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Coverage and Savings Support

Zepbound formulary coverage is at parity with Wegovy® (semaglutide) for commercially insured patients*

“Formulary coverage” is defined as Covered or Better formulary access, inclusive of referred and covered statuses, and exclusive of specialty, not covered, or unknown statuses.

"Parity” is defined as a range of +/- 3% Covered or Better formulary access when comparing Zepbound to Wegovy.

The formulary information in this document is for select products that share an approved indication with Zepbound. Inclusion of a product does not establish clinical comparability of the products for any or all indications and should not be seen as making any claim regarding efficacy or safety.

See Additional Formulary Plan Information below.

How Much Does Each Zepbound Option Cost?

The Zepbound pen

(2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg, and 15 mg)1

INSURED

Eligible and commercially insured patients

With Zepbound coverage

pay as low as $25

for a 1-month, 2-month, or 3-month prescriptiona

Governmental beneficiaries excluded, terms and conditions apply.

aOne month is defined as 28 days and 4 pens. Two months are defined as 56 days and up to 8 pens. Three months are defined as 84 days and up to 12 pens.

The Zepbound vial

(2.5 mg)

CASH-PAY

All patients, regardless of insurance, including Medicare, Medicaid, and no insurance

pay $399

for a 1-month prescription. No insurance or savings card accepted.b

Additional taxes and fees may apply.

No prior authorization required, but an on-label ICD-10 code must be selected

bOne month is defined as 28 days and 4 vials.

Vials are exclusively available through LillyDirect Cash Pay Pharmacy Solutions

How to prescribe

The Zepbound vial

(5 mg)

CASH-PAY

All patients, regardless of insurance, including Medicare, Medicaid, and no insurance

pay $549

for a 1-month prescription. No insurance or savings card accepted.b

Additional taxes and fees may apply.

No prior authorization required, but an on-label ICD-10 code must be selected

bOne month is defined as 28 days and 4 vials.

Vials are exclusively available through LillyDirect Cash Pay Pharmacy Solutions

How to prescribe

Share the Zepbound Savings Card with your eligible, commercially insured patients

Visit the patient savings page

Coverage and Support Tools

Explore formulary coverage in your area

  • Connect with an agent through phone support
  • Prior authorization support and resources
  • Benefits verification
  • Savings information

AND

By providing my professional information, I agree that it may be used by Eli Lilly and Company (“Lilly”) and its affiliates and partners or third parties, working on Lilly’s behalf, for Lilly’s marketing or promotional purposes. I may unsubscribe/opt out by clicking the unsubscribe link within any email I receive or by calling 1-800-LILLYRX (1-800-545-5979). Available Mon - Fri, 9am - 8pm ET. For more information about Lilly's privacy practices, please view the Privacy Statement.

Please see additional formulary plan information below

Complete prior authorization

A helpful guide on how to complete a prior authorization.

Download the guide

Composing a Letter of Medical Necessity

Many health plans require a Letter of Medical Necessity to accompany a coverage authorization appeals letter.

Download the guide

Terms and Conditions

By enrolling in the Zepbound Savings Card Program (“Program”) and using the Zepbound Savings Card (“Card”), you attest that you meet the eligibility criteria, and you agree to comply with the terms and conditions described below:

Card Eligibility:

(1.) You have been prescribed Zepbound consistent with FDA approved product labeling;

(2.) You are enrolled in a commercial insurance plan;

(3.) You are not 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;

