Though many seek to have the cost of Zepbound to be covered by their insurance, whether it does or not is largely dependent on your type of insurance and if you meet all of their contingencies and requirements. With the wave of weight loss medications hitting the market, many insurance companies are pushing back on covering these medications when simple lifestyle changes can often accomplish the same thing. Therefore, many insurance companies are now requiring doctors to fulfill very stringent criteria in order for their patients to be covered, including BMI markers, secondary conditions caused by excessive weight that can threaten the health of the patients such as diabetes or heart disease, and prescribing other generic medications before implementing the use of Zepbound. So while some insurance companies will eventually cover Zepbound, they will make both patients and doctors jump through a lot of hoops to get them to do so.
Neuroscientist | Scientific Consultant in Physics & Theoretical Biology | Author & Co-founder at VMeDx
Answered 16 days ago
Good Day, 1. Zepbound: What is it? What is it for? Zepbound is a weekly injection that is used for type 2 diabetes. It lowers blood sugar and usually promotes weight loss by mimicking hormones that signal appetite and insulin. I have had patients who finally saw progress after struggling with multiple meds---it is that powerful an option. 2. Are there any generic versions of Zepbound? Not yet. Zepbound is still under patent protection, so it's going to be a while before generics will be seen. This is fairly typical for new drugs, especially injectables such as this one. 3. What dosage and form is Zepbound available in? It comes in a single-dose pen that is injected once a week. We usually start at a dose of 2.5 mg and gradually increase the dose to 15 mg, depending on tolerance and response to medication. The gradual increase helps limit side effects. 4. Is Zepbound usually covered by insurance? It varies by insurance. Some insurance companies do cover it but often require prior authorization. Patients can usually find out the hard way just how expensive it is, which is why I recommend patients check their coverage right away and look into savings cards or manufacturer programs. 5. What generic alternatives are available for Zepbound? There is no generic for Zepbound as of yet. However, drugs such as liraglutide and semaglutide act on similar pathways and might be more accessible. They are not exactly the same, but they may be able to serve as alternative options if coverage issues or price problems arise. 6. Would a person have withdrawal symptoms if they missed a weekly dose or shortage happened? Not "withdrawal" in a traditional sense, but blood sugars and appetites could rebound very quickly if doses were missed. We would try to quickly transition to another option if supply became an issue so that we did not risk losing control. 7. Anything else? Zepbound had been a great addition to the diabetes toolkit, especially for those with a weight problem. However, it is not for everybody; therefore, cost, access, and side effects should be part of the talk. If you decide to use this quote, I'd love to stay connected! Feel free to reach me at gregorygasic@vmedx.com and outreach@vmedx.com.
1. What is Zepbound, and what is it used for? Zepbound is the brand name for tirzepatide, which is a GLP-1 drug now FDA approved for weight loss. 2. Is there a generic version of Zepbound available? If not, please explain why. The generic version of Zepbound is tirzepatide, which is what we prescribe at our three med spas. Our tirzepatide is compounded by a local FDA-registered pharmacy here in Atlanta. Although there has been controversy surrounding compounded tirzepatide, it's important to recognize that it is safe when it comes from a pharmacy and when it is prescribed by a medical facility, rather than ordering it online (which are typically labeled as research chemicals, and the potency/quality are typically unknown). 3. What are the typical dosages and forms of Zepbound? Our tirzepatide is concentrated at 10mg/ml, which is one of the highest strengths of Zepbound when prescribed in preloaded injectable pens. The typical starting dose for our patients is 0.25ml once weekly for the first 4 weeks, followed by 0.50ml once weekly for weeks 5 to 8. 4. Is Zepbound typically covered by insurance? Zepbound CAN be covered by insurance, but a myriad of qualifications must be met for maximum coverage. Examples of this can include a patient's BMI, whether he/she is actually diabetic and the healthcare provider under which you are insured. We tend to see patients whose insurance does NOT cover Zepbound, but they still meet our BMI/health history requirements to be prescribed tirzepatide for weight loss. 5. What are some generic alternatives? Generic alternatives to Zepbound in compounded form include: tirzepatide, semaglutide and retatrutide (all in the family of GLP-1s). Other options to consider would be appetite suppressants such as phentermine (Adipex) or cagrilintide (a new injectable appetite suppressant that can actually be taken in conjunction with GLP-1 drugs. 6. While there aren't necessarily "withdrawal" symptoms associated with Zepbound, our patients report their appetites and cravings returning if they haven't kept up with their weekly dose of injections. Our patients who have reached their goal weight typically titrate down to a "maintenance dose" and begin spreading their injections out every 10 days (vs. weekly) or even every other week. 7. Compounded tirzepatide is an ideal option for people who are not approved for Zepbound through their insurance. Our patients generally lose 6 to 10 pounds a month, with minimal side effects.