Zepbound is preferred at: CVS Caremark®*, Express Scripts®*, OptumRx® Premium and Select National Formularies (Tier 2), Cigna®*, and Anthem® Blue Cross & Blue Shield®
Coverage and Savings Support
Complete prior authorization
A helpful guide on how to complete a prior authorization.
Source: Data on File. Lilly USA, LLC. DOF-ZP-US-0017 as of 4/2024, and 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 administrator 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.
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. Other product and company names
mentioned herein are the trademarks of their respective owners.
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 drug 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
(5.) You are 18 years of age or older
Card Terms and Conditions
For patients with commercial drug insurance coverage for Zepbound: You must have commercial drug 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 drug insurance who do not have coverage for Zepbound: You must
have commercial drug insurance that does not cover Zepbound and a prescription consistent with FDA-approved
product labeling to obtain savings of up to $563 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 $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. 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”) (examples
include,
but are not limited to, ImpaxRX, Payer Matrix, SHARx, Script Sourcing, and Paydhealth) 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. No party may 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. 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.
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.
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.