but does not include all information known about this medicine. Read the information that comes with your prescription each time your prescription is filled. This information does not take the place of talking with your healthcare provider. Be sure to talk to your healthcare provider about Zepbound and how to take it. Your healthcare provider is the best person to help you decide if Zepbound is right for you.

ZP CON BS 20DEC2024

Zepbound® and its delivery device base are registered trademarks owned or licensed by Eli Lilly and Company, its subsidiaries, or affiliates.

INDICATIONS

Zepbound® (ZEHP-bownd) is an injectable prescription medicine that may help adults with:

  • obesity, or some adults with overweight who also have weight-related medical problems to lose excess body weight and keep the weight off.
  • moderate-to-severe obstructive sleep apnea (OSA) and obesity to improve their OSA.

It should be used with a reduced-calorie diet and increased physical activity.

Zepbound contains tirzepatide and should not be used with other tirzepatide-containing products or any GLP-1 receptor agonist medicines. It is not known if Zepbound is safe and effective for use in children.