Does insurance cover tirzepatide for weight loss?

Most insurance plans do NOT cover Zepbound (tirzepatide for weight loss). Medicare explicitly excludes weight loss medications. Some commercial plans cover it with prior authorization, but coverage remains rare. Mounjaro for diabetes has much better coverage.

What's the difference between Mounjaro and Zepbound coverage?

Mounjaro (for type 2 diabetes) is typically covered by most insurance plans with prior authorization. Zepbound (identical drug, approved for weight loss) is rarely covered as most plans exclude weight loss treatments. This is despite both containing the same medication.

How much does tirzepatide cost without insurance?

Without insurance: Mounjaro/Zepbound costs $1,050-$1,200/month retail. With manufacturer savings card (if eligible): can reduce to $25-$550/month. Compounded tirzepatide: $199-$345/month from FDA-registered pharmacies (not covered by insurance).

What are the prior authorization requirements for tirzepatide?

Common requirements include: BMI ≥30 or BMI ≥27 with comorbidities, documented diet/exercise attempts (3-6 months), diabetes diagnosis (for Mounjaro), step therapy (trying other medications first), and detailed medical records. Approval process takes 3-7 business days typically.

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The Short Answer: It Depends (Mostly on Why You're Taking It)

Coverage Quick Reference

Mounjaro (for type 2 diabetes):

Covered by most insurance plans with prior authorization

Zepbound (for weight loss):

Rarely covered; most plans specifically exclude weight loss treatments

Compounded tirzepatide:

Not covered by insurance; cash-pay only ($199-$345/month)

Understanding Mounjaro vs Zepbound Coverage

Tirzepatide is sold under two brand names by Eli Lilly: Mounjaro (approved for type 2 diabetes) and Zepbound (approved for chronic weight management). Same medication, different FDA indication, drastically different insurance coverage.

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Written by Trimi Medical Team

Our team of healthcare professionals specializes in weight management and metabolic health, providing evidence-based information to help you make informed decisions about your health journey.

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