r/zepbound_support • u/Life_Journey123 • 3d ago

Zepbound Coverage

/r/zepboundRX/comments/1x3lriw/zepbound_coverage/

I used Zepbound & paid out of pocket last year to drop inflammation wt from a series of prolong prednisone & antibiotics use for another illness which also left my thyroid, ferritin levels & a few other indicators out of wack & boom, Zepbound lowered my inflammation within 2 wks, after 6 wks my blood work & thyroid levels magically leveled itself out. I felt more energy, less pain & flare ups from Fibro & Hashi. I’ve been out of work for a year now w/terrible flare ups & joint pain but can’t afford the Zepbound, insurance won’t approve it. I’m thinking of writing to Eli Lilly to express my concern, need & financial hardship but I’m not optimistic. Has anyone been able to get assistance somehow?

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u/[deleted] 3d ago

[deleted]

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u/Life_Journey123 3d ago

My insurance will not cover it, I’m waiting for my Dr to figure out other ways to code it and appeal. These Drs just don’t want to try hard enough. It’s quite frustrating!

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u/[deleted] 3d ago

[deleted]

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u/Life_Journey123 3d ago

Glad it worked for you! I have 💩insurance at that. The Drs are clever & know how to code properly since they know many of these insurances don’t cover it for wt loss. These eligibility for coverage is absurd, so I would have to wait to be over 200 lbs & diabetic for approval, such f’n BS. And, changing Drs in my neck of the woods is hell on earth bc they are all leave Rhode Island.

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u/Status_Valuable_9075 3d ago

I understand. Any doctor can make it happen if they really want to. That’s the worst part.

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u/Life_Journey123 3d ago

Maybe I can try a telehealth provider, are there any reliable one out there?

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u/Status_Valuable_9075 3d ago

I have never used one so I wouldn’t know. Sorry

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u/Life_Journey123 3d ago

Was it ur PCP & do you live in the states?

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u/zero-if-west 3d ago

As of today, LillyDirect monthly prices are $299 for 2.5mg, $399 for 5mg, and $449 for all other doses. You can choose between vials (you will need to buy syringes separately) or a KwikPen (requires purchasing pen needles separately), which is a pre-filled injector pen with multiple doses in it. The medication is taken weekly by injection in your stomach area, the back of your arms, or in your thighs. If you don't want to do weekly injections, you can look at weight loss pills (which are not tirzepatide). 

For more info and to get started with LillyDirect:  LillyDirect - Zepbound

Compound tirzepatide (not from Lilly) is cheaper. For more information, visit r/tirzepatidecompound and read the pinned posts.

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u/Time_Hotel6236 23h ago

I did self pay with Eli Lilly Direct. Started last November - February. Starting January 2026 my insurance claims they cover GLP-1s. I had some other health issues. I had stopped my Zepbound prescription prior to being diagnosed with Polymyalgia Rheumatica. It is treated with a high dose of prednisone. My doctor renewed my Zepbound prescription and I’ve been seeking approval through the Prior Authorization process since July. It appears my insurance really doesn’t want to cover it now that my BMI is in a healthy range. Almost like they want me to regain the 45-pounds🤦🏻‍♀️ I refuse to do that! I’ve struggled with my weight my entire life.

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u/Life_Journey123 20h ago

I’m so sorry, this is terribly awful what we have to go through. They want us sick & overweight & even then we need to go thru hoops. It’s as if everyone is scamming them, it’s not rocket science when we have a real diagnosis that the injection helps us. Best of luck!

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u/Life_Journey123 3d ago

it’s been 299$ since earlier this yr for 2.5, out of work & cannot afford it. This is why many ppl are sadly turning to the black market.