Do You Qualify for Zepbound? How to Find Out

Do You Qualify for Zepbound? How to Find Out

Introduction

 

Zepbound is one of the most powerful weight loss medications available today—helping people lose up to 22.5% of their body weight. But before starting treatment, it’s important to know:

Do you meet the requirements to get a prescription for Zepbound?

 

In this guide, we’ll explain who qualifies for Zepbound, what medical criteria are needed, and how to improve your chances of insurance approval.

 

What Is Zepbound?

 

Zepbound is a GLP-1/GIP receptor agonist with the active ingredient tirzepatide. It works by:

  • Suppressing appetite
  • Slowing digestion
  • Improving insulin sensitivity

📌 It’s FDA-approved for chronic weight management in adults with obesity or overweight plus a related condition.

 

Learn more: Zepbound for Weight Loss – How It Works

 

Who Qualifies for Zepbound?

 

You likely qualify for Zepbound if:

 

✅ You have a BMI ≥30

→ This qualifies as obesity and meets FDA approval guidelines.

 

✅ Or you have a BMI ≥27 plus one of these conditions:

  • Type 2 diabetes
  • High blood pressure
  • High cholesterol
  • Insulin resistance or prediabetes
  • PCOS
  • Obstructive sleep apnea
  • Cardiovascular risk factors

📌 Use this CDC BMI calculator to check your number.

 

What If You Don’t Know Your Diagnosis?

 

If you’re unsure whether you meet the criteria:

  • Book a full physical exam with your primary care provider
  • Request bloodwork (A1C, glucose, cholesterol, etc.)
  • Ask your provider if you meet the guidelines for “chronic weight management therapy”

 

💡 Even if you don’t meet the criteria yet, you may still qualify later as your health or weight status changes.

 

What Documentation Do You Need?

 

To improve your chances of getting a Zepbound prescription (and insurance coverage), your doctor may need to document:

  • Your current BMI
  • Any weight-related health conditions
  • Past weight loss attempts (diet, exercise, programs)
  • A clear treatment plan combining medication + lifestyle changes

Many insurance plans require a prior authorization—your doctor can help with this process.

 

📌 Learn more: How to Get Wegovy or Zepbound Covered by Insurance

 

Zepbound Eligibility Checklist ✅

 

Requirement

Do You Meet It?

BMI is 30 or higher

☐ Yes ☐ No

BMI is 27–29.9 with a health condition

☐ Yes ☐ No

Have tried to lose weight before

☐ Yes ☐ No

Willing to follow a lifestyle plan

☐ Yes ☐ No

No history of thyroid cancer or MEN-2

☐ Yes ☐ No

What If You Don’t Qualify?

 

If you don’t currently meet the Zepbound criteria:

  • Talk to your doctor about alternatives (e.g., Saxenda, Contrave, Qsymia)
  • Start a medically supervised weight loss program
  • Work on lifestyle changes that may improve your eligibility in future

Some people also choose to pay out-of-pocket through:

  • Licensed telehealth providers
  • Canadian pharmacies
  • Weight loss membership programs with bundled medication access

📌 Check cost options: Zepbound Cost Breakdown – U.S. vs Canada

 

Final Thoughts

 

If you have obesity or are overweight with a related condition, you likely qualify for Zepbound—and it could be a powerful next step in your weight loss journey.

 

✔️ Meet the BMI + health condition criteria
 ✔️ Work with your provider to gather the right documentation
 ✔️ Don’t give up if your first insurance request is denied—appeals are common and often successful

 

📌 To check your eligibility or download a Zepbound qualification worksheet, visit our Zepbound Eligibility Center.