(4.) You are a resident of the United States or Puerto Rico; and

(5.) You are 18 years of age or older

Card Terms and Conditions

For patients with commercial insurance coverage for Zepbound: You must have commercial insurance that covers Zepbound® (tirzepatide) and a prescription consistent with FDA-approved product labeling to pay as little as $25 for a 1-month, 2-month, or 3-month prescription fill of Zepbound. Month is defined as 28-days and up to 4 pens. 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 $1,800 per calendar year. Card may be used for a maximum of up to 13 prescription fills per calendar year. Participation in the Program requires a valid patient HIPAA authorization. Subject to Lilly USA, LLC’s (“Lilly”) right to terminate, rescind, revoke, or amend Card eligibility criteria and/or Card terms and conditions which may occur at Lilly’s sole discretion, without notice, and for any reason, Card expires and savings end on 12/31/2024.
For patients with commercial insurance who do not have coverage for Zepbound: You must have commercial insurance that does not cover Zepbound and a prescription consistent with FDA-approved product labeling to obtain savings of up to $463 off your 1-month prescription fill of Zepbound. Month is defined as 28-days and up to 4 pens. Card savings are subject to a maximum monthly savings of up to $463 and a separate maximum annual savings of up to $2,315 per calendar year. Card may be used for a maximum of up to 5 prescription fills per calendar year. Participation in the Program requires a valid patient HIPAA authorization. Subject to Lilly’s right to terminate, rescind, revoke, or amend Card eligibility criteria and/or Card terms and conditions which may occur at Lilly’s sole discretion, without notice, and for any reason, Card expires and savings end on 12/31/2024.

Additional Terms and Conditions

If you have an insurance plan that is participating in an alternate funding program (“AFP”) that requires you to apply to the Zepbound Savings Card Program or otherwise pursue specialty drug prescription coverage through an alternate funding vendor as a condition of, requirement for, or prerequisite to coverage of Zepbound, you are not eligible for and are prohibited from using the Zepbound Savings Card Program. AFPs include programs where coverage, reimbursement, or patient out of pocket costs for a product in some way vary based on the availability of a manufacturer co-pay program. AFPs may modify, delay, deny, restrict, or withhold insurance benefits or coverage from patients, or exclude Lilly products from coverage contingent upon a member’s use of Zepbound Savings Card Program. You agree to inform the Zepbound Savings Card Program if you are or become a member of such an alternative funding program. You are responsible for any applicable taxes, fees, and any amount that exceeds the monthly or annual maximum Card savings. Monthly and annual maximum savings are set at Lilly’s sole and absolute discretion and may be changed with or without notice at any time for any reason. At its sole discretion and with or without notice, Lilly may reduce, eliminate, or otherwise modify the Card savings for any reason, including but not limited to if your commercial drug insurance plan imposes additional requirements which limits or prevents you from receiving coverage for Zepbound, only allows partial coverage for Zepbound, removes coverage for Zepbound and requires you to utilize the Card, does not provide a material level of financial assistance for the cost of Zepbound, or does not apply Card payments to satisfy your co-payment, deductible, or coinsurance for Zepbound. Card savings are not valid for: Massachusetts residents if an AB-rated generic equivalent is available; California residents if an FDA-approved therapeutic equivalent is available. You must meet the Card eligibility criteria, terms and conditions every time you use the Card. Card activation is required. You may not seek reimbursement from your health insurance, any third party, or any health savings, flexible spending, or other healthcare reimbursement accounts, for any amount of the savings received through the Card. By utilizing the Card, you agree that if you are required to do so under the terms of your insurance coverage for this prescription or are otherwise required to do so by law, you will notify your Insurance Carrier of your redemption of the Card. Card savings cannot be combined or utilized with any other program, discount, discount card, cash discount card, coupon, incentive, or similar offer involving Zepbound. You agree that this Card savings is intended solely for the benefit of you, the patient, and that the Card benefits are nontransferable. It is prohibited for any person to sell, purchase, or trade; or to offer to sell, purchase, or trade, or to counterfeit the Card.

The Card is not insurance. Lilly has the sole right to interpret and apply Card eligibility criteria, and terms and conditions. Card eligibility, and terms and conditions may be terminated, rescinded, revoked, or amended by Lilly at any time without notice and for any reason. Lilly’s sole discretion to terminate, rescind, revoke, or amend Card eligibility criteria and/or Card terms and conditions includes the right to terminate any individual Card if Lilly determines, in its sole discretion, that a patient does not satisfy the Card’s eligibility criteria or is using or has attempted to use the Card inconsistently with these Terms and Conditions. Eligibility criteria, and terms and conditions for the Zepbound Savings Card Program may change from time to time; the most current version can be found at https://zepbound.lilly.com/coverage-savings. You may be required to obtain a new Card, including if any Card terms and conditions have been terminated, rescinded, revoked, or amended by Lilly. Card void where prohibited by law. Subject to Lilly’s right to terminate, rescind, revoke or amend Card eligibility criteria and/or Card terms and conditions which may occur at Lilly’s sole discretion, without notice, and for any reason, the Card expires and savings end on 12/31/2024.

