Introduction

Zepbound (tirzepatide) is one of the most effective prescription weight loss medications on the market today—but it also comes with a high retail cost of over $1,000 per month in the U.S. That leads many people to ask:

“Is Zepbound covered by insurance?”

In this blog, we’ll break down Zepbound’s insurance status in 2025, what plans are more likely to approve it, and how you can improve your chances of getting it covered.

Is Zepbound FDA-Approved for Weight Loss?

Yes.

Zepbound was FDA-approved in November 2023 for the treatment of obesity or overweight with a weight-related condition.

To qualify:

• BMI ≥30, or
• BMI ≥27 with at least one comorbidity (e.g., hypertension, Type 2 diabetes, sleep apnea)

Learn more: Do You Qualify for Zepbound? How to Find Out

Is Zepbound Covered by Insurance in 2025?

It depends.

Since Zepbound is still relatively new, coverage is expanding, but it’s not yet guaranteed across all insurance plans.

Plan Type	Coverage Likelihood
Employer-Sponsored Plans	Moderate to High (if obesity meds are included)
ACA Marketplace Plans	Varies by state and tier
Medicare / Medicaid	Generally not covered for weight loss
Tricare / VA	Limited, case-by-case

Coverage may require a prior authorization (PA) and proof of medical necessity.

How to Get Zepbound Covered by Insurance

Step 1: Confirm You Meet the Criteria

• BMI ≥30
• Or BMI ≥27 with a documented comorbidity

Step 2: Talk to Your Doctor About Prior Authorization

Most insurers require your doctor to submit:

• Your BMI and diagnosis
• Relevant lab results (blood pressure, A1C, cholesterol)
• A note stating you’ve tried lifestyle changes before medication
• A Letter of Medical Necessity (often required)

Step 3: Be Prepared to Appeal

If denied, you can:

• Submit an appeal with additional documentation
• Ask your provider to resubmit the request
• Contact your HR department or plan administrator for clarification

Visit our Insurance Support Center for PA forms and appeal letter templates.

What If Insurance Won’t Cover It?

If your insurance doesn’t currently cover Zepbound:

• Apply for the Zepbound Savings Card (eligible patients with commercial insurance may pay as little as $25/month)
• Ask your provider if Mounjaro (same active ingredient) is covered for diabetes
• Consider licensed Canadian pharmacies, where Zepbound costs around $450–$500/month

• Explore telehealth membership services that bundle medication + care

Compare prices: Zepbound Cost Breakdown – U.S. vs Canada

Pro Tips to Improve Approval Odds

Keep a record of:

• Your BMI trends
• Comorbidities with supporting labs or diagnoses
• Failed diet, exercise, or program attempts

Ask your doctor to use proper diagnostic codes:

• ICD-10: E66.9 (Obesity, unspecified)
• ICD-10: E66.01 (Morbid obesity due to excess calories)
• ICD-10: E66.2 (Obesity with alveolar hypoventilation)

Final Thoughts

Zepbound is covered by many employer-sponsored and commercial insurance plans in 2025—but access often depends on having the right documentation and being persistent.

You’ll likely need a prior authorization
You may need to appeal a denial
You can still save using manufacturer discounts or international pharmacies

For downloadable guides, savings links, and step-by-step support, visit our Zepbound Insurance Hub.