Does Cigna Healthcare Cover Zepbound?

Zepbound is a popular weight-loss drug that has helped many people manage obesity. With its rising demand, those with Cigna Healthcare insurance often ask, “Does Cigna Healthcare cover Zepbound?” This article explains Cigna’s coverage policies for Zepbound in clear, simple language.

What Is Zepbound?

Zepbound is a prescription drug made by Eli Lilly. Its active ingredient, tirzepatide, helps reduce appetite and promote weight loss. The FDA approved Zepbound in 2023 for adults with obesity or those overweight with health issues.

It’s also approved for obstructive sleep apnea (OSA). Zepbound is similar to Mounjaro, a diabetes drug with the same ingredient. It’s given as a weekly injection under a doctor’s supervision.

How Zepbound Helps with Weight Loss

Zepbound works by mimicking the GLP-1 hormone, which controls hunger. It slows digestion, helping you feel full longer. This reduces food intake and supports weight loss.

Clinical trials show Zepbound can lead to 15% to 25% body weight loss. Patients often lose 34 to 48 pounds on average. Results vary based on dose and lifestyle changes.

Cigna Healthcare and Weight-Loss Drugs

Cigna Healthcare offers various health insurance plans for individuals and employers. These plans typically cover prescription drugs, but weight-loss medications like Zepbound have specific rules. Coverage depends on the plan and medical necessity.

Cigna often requires prior authorization for weight-loss drugs. This means your doctor must prove the drug is needed. Coverage isn’t guaranteed for all plans.

Does Cigna Healthcare Cover Zepbound?

Cigna’s coverage for Zepbound varies by plan. Some plans cover Zepbound for weight loss, but prior authorization is usually required. Others list Zepbound as an excluded drug, especially for weight loss.

For obstructive sleep apnea, Cigna may cover Zepbound if other treatments fail. Coverage for weight loss is stricter, often requiring specific criteria like a high BMI. Always check your plan details or contact Cigna directly.

Criteria for Zepbound Coverage

To get Zepbound covered, Cigna often requires a BMI of 30 or higher. Alternatively, a BMI of 27 with conditions like diabetes or hypertension may qualify. Prior authorization paperwork must show medical necessity.

After starting Zepbound, Cigna may require proof of at least 5% weight loss to continue coverage. Coverage is denied if you’re already taking another weight-loss or GLP-1 drug. Your doctor handles the authorization process.

States and Plan Variations

Cigna operates in many states, and coverage can differ by region. Employer-sponsored plans may have different rules than individual plans. Some plans cover Zepbound, while others exclude it entirely.

For example, Cigna’s national plan often lists Zepbound as excluded. However, specific employer plans may allow coverage with prior authorization. Contact Cigna using the number on your insurance card for clarity.

Table: Zepbound Coverage by Cigna Plan Type (As of 2025)

This table shows general trends. Check your specific plan for accurate details.

Cost of Zepbound Without Coverage

Without insurance, Zepbound costs about $1,060 per month. This high price makes it unaffordable for many. Cigna’s coverage can significantly reduce out-of-pocket costs if approved.

If Cigna doesn’t cover Zepbound, Eli Lilly’s savings card may lower the cost to $550 monthly for eligible patients. This card doesn’t apply to those with government insurance. Pharmacy discount cards are another option.

Cigna’s EncircleRx Program

Cigna’s Evernorth unit offers the EncircleRx program for weight-loss drugs. This program caps annual cost increases for GLP-1 drugs like Zepbound at 15%. It aims to make coverage more predictable for employers.

EncircleRx includes lifestyle support, like nutrition coaching. Patients must meet eligibility criteria, such as a BMI of 32 or higher. This program expands access but still requires prior authorization.

Steps to Check Zepbound Coverage

To find out if Cigna Healthcare covers Zepbound, start by reviewing your plan documents. Look for the drug formulary, which lists covered medications. Check for prior authorization requirements, marked as “PA.”