*Additional Formulary Plan Information

National Commercial Formularies

  • Sources: Data on File. Lilly USA, LLC. DOF-ZP-US-0017 as of 01/2024, and Managed Markets Insight & Technology (MMIT), LLC as of 06/2024. This information is subject to change without notice by a health plan or state. Please contact the plan or state for the most current information.
  • Specific to the anti-obesity market, employers and employer groups may offer additional benefit designs where a patient is further subject to the coverage decisions of their employer.
  • This information is not a guarantee of coverage or payment (partial or full). Actual benefits are determined by each plan in accordance with its respective policy and procedures.
  • This list may not be an exhaustive list of all plans in your area, and the coverage of other plans in your area may vary.
  • Employers and employer groups may also offer additional benefit designs which may be different than described.
  • The company/plan names listed do not imply their endorsement of Lilly USA, LLC, or the product(s) referenced.
  • Lilly USA, LLC, does not endorse any particular plan. The other product and company names mentioned herein are the trademarks of their respective owners.
  • The formulary information in this document is for select products that share an approved indication with Zepbound. Inclusion of a product in this chart does not establish clinical comparability of the products for any or all indications and should not be seen as making any claim regarding efficacy or safety.

Other product/company names mentioned herein are the trademarks of their respective owners.

1. Zepbound. Prescribing Information. Lilly USA, LLC.

Wegovy® is a registered trademark of Novo Nordisk A/S.

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IMPORTANT SAFETY INFORMATION

Warning:

WARNING: RISK OF THYROID C-CELL TUMORS

In rats, tirzepatide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures. It is unknown whether Zepbound causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans as human relevance of tirzepatide-induced rodent thyroid C-cell tumors has not been determined.

Zepbound is contraindicated in patients with a personal or family history of MTC or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk for MTC with the use of Zepbound and inform them of symptoms of thyroid tumors (e.g., a mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with Zepbound.

Contraindications:
Zepbound is contraindicated in patients with a personal or family history of MTC or in patients with MEN 2, and in patients with known serious hypersensitivity to tirzepatide or any of the excipients in Zepbound. Serious hypersensitivity reactions including anaphylaxis and angioedema have been reported with tirzepatide.

Risk of Thyroid C-cell Tumors: Counsel patients regarding the potential risk for MTC with the use of Zepbound and inform them of symptoms of thyroid tumors (e.g., a mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with Zepbound. Such monitoring may increase the risk of unnecessary procedures, due to the low test specificity for serum calcitonin and a high background incidence of thyroid disease. Significantly elevated serum calcitonin values may indicate MTC and patients with MTC usually have calcitonin values >50 ng/L. If serum calcitonin is measured and found to be elevated, the patient should be further evaluated. Patients with thyroid nodules noted on physical examination or neck imaging should also be further evaluated.

Severe Gastrointestinal Disease: Use of Zepbound has been associated with gastrointestinal adverse reactions, sometimes severe. In clinical trials, severe gastrointestinal adverse reactions were reported more frequently among patients receiving Zepbound (5 mg 1.7%, 10 mg 2.5%, 15 mg 3.1%) than placebo (1.0%). Zepbound has not been studied in patients with severe gastrointestinal disease, including severe gastroparesis, and is therefore not recommended in these patients.

