Does Insurance Cover Tirzepatide for Weight Loss, and How Much Does It Cost Out of Pocket?

If you’re considering Tirzepatide (Zepbound) for weight loss, two big questions probably top your list: Will your insurance plan cover the cost, and if not, how much will you pay out of pocket? For many people, cost is a make-or-break factor when choosing a long-term weight management treatment—so getting clear answers is key.

First, let’s tackle insurance coverage. The good news is that most major insurance plans now cover Tirzepatide for weight loss—but only if you meet specific criteria. Typically, insurers require you to have a BMI of 30 or higher (or 27 or higher with weight-related conditions like high blood pressure or type 2 diabetes). You may also need to show you’ve tried “first-line” weight-loss methods first, such as a supervised diet or exercise program, without long-term success. To confirm coverage, call your insurance provider’s customer service line (found on your insurance card) and ask: “Does my plan cover Tirzepatide (Zepbound) for chronic weight management, and what are the eligibility requirements?”

If you’re eligible, your out-of-pocket cost will depend on your plan’s structure—like your deductible, copay, or coinsurance. On average, insured patients pay between \(50 and \)200 per month for Tirzepatide. Some manufacturers also offer savings cards: For example, Eli Lilly (the maker of Zepbound) has a program that can reduce monthly costs to as low as $25 for eligible patients with commercial insurance.

What if you don’t have insurance, or your plan doesn’t cover Tirzepatide? Out-of-pocket costs can be steep—usually between \(1,000 and \)1,500 per month for a standard dose. But there are ways to lower this: Many pharmacies offer discount programs (like GoodRx or SingleCare) that can cut costs by 20-40%. You can also ask your doctor about generic alternatives (though none are currently available for Tirzepatide) or patient assistance programs for low-income individuals.

Another cost-related tip: Tirzepatide is sometimes covered under “metabolic health” or “diabetes” benefits if you have type 2 diabetes (under the brand name Mounjaro). If you have both diabetes and obesity, your doctor may be able to frame the prescription to qualify for this coverage, which could be more generous.

Finally, don’t skip talking to your healthcare provider about costs. They can help you navigate insurance paperwork, recommend savings programs, and even adjust your treatment plan if Tirzepatide is out of your budget.

In short, while Tirzepatide can be costly, insurance coverage and savings programs make it accessible for many. By checking your plan’s rules and using available discounts, you can avoid sticker shock and focus on your weight-loss goals.