You can also call Cigna’s customer service using the number on your insurance card. Ask about Zepbound coverage for weight loss or OSA. Your doctor or pharmacist can also help confirm coverage.

Alternatives If Zepbound Isn’t Covered

If Cigna doesn’t cover Zepbound, other weight-loss drugs may be options. Cigna sometimes covers medications like Contrave, Qsymia, or Xenical. These are often cheaper than Zepbound.

Your doctor can suggest alternatives based on your health needs. They may also recommend lifestyle programs or other GLP-1 drugs like Wegovy, if covered. Discuss all options with your provider.

Why Coverage for Zepbound Matters

Obesity affects over 40% of Americans, leading to health issues like diabetes and heart disease. Zepbound can reduce these risks by helping patients lose significant weight. Coverage makes it accessible to more people.

Without coverage, high costs limit access. Cigna’s efforts, like EncircleRx, aim to balance cost and access. This helps patients achieve better health outcomes.

Challenges of Covering Zepbound

Zepbound’s high cost is a challenge for insurers like Cigna. A single month’s supply can exceed $1,000, straining plan budgets. Cigna caps cost increases to manage this issue.

Drug shortages are another concern. High demand for Zepbound has caused supply issues. Expanded coverage could worsen shortages, affecting patient access.

Side Effects and Considerations

Zepbound is effective but has side effects. Common ones include nausea, diarrhea, and fatigue. Rare but serious risks include thyroid tumors or gallbladder issues.

Your doctor will monitor you while on Zepbound. Report any side effects immediately. Cigna may require regular check-ins to continue coverage.

Future of Zepbound Coverage with Cigna

Cigna is working to expand coverage for weight-loss drugs. Agreements with Eli Lilly and Novo Nordisk aim to control costs. The EncircleRx program is a step toward broader access.

However, coverage remains limited for many plans. Future policy changes or new agreements could increase Zepbound coverage. Stay informed by checking with Cigna regularly.

Tips for Getting Coverage Approved

To improve your chances of getting Zepbound covered, work closely with your doctor. Ensure all prior authorization paperwork is complete and accurate. Provide medical records showing your BMI and health conditions.

If coverage is denied, you can appeal. Contact Cigna for appeal instructions. Your doctor or a patient advocate can assist with the process.

Health Benefits of Zepbound

Using Zepbound can lead to significant weight loss. This reduces the risk of diabetes, heart disease, and joint problems. Patients often report improved energy and confidence.

Weight loss with Zepbound is most effective with diet and exercise. Cigna’s EncircleRx program offers support for these lifestyle changes. Long-term use may be needed to maintain results.

Summary

Does Cigna Healthcare cover Zepbound? It depends on your specific plan. Some Cigna plans cover Zepbound for weight loss with prior authorization, while others exclude it. The EncircleRx program helps manage costs, but strict criteria like a high BMI apply. Check your plan details or call Cigna to confirm coverage. If Zepbound isn’t covered, explore alternatives like Contrave or Xenical with your doctor. Cigna’s efforts to cap costs may improve access in the future.

FAQ

Does Cigna Healthcare cover Zepbound for weight loss?
Some Cigna plans cover Zepbound for weight loss with prior authorization. Coverage varies by plan, and many exclude it. Contact Cigna to verify your plan’s policy.

What are the requirements for Zepbound coverage?
Cigna typically requires a BMI of 30 or higher, or 27 with health issues. Prior authorization is needed, and 5% weight loss may be required to continue. Your doctor submits the paperwork.

How much does Zepbound cost without Cigna coverage?
Zepbound costs about $1,060 monthly without insurance. Eli Lilly’s savings card may reduce it to $550 for eligible patients. Pharmacy discount cards can also help.

What if Cigna denies Zepbound coverage?
You can appeal the denial through Cigna’s process. Your doctor can suggest alternatives like Contrave or Xenical. Patient assistance programs may also be available.

Does Cigna cover Zepbound for obstructive sleep apnea?
Cigna may cover Zepbound for OSA if other treatments fail. Prior authorization is required. Check with Cigna for your plan’s specific coverage details.