Acute Kidney Injury: Use of Zepbound has been associated with acute kidney injury, which can result from dehydration due to gastrointestinal adverse reactions to Zepbound, including nausea, vomiting, and diarrhea. In patients treated with GLP-1 receptor agonists there have been postmarketing reports of acute kidney injury and worsening of chronic renal failure, which may sometimes require hemodialysis. Some of these events have been reported in patients without known underlying renal disease. A majority of the reported events occurred in patients who had experienced nausea, vomiting, diarrhea, or dehydration. Monitor renal function in patients reporting adverse reactions to Zepbound that could lead to volume depletion.

Acute Gallbladder Disease: Treatment with Zepbound and GLP-1 receptor agonists is associated with an increased occurrence of acute gallbladder disease. In clinical trials of Zepbound, cholelithiasis was reported in 1.1% of Zepbound-treated patients and 1.0% of placebo-treated patients, cholecystitis was reported in 0.7% of Zepbound-treated patients and 0.2% of placebo-treated patients, and cholecystectomy was reported in 0.2% of Zepbound-treated patients and no placebo-treated patients. Acute gallbladder events were associated with weight reduction. If cholecystitis is suspected, gallbladder diagnostic studies and appropriate clinical follow-up are indicated.

Acute Pancreatitis: Acute pancreatitis, including fatal and non-fatal hemorrhagic or necrotizing pancreatitis, has been observed in patients treated with GLP-1 receptor agonists or tirzepatide. In clinical trials of tirzepatide for a different indication, 14 events of acute pancreatitis were confirmed by adjudication in 13 tirzepatide-treated patients (0.23 patients per 100 years of exposure) versus 3 events in 3 comparator-treated patients (0.11 patients per 100 years of exposure). In Zepbound clinical trials, 0.2% of Zepbound-treated patients had acute pancreatitis confirmed by adjudication (0.14 patients per 100 years of exposure) versus 0.2% of placebo-treated patients (0.15 patients per 100 years of exposure). Zepbound has not been studied in patients with a prior history of pancreatitis. It is unknown if patients with a history of pancreatitis are at higher risk for development of pancreatitis on Zepbound. Observe patients for signs and symptoms of pancreatitis, including persistent severe abdominal pain sometimes radiating to the back, which may or may not be accompanied by vomiting. If pancreatitis is suspected, discontinue Zepbound and initiate appropriate management. If the diagnosis of pancreatitis is confirmed, Zepbound should not be restarted.

Hypersensitivity Reactions: There have been postmarketing reports of serious hypersensitivity reactions (e.g., anaphylaxis, angioedema) in patients treated with tirzepatide. In Zepbound clinical trials, 0.1% of Zepbound-treated patients had severe hypersensitivity reactions compared to no placebo-treated patients. If hypersensitivity reactions occur, advise patients to promptly seek medical attention and discontinue use of Zepbound. Do not use in patients with a previous serious hypersensitivity reaction to tirzepatide or any of the excipients in Zepbound. Use caution in patients with a history of angioedema or anaphylaxis with a GLP-1 receptor agonist because it is unknown if such patients will be predisposed to these reactions with Zepbound.

Hypoglycemia: Zepbound lowers blood glucose and can cause hypoglycemia. In a trial of patients with type 2 diabetes mellitus and BMI ≥27 kg/m2, hypoglycemia (plasma glucose <54 mg/dL) was reported in 4.2% of Zepbound-treated patients versus 1.3% of placebo-treated patients. In this trial, patients taking Zepbound in combination with an insulin secretagogue (e.g., sulfonylurea) had increased risk of hypoglycemia (10.3%) compared to Zepbound-treated patients not taking a sulfonylurea (2.1%). Hypoglycemia has also been associated with Zepbound and GLP-1 receptor agonists in adults without type 2 diabetes mellitus. There is also increased risk of hypoglycemia in patients treated with tirzepatide in combination with insulin. Inform patients of the risk of hypoglycemia and educate them on the signs and symptoms of hypoglycemia. In patients with diabetes mellitus, monitor blood glucose prior to starting Zepbound and during Zepbound treatment. The risk of hypoglycemia may be lowered by a reduction in the dose of sulfonylurea (or other concomitantly administered insulin secretagogue) or insulin.

