Securing the $25 Price with the Zepbound Savings Card
The most direct path to paying $25 for Zepbound is through the manufacturer's savings card program, offered by Eli Lilly. This program is specifically designed to reduce out-of-pocket expenses for eligible patients, but it comes with strict requirements. The eligibility criteria hinge primarily on your type of health insurance and whether that insurance includes coverage for Zepbound.
Eligibility Criteria for the Covered Benefit
To be eligible for the low $25 copay for a 1-month or 3-month prescription, you must meet all the following conditions:
- Commercial Insurance: You must have a commercial drug insurance plan (e.g., through your employer or a marketplace plan). People with government-funded insurance like Medicare, Medicare Part D, Medicaid, or TRICARE are explicitly excluded.
- Insurance Coverage: Your commercial plan must cover Zepbound. Your insurance provider determines this. It often requires your healthcare provider to submit a prior authorization (PA) form.
- Valid Prescription: You must have a valid prescription for Zepbound for an FDA-approved indication, which includes chronic weight management and obstructive sleep apnea.
- Residency and Age: You must be 18 years or older and a resident of the United States or Puerto Rico.
How to Get and Use the Savings Card
Obtaining and using the savings card is a straightforward process once you have confirmed your eligibility.
- Visit the Official Zepbound Website: Go to the official Zepbound website provided by Eli Lilly and find the savings and support section. The manufacturer's site has the most accurate and up-to-date terms.
- Enroll Online: Fill out the enrollment form on the website. If you meet the criteria, you can download, print, or receive your card via email or mobile wallet.
- Use at the Pharmacy: Present the activated savings card to your pharmacist when filling your prescription. They will process it along with your commercial insurance.
- LillyDirect Integration: If you use LillyDirect Pharmacy Solutions, the savings may be automatically applied at checkout.
Important Details for the Covered Program
- Supply Duration: The $25 copay can apply to a 1-month (28 days and up to 4 pens), 2-month, or 3-month supply.
- Annual and Monthly Limits: The card has a maximum monthly savings limit (e.g., $150 for a 1-month fill) and a separate annual cap (e.g., $1,950 per calendar year).
- Expiration: The program and savings card are subject to an expiration date, which can vary by year. For example, some cards expire on December 31, 2025.
Alternatives When Commercial Insurance Does Not Cover Zepbound
Even if your commercial insurance plan does not provide coverage for Zepbound, there are other pathways to reduce the cost significantly. Eli Lilly offers a separate savings card for this specific scenario.
The Zepbound Savings Card for Non-Covered Patients
This card is for commercially insured patients whose plans do not include coverage for Zepbound. The savings are not as substantial as the $25 program but still offer a considerable discount off the retail price.
- Discounted Price: Eligible patients may pay as low as $650 for a 1-month supply of the Zepbound pen.
- Other Eligibility: You must still have commercial insurance, be 18+, a US/PR resident, and have a valid FDA-approved prescription, but importantly, your plan does not cover Zepbound.
- Annual and Monthly Limits: Similar to the covered benefit card, this program has annual and monthly savings caps.
Options for Uninsured and Government-Insured Patients
Those without commercial insurance or who are on a government-funded program have different options to explore.
The Lilly Cares Foundation Patient Assistance Program
This charitable program may provide medication at no cost to individuals who meet certain income and eligibility requirements. It is not available for those whose prescription is reimbursed by a government-funded plan.
The LillyDirect Self-Pay Journey Program
Eli Lilly offers a direct-to-consumer pharmacy solution called LillyDirect. It includes a self-pay option where patients can purchase Zepbound vials (not pens) at a reduced rate.
- Vial Pricing: The price for a one-month supply of vials can be as low as $349-$499, depending on the dosage.
- Exclusion: This option is for self-pay only and cannot be combined with insurance.
Comparison of Zepbound Savings Programs
| Program | Eligibility | Estimated Cost | Details & Limitations |
|---|---|---|---|
| Zepbound Savings Card (Covered) | Commercial insurance with coverage for Zepbound | As low as $25/month | Maximum annual savings limit, not for government plans. |
| Zepbound Savings Card (Not Covered) | Commercial insurance without coverage for Zepbound | As low as $650/month | Maximum annual savings limit, not for government plans. |
| LillyDirect Self-Pay Vials | Uninsured or no coverage, pay cash | $349–$499/month (vials) | Vial only, no insurance used. Pricing varies by dosage. |
| Lilly Cares Foundation | Uninsured or specific Medicare, based on income | Free (if eligible) | Charitable program with strict income and insurance criteria. |
Conclusion
While paying as little as $25 for Zepbound is possible, it is not a universal discount and is restricted to patients with commercial insurance that specifically covers the medication. The key to accessing this price is confirming your plan's coverage and obtaining the manufacturer's savings card. If you do not qualify for the $25 card, alternative savings programs from Eli Lilly, such as the discount card for non-covered plans, the LillyDirect self-pay vials, or the Lilly Cares Foundation, may offer substantial relief from the high list price. Always check the latest terms and conditions on the official Zepbound website or consult with your healthcare provider and insurance company to determine the best path for your situation. For additional assistance resources, the Medication Assistance Tool is a useful resource.
