How much is Zepbound if covered by insurance? A detailed look at costs in 2025

October 9, 2025 •

4 min read

For eligible, commercially insured patients with Zepbound coverage and the manufacturer's savings card, the cost can be as low as $25 for a one- or three-month supply. However, the actual out-of-pocket expense for Zepbound if covered by insurance varies significantly depending on your specific plan's details, deductible, and recent formulary changes by pharmacy benefit managers.

Quick Summary

Understanding Zepbound's cost with insurance requires navigating plan specifics, deductibles, and eligibility for the manufacturer's savings card. Costs can range from a low copay to hundreds of dollars monthly, especially with prior authorization rules or recent formulary shifts by major pharmacy benefit managers.

Key Points

Savings Card: Eligible commercially insured patients with Zepbound coverage can pay as little as $25 per month with the manufacturer's savings card.
Coverage Varies: Insurance coverage is highly variable and not guaranteed; it depends on your specific plan's formulary, often requiring prior authorization.
Deductibles Matter: Your out-of-pocket cost is also determined by your deductible, copay, and coinsurance, which may result in higher initial expenses.
Recent Formulary Changes: In 2025, major pharmacy benefit managers like CVS Caremark have made changes that may remove Zepbound coverage for some commercially insured plans.
Government Insurance Exclusions: Patients on government-funded programs like Medicare and Medicaid are generally not eligible for the savings card, and coverage is limited or nonexistent for weight loss.
No-Coverage Discount: Commercially insured patients without coverage may still get a discount via the savings card, potentially lowering the monthly cost to around $650.
Self-Pay Vials: A direct self-pay option is available through LillyDirect, offering Zepbound vials at a discounted rate compared to the list price, ranging from $349–$499 per month for certain doses.

Zepbound's Cost With and Without Commercial Insurance

Without insurance, the monthly list price for Zepbound pens is roughly $1,086, though retail prices can be higher. This high cost makes insurance coverage a crucial factor for most patients considering the medication. Even with insurance, however, your out-of-pocket costs are not guaranteed to be minimal. Many variables, including your plan's formulary, deductible status, and the use of supplemental savings programs, influence the final price you pay at the pharmacy.

The Role of the Manufacturer's Savings Card

Eli Lilly, Zepbound's manufacturer, offers a savings card that significantly reduces the cost for eligible, commercially insured patients. This program is key to achieving the lowest out-of-pocket expenses for Zepbound in 2025.

Here's how the savings card works for commercially insured patients:

With Insurance Coverage: If your commercial insurance plan includes Zepbound on its formulary, the savings card can lower your copay to as little as $25 for a one-month or three-month prescription. A calendar year cap on total savings and a limit on the number of fills typically apply.
Without Insurance Coverage: If you have commercial insurance, but your plan does not cover Zepbound, the savings card can still provide a discount. As of mid-2025, this discount could be as low as $650 per month, though terms and conditions, including expiration dates, can change.

Navigating Coverage with Insurance and Savings Programs

For commercially insured patients, the path to affordable Zepbound typically involves leveraging the manufacturer's savings card, but several requirements must be met. Government-funded programs, including Medicare and Medicaid, are generally excluded from using this savings card. The eligibility criteria for the card also include having a valid prescription for an FDA-approved indication, being a U.S. or Puerto Rico resident, and being at least 18 years old.

For those on government-funded healthcare, or those with commercial insurance that does not provide coverage, other options exist. These include Eli Lilly's LillyDirect self-pay pharmacy, which offers Zepbound vials at a discounted rate compared to the list price. However, these are still significantly higher than the out-of-pocket cost with insurance and the savings card. Additionally, Lilly offers a patient assistance program (Lilly Cares Foundation) for uninsured or low-income individuals who meet certain criteria, potentially providing the medication at no cost.

Insurance Coverage Challenges and Updates for 2025

Coverage for GLP-1 medications like Zepbound has become increasingly complex, particularly in 2025. This includes changes made by major pharmacy benefit managers (PBMs) like CVS Caremark, which removed Zepbound from certain formularies effective July 1, 2025. These decisions can force patients to switch to alternative medications like Wegovy unless they successfully appeal the denial. Similarly, Blue Cross Blue Shield of Michigan announced it would drop coverage for several GLP-1 drugs for certain plans starting in 2025.

Factors Influencing Your Zepbound Cost

Your final out-of-pocket cost is a product of several factors:

Prior Authorization (PA): Most insurers require a PA for Zepbound, where your doctor must submit documentation to justify the medical necessity of the prescription. A denied PA means no coverage.
Step Therapy: Some plans mandate that you first try cheaper weight-loss medications and fail to achieve your goals before they will cover Zepbound.
Your Deductible: If your deductible has not been met, you may have to pay a higher percentage of the cost until you reach your plan's annual limit.
Formulary Status: Your insurer's specific list of covered drugs (formulary) can change annually, so verifying coverage before starting treatment is essential.

Comparison Table: Zepbound Cost Scenarios


Scenario	Monthly Out-of-Pocket Cost (approx.)	Details and Considerations
Commercially Insured + Savings Card + Coverage	As low as $25	Requires meeting eligibility criteria for Eli Lilly's savings card and successful prior authorization. Annual savings limits apply.
Commercially Insured + Savings Card + No Coverage	As low as $650	A significant discount off the list price for those whose commercial plan excludes Zepbound. Savings card terms are subject to change.
Uninsured or Ineligible for Savings Card	$1,086 (list price)	The full monthly list price. The total annual cost would exceed $12,700 without discounts.
LillyDirect Self-Pay (vial)	$349–$499	For certain doses of Zepbound vials, purchased directly from the manufacturer without using insurance. Pricing is tiered by dose.

Conclusion

While a potential cost of $25 per month for Zepbound is possible for a subset of patients, it is not a guaranteed outcome. The price you pay depends on a complex interplay between your specific insurance plan's coverage, your eligibility for the manufacturer's savings program, and the fulfillment of stringent requirements like prior authorization. Patients on government-funded programs like Medicare generally face different, and often more limited, coverage options. Significant shifts in PBM formularies in 2025 further emphasize the need for patients to be proactive and verify their coverage status with their insurer and doctor. Ultimately, a candid discussion with your healthcare provider and insurance company is the only reliable way to understand the specific cost you will pay for Zepbound.

Frequently Asked Questions

Yes, if you have a commercial insurance plan that covers Zepbound and are eligible for and use the manufacturer's savings card, your out-of-pocket cost could be as low as $25 for a one- or three-month supply.

Prior authorization is a process required by many insurance companies where your doctor must submit documentation to prove that Zepbound is medically necessary for your condition before your insurer will cover it.

The Zepbound savings card is a program offered by the manufacturer, Eli Lilly, to help eligible, commercially insured patients save money on their prescriptions. It offers significant discounts, with the lowest costs going to those whose insurance already covers the drug.

Generally, Medicare does not cover medications prescribed solely for weight loss. While Zepbound was approved for Obstructive Sleep Apnea (OSA) in late 2024, coverage depends on the specific Medicare plan and indication.

If your commercial insurance, managed by a PBM like CVS Caremark, removes Zepbound from its formulary, you may need to switch to an alternative or pay a much higher out-of-pocket cost. You can also work with your doctor to appeal the coverage denial.

No, patients enrolled in any government-funded healthcare program, including Medicare, Medicaid, and TRICARE, are not eligible for the Eli Lilly savings card.

The best way to verify coverage is to call your insurance provider directly using the phone number on the back of your insurance card. You can also ask your doctor to check your plan's drug formulary.