Diabetic Retinopathy Complications in Patients with Type 2 Diabetes Mellitus: Rapid improvement in glucose control has been associated with a temporary worsening of diabetic retinopathy. Tirzepatide has not been studied in patients with non-proliferative diabetic retinopathy requiring acute therapy, proliferative diabetic retinopathy, or diabetic macular edema. Patients with a history of diabetic retinopathy should be monitored for progression of diabetic retinopathy.

Suicidal Behavior and Ideation: Suicidal behavior and ideation have been reported in clinical trials with other chronic weight management products. Monitor patients treated with Zepbound for the emergence or worsening of depression, suicidal thoughts or behaviors, and/or any unusual changes in mood or behavior. Discontinue Zepbound in patients who experience suicidal thoughts or behaviors. Avoid Zepbound in patients with a history of suicidal attempts or active suicidal ideation.

Most common adverse reactions: The most common adverse reactions, reported in ≥5% of patients treated with Zepbound are: nausea, diarrhea, vomiting, constipation, abdominal pain, dyspepsia, injection site reactions, fatigue, hypersensitivity reactions, eructation, hair loss, and gastroesophageal reflux disease.

Drug Interactions: Zepbound lowers blood glucose. When initiating Zepbound, consider reducing the dose of concomitantly administered insulin secretagogues (e.g., sulfonylureas) or insulin to reduce the risk of hypoglycemia. Zepbound delays gastric emptying and thereby has the potential to impact the absorption of concomitantly administered oral medications. Caution should be exercised when oral medications are concomitantly administered with Zepbound. Monitor patients on oral medications dependent on threshold concentrations for efficacy and those with a narrow therapeutic index (e.g., warfarin) when concomitantly administered with Zepbound.

Pregnancy: Advise pregnant patients that weight loss is not recommended during pregnancy and to discontinue Zepbound when a pregnancy is recognized. Available data with tirzepatide in pregnant patients are insufficient to evaluate for a drug-related risk of major birth defects, miscarriage, or other adverse maternal or fetal outcomes. Based on animal reproduction studies, there may be risks to the fetus from exposure to tirzepatide during pregnancy. There will be a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to Zepbound (tirzepatide) during pregnancy. Pregnant patients exposed to Zepbound and healthcare providers are encouraged to contact Eli Lilly and Company at 1-800-LillyRx (1-800-545-5979).

Lactation: There are no data on the presence of tirzepatide or its metabolites in animal or human milk, the effects on the breastfed infant, or the effects on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for Zepbound and any potential adverse effects on the breastfed infant from Zepbound or from the underlying maternal condition.

Females and Males of Reproductive Potential: Use of Zepbound may reduce the efficacy of oral hormonal contraceptives due to delayed gastric emptying. This delay is largest after the first dose and diminishes over time. Advise patients using oral hormonal contraceptives to switch to a non-oral contraceptive method or add a barrier method of contraception, for 4 weeks after initiation with Zepbound and for 4 weeks after each dose escalation.

Pediatric Use: The safety and effectiveness of Zepbound have not been established in pediatric patients less than 18 years of age.

Please see accompanying Prescribing Information, including Boxed Warning about possible thyroid tumors, including thyroid cancer, and Medication Guide.

Please see Instructions for Use for pen and Instructions for Use for vial.

ZP HCP ISI 08NOV2023

INDICATION

Zepbound® is indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with an initial body mass index (BMI) of:

  • 30 kg/m2 or greater (obesity) or
  • 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbid condition (e.g., hypertension, dyslipidemia, type 2 diabetes mellitus, obstructive sleep apnea, or cardiovascular disease).

Limitations of Use:

  • Zepbound contains tirzepatide. Coadministration with other tirzepatide-containing products or with any glucagon-like peptide-1 (GLP-1) receptor agonist is not recommended.
  • The safety and efficacy of Zepbound in combination with other products intended for weight management, including prescription drugs, over-the-counter drugs, and herbal preparations, have not been established.
  • Zepbound has not been studied in patients with a history of pancreatitis.