Zepbound, the latest injectable weight-loss medication, is on the way to take over the market.
This diet pill from Eli Lilly is proven to help adults with obesity or excess weight to lose a substantial amount of weight and still maintain the weight loss.
However, this list price of $1,060 for a one-month supply is also a source of worry for many people about how much it costs.
If you’ve been considering trying but don’t have Zepbound without insurance coverage, you may be wondering how you can afford this pricey new treatment.
The good news is there are some options that could help make Zepbound more accessible, even if your health plan doesn’t cover it.
Let’s take a look at what you can do to get the Zepbound without insurance coverage.
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What Is Zepbound?
The FDA has given the green light to Zepbound, which is the brand name of Tirzepatide, an injectable medication that helps with weight loss.
As with the action of two hormones- GLP-1 and GIP, which are responsible for appetite and blood sugar regulation – this medication replicates their effects.
The results of clinical trials show that those taking Zepbound are likely to lose between 15% and 20% of their body weight when they exercise and eat right.
It’s the first drug in a new class of obesity medications that work differently than previous weight-loss drugs.
Zepbound gets approval for adults whose BMI is 30 kg/m2 or greater, or who are overweight with at least one weight-related health condition such as high blood pressure, type 2 diabetes, or high cholesterol.
It is designed for the purpose of being part of a weight management plan not as a short-term solution.
What is the reason that Zepbound is so pricey?
1. It is a newly invented drug. Zepbound is the first drug of its kind to receive approval for weight loss and as a result, there is a lot of buzz and demand around this product. The manufacturer, Eli Lilly, can mark up the price when the product is the only one on the market.
2. The production of new drugs is very costly. It takes years of research, testing, and regulatory approval to take the new drug to the market. Pharmaceutical companies have to get back these large investments.
3. Weight loss drugs are additionally faced with a set of challenges. Insurers and government health programs have been reluctant to cover weight-loss medications as they view them as a cosmetic treatment rather than a medical necessity. Consequently, this implies that pharmaceutical companies have to charge higher prices to make a profit.
The $1,060 list price for a 4-week supply of Zepbound, on the other hand, is about $13,800 a year.
This is twice as expensive as previous weight loss drugs like Wegovy, which had a list price of $1,350 a month or $16,200 annually.
Will Insurance Cover Zepbound?
Whether your health insurance policy covers Zepbound or not will be determined by the individual provisions of your plan.
- Medicaid benefits are different in each state. The Zepbound may be covered in some state Medicaid programs, but not in others. You can start by looking at your state’s formulary.
- Weight-loss drugs are not covered by Medicare. Medicare will pay for weight loss treatments only if they are medically necessary for the treatment of a related disease.
- Commercial health plans may cover the cost, but few of them cover weight loss drugs without restrictions. You’ll have to verify with your insurance carrier.
- Government employee health plans, VA benefits, and Tricare might have Zepbound coverage, but you will have to check your specific plan.
The good news is that the American Medical Association has asked insurers to remove the obstacles that are facing weight-loss medications.
It could be the start of coverage of the issue in the wider community.
However, for the time being, a large number of patients will have to pay the full price at the retailer.
What Is The Possibility Of Zepbound Without Insurance?
If your health plan doesn’t cover Zepbound, there are a few strategies you can try to make the treatment more affordable. Some of the possibilities you can try to get the Zepbound without insurance are as follows,
1. Manufacturer Savings Program
Zepbound is manufactured by Eli Lilly, which also offers a savings program for the patients who are eligible. If you have private insurance, you may be able to get Zepbound for as low as $25 per prescription (through the end of 2024).
If your insurance does not cover Zepbound at all, you will pay approximately 550 dollars per prescription through the program – which is half the list price.
To qualify the Zepbound without Insurance coverage, you should meet the eligibility criteria which are set according to your income level and you should also have a valid prescription from your doctor.
You can do this by visiting the Zepbound website where you can get more information and enroll.
2. Patient Assistance Programs
There are patient assistance programs that give free or discounted medication to people who can’t afford the full price.
The Lilly Cares Foundation has a program that may be able to get you Zepbound free (Zepbound without insurance), depending on your income and insurance condition.
Other pharmaceutical companies and non-profit organizations could also offer similar programs which could be considered.
Your medical doctor or a social worker may be the right people to guide you in getting hold of some of these forms of help.
3. Discount Cards and Coupons
Even if you don’t qualify for a savings program for Zepbound without insurance, you may be able to reduce the price of Zepbound through discount cards or coupons.
Websites like GoodRx allow you to compare prices at local pharmacies and provide coupon codes to use at checkout.
Using a GoodRx coupon could potentially save you 17% or more on the cost of Zepbound.
Just be sure to double-check that the pharmacy accepts the discount, as some may not.
4. Appeal to Your Insurance
If your health plan initially denies coverage for Zepbound, you can try appealing the decision. Work with your doctor to explain why the medication is medically necessary for you, and ask the insurer to make an exception.
Insurers may be more willing to cover if you can demonstrate that it’s the best treatment option for your specific health needs and circumstances. Persistence and clear documentation can sometimes pay off to get the Zepbound without insurance.
5. Consider Other Options
If you simply can’t afford Zepbound without insurance, even with the strategies above, you may need to look at other weight-loss treatments that are more accessible.
This could include
- Generic or over-the-counter weight-loss medications
- Physician-supervised weight management programs
- Bariatric (weight-loss) surgery
- Lifestyle changes like diet and exercise
Your doctor can help you determine the right approach based on your health, budget, and weight-loss goals.
The key is not to let the high cost of Zepbound discourage you from seeking effective ways to improve your health.
Zepbound Without Insurance – Making More Affordable
There’s no denying that Zepbound is an expensive medication, especially for those without insurance coverage.
But with some creativity and persistence, it may be possible to get this new weight-loss treatment at a more manageable cost.
Start by talking to your doctor about your options to get the Zepbound without insurance. They can help you navigate the complex landscape of discounts, savings programs, and appeals to maximize your chances of affording Zepbound.
And if that’s not feasible, they can suggest alternative paths to achieving your weight-loss goals.
The most important thing is taking steps to improve your health, whether that involves Zepbound or another approach.
With the right plan and resources, you can overcome the financial hurdles and find a solution that works for you.