Is Zepbound Available in Pharmacies
Yes, Zepbound is now available in pharmacies across the United States. Zepbound is officially approved by FDA on November 8, 2023. Managing weight in adults dealing with obesity (body mass index of 30 kilograms per square meter (kg/m2) or more) or those classified as overweight (body mass index of 27 kg/m2 or more) and experiencing at least one weight-related condition (such as high blood pressure, type 2 diabetes, or high cholesterol) involves utilizing Tirzepatide.
Tirzepatide, the active component found in Zepbound, has already gained approval under the trade name Mounjaro. It is supposed to be used with reduced calorie diet and increased physical activity. This therapy aims to enhance blood sugar (glucose) levels in adults, therefore reducing type 2 diabetes mellitus. importance of lifestyle adjustments alongside medication is a must.
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Zepbound Insurance Coverage
Today as of December 17, 2023 Zepbound is not covered by a lot of insurances with different reasons. Below I am explaining a few of the reasons of non-approval. In future scenario might be different as the situation improves.
1. New Drug: Zepbound is a relatively new drug, having just been approved by the FDA in November 2023. Its long-term safety and efficacy are still being established, and insurance companies may be hesitant to cover it until they have more data.
2. Cost: Zepbound is expensive, retail price being over $1,000. Using Zepbound coupon for cash patients or not covered patients, it has a list price of around $550 per month. This high cost can make it difficult for insurance companies to justify covering it, especially compared to other, more established weight-loss medications.
3. Off-label use: Currently, Zepbound is only approved for the treatment of weight loss, this is considered an “off-label” use. Insurance companies are generally less likely to cover off-label uses of medications unless there is strong evidence of their safety and efficacy.
4. Less preferred alternatives: There are other weight-loss medications available, such as Wegovy and Saxenda, that may be covered by insurance. Insurance companies may consider these medications to be a more cost-effective option than Zepbound.
5. Formulary decisions: Each insurance company has its own formulary, which is a list of medications that the company will cover. The decision of whether or not to cover a new drug like Zepbound is made by a committee that weighs the factors mentioned above.
Cigna Insurance Zepbound Coverage
Cigna’s PBM decision: Cigna’s PBM has recently added Zepbound to its preferred medicines list, which could lead to lower costs for insured patients and encourage other insurance companies to follow suit.
Growing evidence: As more clinical data becomes available on the safety and efficacy of Zepbound for weight loss, it is likely that more insurance companies will start to cover it.
Cigna Drug and Biologic Coverage Policy – Click Here
It is important to note that coverage can vary depending on your specific insurance plan, so it is always best to check with your insurance provider to see if Zepbound is covered. Cigna’s PBM has added Zepbound to its preferred medicines list, possibly leading to lower costs for insured patients.
Cigna insurance added certain criteria for zepbound coverage like:
- Medical Necessity Criteria
- Reauthorization Criteria
- Authorization Duration
Blue Cross Blue Shield (BCBS) Zepbound Coverage
Blue Cross Blue Shield (BCBS) plan covers Zepbound depends on several factors, including:
- Specific BCBS plan: Coverage varies across different BCBS plans, even within the same state. Your best bet is to check your plan’s formulary, which is a list of covered medications. You can usually find the formulary on your BCBS plan’s website or by calling customer service.
- Cost-sharing: Even if your BCBS plan covers Zepbound, you may still be responsible for some of the cost, such as copayments or coinsurance. The specific amount you will owe will depend on your plan’s details.
Does Medicare Cover Zepbound?
Here’s a breakdown of the situation:
- Medicare Part D: This part of Medicare helps cover the cost of prescription drugs. However, it has a specific list of covered drugs, and Zepbound is not currently on that list.
- Anti-obesity medications: Medicare generally excludes coverage for weight-loss drugs because they are considered to be for cosmetic purposes, not for treating a medical condition.
- Exceptions: There may be some rare exceptions to this rule, such as if a person with obesity has a comorbidity like type 2 diabetes that could be improved by using Zepbound. However, these exceptions are very limited.
Here are some additional things to keep in mind:
- Medicare Advantage plans: Some Medicare Advantage plans may offer coverage for Zepbound. However, this is not guaranteed, and you would need to check with your specific plan to see if it is covered.
- Cost-sharing: Even if your plan does cover Zepbound, you may still be responsible for some of the cost, such as copayments or coinsurance.
- Other options: If you are unable to get coverage for Zepbound through Medicare, there may be other options available, such as using a patient assistance program or negotiating with the manufacturer for a discount.
Does Medicare Cover Zepbound?
Zepbound coverage by Tricare is still uncertain. It’s a new medication, and Tricare is currently in the process of reviewing it for coverage. Here’s what we know so far:
Positive indications:
- Some sources report successful coverage for Zepbound with prior authorization. This suggests that Tricare may be open to covering the medication in some cases.
- Tricare covers other GLP-1 medications for type-2 diabetes and/or weight management. GLP-1s are the same class of drugs as Zepbound, and their effectiveness for weight loss is well-established.
Negative indications:
- Tricare generally excludes coverage for weight-loss medications. Since Zepbound is not yet approved for weight management, this could be a barrier to coverage.
- The high cost of Zepbound (around $550 per month) might make it less likely for Tricare to cover it.
Zepbound Alternatives
If you can’t find Zepbound or it’s not covered by your insurance, you might consider discussing other weight-loss medications with your doctor. Wegovy is another option but might still face supply issues. Saxenda is also an alternate with only one common strength available.
Remember, Zepbound is a prescription medication, so you’ll need to talk to your doctor to see if it’s right for you.
